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Template for Departments' Injury and Illness Prevention Program

at the University of California, Berkeley

Revised September 2003

(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 "What We Do: Services & Compliance Assistance" heading on the EH&S home page. Select the "Injury and Illness Prevention Program Template and Forms" to see a list of forms available.)

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, first download the Word or PDF document above. Carefully read through the document and fill out the first and second page with specific information related to your department. Save your changes and print out your new IIPP. Send an electronic file of the entire document to ehs@uclink.berkley.edu, or print the document and send a copy of the first two pages to the Office of Environment, Health & Safety (EH&S) at 317 University Hall #1150 for review. EH&S will review the draft against applicable legal requirements. Please resubmit this form whenever there are changes in the information.

The next step is to put the program into action and ensure that all personnel are trained on this document. An IIPP's benefits will be realized only through effective implementation.

To assist departments with the IIPP training requirements, EH&S offers a 1-hour IIPP/BEP Training for all departments (642-3073). This training is customized and reviews the department's IIPP and applicable Building Emergency Plan (BEP) for the building(s) the department occupies. It reviews the components of the IIPP, gives an overview of the campus safety structure, informs employees how to participate in the safety program, summarizes the Building Emergency Plan (BEP) and reviews the campus resources available to help make this a safe and healthy environment.

University of California, Berkeley
Injury and Illness Prevention Program

(Training Documentation Form can be found in Appendix A of this document.)

Buildings occupied by this department: (For off campus buildings, write the physical address of the building. Also, do not include buildings used only for storage.) Please note, this section will assist you in ensuring that all your staff are trained on the appropriate Building Emergency Plan(s) (BEP). While the Building Coordinator is required to create the BEP, you are responsible for ensuring your department’s personnel receive training on the applicable BEP. If you need assistance completing this section, please call EH&S at 642-3073.

1. Building name or address:
Unit within your department (if applicable):
Building Coordinator and phone no at this location:

2. Building name or address:
Unit within your department (if applicable):
Building Coordinator and phone no at this location:

3. Building name or address:
Unit within your department (if applicable):
Building Coordinator and phone no at this location:

4. Building name or address:
Unit within your department (if applicable):
Building Coordinator and phone no at this location:

5. Building name or address:
Unit within your department (if applicable):
Building Coordinator and phone no at this location:

6. Building name or address:
Unit within your department (if applicable):
Building Coordinator and phone no at this location:

(Add more building names or addresses as necessary.)

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

INJURY AND ILLNESS PREVENTION PROGRAM (IIPP) FORMS

University of California, Berkeley
Injury and Illness Prevention Program

I. INTRODUCTION AND PURPOSE

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II. RESPONSIBILITIES

Department Head

Department Safety Committee

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:

• Review the results of periodic, scheduled workplace inspections to identify any needed safety procedures or programs and to track specific corrective actions
• Review supervisors’ investigations of accidents and injuries to ensure that all causes have been identified and corrected
• Where appropriate, submit suggestions to department management for the prevention of future incidents
• Review alleged hazardous conditions brought to the attention of any committee member, determine necessary corrective actions, and assign responsible parties and correction deadlines
• When determined necessary by the Committee, the Committee may conduct its own investigation of accidents and/or alleged hazards to assist in establishing corrective actions
• Submit recommendations to assist department management in the evaluation of employee safety suggestions

The Safety Committee must prepare and make available to all department personnel written minutes of issues discussed at the meetings. The Committee meeting minutes must be documented on IIPP Form 2, "Safety Committee Meeting Documentation," or a similar form. These minutes must be posted or made available in a convenient location and must be maintained on file for at least one year.

The Safety Committee can seek assistance in the remediation of a hazard from other departments, including the Office of Environment, Health & Safety (EH&S) for campus health and safety issues, radiation and laser beam issues (see Section X), University Health Services (UHS) for ergonomic and workers’ compensation issues, and the University of California Police Department (UCPD) for personal security concerns.

Department Safety Coordinator

• Ensuring that the Safety Committee is aware of all accidents which have occurred, and all hazards which have been observed since the last meeting
• Working with the Building Coordinator to address facility-related safety concerns
• Assisting in the coordination of required health and safety training
• Serving as liaison with EH&S and other campus safety resources on issues the department cannot resolve
• Maintaining copies of Safety Committee minutes and other safety-related records

Supervisors

• Communicating to their staff and students the Berkeley campus's emphasis on health and safety.
  
