Template for Departments' Injury and Illness Prevention Program

Template for Departments' Injury and Illness Prevention Program at the University of California, Berkeley

(Note: This template was downloaded from the web site of the Office of Environment, Health & Safety at the University of California, Berkeley, http://ehs.berkeley.edu/. The forms mentioned in this template can also be downloaded from the web site. Click on "Injury & Illness Prevention Program" under the "Services, Programs, & Compliance Assistance" heading on the EH&S home page.)

Departments at the University of California, Berkeley can use the following template to create a written Injury and Illness Prevention Program (IIPP) that meets the requirements of state law. (Each department at UC Berkeley is required to have its own IIPP.) Putting the written program into action will help to ensure a healthful and safe workplace for department employees.

To use the template, replace any italicized text with your department's specific information. Then send a copy to the Office of Environment, Health & Safety (EH&S) at 317 University Hall #1150 for review. (You may also send it as an e-mail attachment to ehs@uclink.berkeley.edu.) EH&S will review the draft against applicable legal requirements. The next step is to put the program into action. An IIPP's benefits will be realized only through effective implementation.

University of California, Berkeley

(Department Name)

Injury and Illness Prevention Program

(Date adopted)

University of California, Berkeley

(Department Name)

Injury and Illness Prevention Program

TABLE OF CONTENTS

I. INTRODUCTION AND PURPOSE

II. RESPONSIBILITIES

III. IDENTIFYING WORKPLACE HAZARDS

IV. COMMUNICATING WORKPLACE HAZARDS

V. CORRECTING WORKPLACE HAZARDS

VI. INVESTIGATING INJURIES AND ILLNESSES

VII. EMPLOYEE HEALTH AND SAFETY TRAINING

VIII. ENSURING COMPLIANCE

IX. RECORD KEEPING

X. CAMPUS SAFETY RESOURCES

APPENDICES

University of California, Berkeley

(Department Name)

Injury and Illness Prevention Program

I. INTRODUCTION AND PURPOSE

It is the policy of the University of California, Berkeley to maintain a safe and healthful work environment for each employee (including student and contract employees), and to comply with all applicable occupational health and safety regulations. The (Department Name) Injury and Illness Prevention Program (IIPP) is intended to establish a framework for identifying and correcting workplace hazards within the department, while addressing legal requirements for a formal, written IIPP.

II. RESPONSIBILITIES

( Department Head's title, and name)

(Name of department head) has primary authority and responsibility to ensure departmental implementation of the IIPP and to ensure the health and safety of the department's faculty, staff and students. This is accomplished by communicating the Berkeley campus's emphasis on health and safety, analyzing work procedures for hazard identification and correction, ensuring regular workplace inspections, providing health and safety training, and encouraging prompt employee reporting of health and safety concerns without fear of reprisal.

(Department Name) Safety Committee

The (Department Name) Safety Committee has the ongoing responsibility to maintain and update this IIPP, to assess departmental compliance with applicable regulations and campus policies, to evaluate reports of unsafe conditions, and to coordinate any necessary corrective actions. The Safety Committee meets (at least quarterly) and includes representatives from (list the various sections or each major subunit of the department). Each employee has a designated representative on the committee. Currently, the department's Safety Committee consists of: (list the committee members and the committee chair)

Ð'*

Ð'*

Ð'*

Ð'*

Ð'*

The Safety Committee membership rotates periodically.

Unsafe conditions that cannot be immediately corrected by an employee or his/her supervisor should be reported to the Department Safety Coordinator or any Safety Committee member by filling out a "Report of Unsafe Condition or Hazard" form (IIPP Form 1).

Timely correction of workplace hazards will be tracked by the Safety Committee which will receive and review reports of unsafe conditions, workplace inspection reports, and injury reports. Specifically, the Safety Committee will:

Ð'* Review the results of periodic, scheduled workplace inspections to identify any needed safety procedures or programs and to track specific corrective actions

Ð'* Review supervisors' investigations of accidents and injuries to ensure that all causes have been identified and corrected

Ð'* Where appropriate, submit suggestions to department management for the prevention of future incidents

Ð'* Review alleged hazardous conditions brought to the attention of any committee member, determine necessary corrective actions, and assign responsible parties and correction deadlines

Ð'* When determined necessary by the Committee, the Committee may conduct its own investigation of accidents and/or alleged hazards to assist in establishing corrective