• Ensuring periodic, documented inspection of workspaces under their authority.
  
• Promptly correcting identified hazards.
  
• Modeling and enforcing safe and healthful work practices.
  
• Providing appropriate safety training and personal protective equipment.
  
• Implementing measures to eliminate or control workplace hazards.
  
• Stopping any employee's work that poses an imminent hazard to either the employee or any other individual.
  
• Encouraging employees to report health and safety issues to the Safety Committee without fear of reprisal.

All Employees

• Observing health and safety-related signs, posters, warning signals and directions.
  
• Reviewing the building emergency plan and assembly area
  
• Learning about the potential hazards of assigned tasks and work areas.
  
• Taking part in appropriate health and safety training.
  
• Following all safe operating procedures and precautions.
  
• Using proper personal protective equipment.
  
• Warning coworkers about defective equipment and other hazards.
  
• Reporting unsafe conditions immediately to a supervisor, and stopping work if an imminent hazard is presented.
  
• Participating in workplace safety inspections.

III. IDENTIFYING WORKPLACE HAZARDS

Generally, supervisors are responsible for identification and correction of hazards that their staff and/or students face and should ensure that work areas they exercise control over are inspected at least annually. Supervisors should check for safe work practices with each visit to the workplace and should provide immediate verbal feedback where hazards are observed.

The "Report of Unsafe Condition" Form 1 should be filled out when a referral is made to the Safety Committee as a result of a condition discovered during an inspection for which the responsible supervisor could not determine an immediate remedy. The "Report of Unsafe Condition" form can also be obtained by any employee, filled out and turned in anonymously.

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IV. COMMUNICATING WORKPLACE HAZARDS

Supervisors are responsible for communicating with all workers about safety and health issues in a form readily understandable by all workers. All department personnel are encouraged to communicate safety concerns to their supervisor without fear of reprisal. The Safety Committee is another resource for communication regarding health and safety issues for department employees. Each employee has a representative on the committee that will inform him or her of hazard corrections and committee activities. Additionally, Safety Committee minutes and other safety-related items are posted or made available at a convenient location. Employees will also be informed about safety matters by e-mail, voice mail, distribution of written memoranda, or by articles in the internal Departmental newsletter (if applicable). Occasionally, the Safety Committee may also sponsor seminars or speakers or coordinate other means to communicate with employees regarding health and safety matters.

Supervisors are responsible for ensuring that employees are supplied access to hazard information pertinent to their work assignments. Information concerning the health and safety hazards of tasks performed by department staff is available from a number of sources. These sources include, but are not limited to, Material Safety Data Sheets (MSDSs, see below), equipment operating manuals, the Department Safety Coordinator, EH&S, campus libraries, container labels and work area postings.

Material Safety Data Sheets

MSDSs are also available over the Internet from a variety of sources. They can be obtained by accessing the EH&S web page (http://www.ehs.berkeley.edu) and clicking on "MSDS." For further information, contact EH&S for a fact sheet explaining how to use MSDSs. Videos and training on how to read and understand the information presented on an MSDS are also available from EH&S.

Equipment Operating Manuals

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V. CORRECTING WORKPLACE HAZARDS

Specific procedures that can be used to correct hazards include, but are not limited to, the following:

• Tagging unsafe equipment "Do Not Use Until Repaired," and providing a list of alternatives for employees to use until the item is repaired.
  
• Stopping unsafe work practices and providing retraining on proper procedures before work resumes.
  
• Reinforcing and explaining the need for proper personal protective equipment and ensuring its availability.
  
• Barricading areas that have chemical spills or other hazards and reporting the hazardous conditions to a supervisor or Building Coordinator.

Supervisors should use the "Hazard Correction Report" (IIPP Form 4) to document corrective actions, including projected and actual completion dates. If necessary, supervisors can seek assistance in developing appropriate corrective actions by submitting a "Report of Unsafe Condition" to the Safety Committee. If the Safety Committee requires assistance from other campus resources such as EH&S, PP-CS, or UCPD, these resources should be contacted immediately.

If an imminent hazard exists, work in the area should cease, and the appropriate supervisor must be contacted immediately. If the hazard cannot be immediately corrected without endangering employees or property, all personnel need to be removed from the area except those qualified and necessary to correct the condition. These qualified individuals will be equipped with necessary safeguards before addressing the situation.

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VI. INVESTIGATING INJURIES AND ILLNESSES

Injury Reporting

The supervisor of the injured employee must work with a designated department personnel to ensure that the "Employer's Report of Occupational Injury or Illness" and a "Workers' Compensation Claim Form" are completed properly and submitted to the Workers' Compensation Office (Tang Center, Suite 2100).

If the injured employee saw a physician, the supervisor should obtain a medical release form before allowing the employee to return to work. The health care provider may stipulate work tasks that must be avoided or work conditions that must be altered before the employee resumes his or her full duties.

Injury Investigation

• Interviewing injured personnel and witnesses.
  
• Examining the injured employee's workstation for causative factors.
  
• Reviewing established procedures to ensure they are adequate and were followed.
  
• Reviewing training records of affected employees.
  
• Determining all contributing causes to the accident.
  
• Taking corrective actions to prevent the accident/exposure from reoccurring.
  
• Recording all findings and actions taken.
  

The supervisor’s findings and corrective actions should be documented and presented to the Safety Committee using the "Occupational Accident, Injury or Illness Investigation Report" (IIPP Form 5). If the supervisor is unable to determine the cause(s) and appropriate corrective actions, other resources should be sought. Available resources include the department’s Safety Committee, EH&S, and other campus safety organizations (see Section X).

The Safety Committee will review each accident or injury report to ensure that the investigation was thorough and that all corrective actions are completed. Investigations and/or corrective actions that are found to be incomplete will be routed back to the supervisor for further follow-up, with specific recommendations noted by the committee. Corrective actions that are not implemented in a reasonable period of time will be brought to the attention of the Department head by the Department Safety Coordinator.

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VII. EMPLOYEE HEALTH AND SAFETY TRAINING

Initial IIPP Training

Personnel hired after the initial training session will be oriented on this material as soon as possible by the Safety Coordinator or appropriate supervisor. These individual training sessions should be documented using IIPP Form 7, "New Employee Safety Training Record," or the equivalent.

Training on Specific Hazards

All supervisors must ensure that the personnel they supervise receive appropriate training on the specific hazards of work they perform, and the proper precautions for protection against those hazards. Training is particularly important for new employees and whenever a new hazard is introduced into the workplace. Such hazards may include new equipment, hazardous materials, or procedures. Health and Safety training is also required when employees are given new job assignments on which they have not previously been trained and whenever a supervisor is made aware of a new or previously unrecognized hazard.

Specific topics which may be appropriate to department personnel include, but are not limited to, the following:

• Fire prevention techniques and fire extinguisher use.
  
• Obtaining emergency medical assistance and first aid.
  
• Disaster preparedness and response, including building evacuation procedures.
  
• Health and safety for computer users.
  
• Back care, body mechanics, and proper lifting techniques.
  
• Hazard communication, including training on MSDSs, chemical hazards and container labeling.
  
• Proper housekeeping.
  
• Chemical spill reporting procedures

Safety Videos

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VIII. ENSURING COMPLIANCE

Standard progressive disciplinary measures in accordance with the applicable personnel policy or labor contract will result when employees fail to comply with applicable regulations, campus policy, and/or departmental safety procedures. Faculty members will be disciplined for unsafe practices in accordance with the Faculty Code of Conduct. Students not employed by the University will be disciplined for unsafe practices in accordance with the Student Code of Conduct. All personnel will be given instruction and an opportunity to correct unsafe behavior. Repeated failure to comply or willful and intentional noncompliance may result in disciplinary measures up to and including termination.

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IX. RECORD KEEPING

• Records of scheduled and periodic workplace inspections, including the persons conducting the inspection, any identified unsafe conditions or work practices, and corrective actions (IIPP Form 3 or equivalent)
  
• Employee safety training records, including the names of all attendees and instructors, the training date, and material covered (IIPP Form 6 and IIPP Form 7 or equivalent)
  
• Reports of Unsafe Conditions or Hazards (IIPP Form 1)
  
• Safety Committee Meeting Documentation (IIPP Form 2)
  
• Hazard Correction Reports (IIPP Form 4)
  
• Accident, Injury or Illness Investigation Reports (IIPP Form 5)

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X. CAMPUS SAFETY RESOURCES

A number of University programs and service organizations have been established to address injury and illness prevention and to maintain and promote a safe and healthful work environment for the campus community. A list is provided below, please use the Campus Telephone Directory for up-to-date telephone numbers.

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Appendix A: Training Documentation

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