INJURY AND ILLNESS PREVENTION PROGRAM

Transcription

1 INJURY AND ILLNESS PREVENTION PROGRAM Revised December INTRODUCTION RESPONSIBILITIES Program Administrator Managers Supervisors Employees Safety Committee COMPLIANCE COMMUNICATION HAZARD ASSESSMENT Inspection Schedule REPORTING OBLIGATIONS IMPORTANT PLEASE REVIEW CAREFULLY INJURY AND ILLNESS INVESTIGATIONS HAZARD CORRECTION Identification of Hazardous Materials TRAINING AND INSTRUCTION Safety Orientation Basic Safety Rules Training Safety Practices EMERGENCY ACTION AND FIRE PROCEDURE PLAN Workplace Violence Fire Procedures Fire Extinguishers Earthquake Procedures Evacuation Plan First Aid Kits Emergency Training and Response Page 1 of 29

2 11.0 RECORD KEEPING Record keeping PROGRAM REVIEW APPENDIX A NEW STAFF EMPLOYEE SAFETY TRAINING ACKNOWLEDGEMENT APPENDIX B IN-HOUSE TEMPORARY EMPLOYEE SAFETY ORIENTATION ACKNOWLEDGMENT APPENDIX C HAZARD ASSESSMENT CHECKLIST AND CORRECTIVE ACTION REPORT 16 APPENDIX D WORK TRAINING AND INSTRUCTION RECORD APPENDIX E HAZARD REPORTING FORM APPENDIX F ACCIDENT/EXPOSURE INVESTIGATION REPORT APPENDIX G INCIDENT REPORT FOR WORKPLACE VIOLENCE APPENDIX H INCIDENT REPORT FOR WORKPLACE VIOLENCE APPENDIX I STATE OCCUPATIONAL SAFETY AND HEALTH CONTACT INFORMATION24 APPENDIX J SPECIAL STATE REPORTING OBLIGATIONS SAFETY COMMITTEE SUPPLEMENT (Oregon and Washington) INTRODUCTION Protiviti Inc. (Protiviti) makes all reasonable efforts to: Protect the health and safety of Protiviti employees and contract workers. Provide safe workplaces for all employees. Provide information to employees about health and safety hazards. Identify and correct health and safety hazards and encourage employees to report hazards. Page 2 of 29

3 Provide information and safeguards regarding environmental hazards arising from operations at Protiviti. Protiviti has adopted this Injury and Illness Prevention Program ( the Plan ) which describes specific requirements for program responsibility, compliance, communication, hazard assessment, accident/exposure investigations, hazard correction, training, and record keeping. A copy of this Plan is available from the HR Lead at each office and is also posted on ishare. 2.0 RESPONSIBILITIES 2.1 Program Administrator The responsibility for Protiviti s Plan rests with the Program Administrator, Kim Lampo. Responsibilities include: Advising senior management on safety and health issues. Working with senior management to develop safety and health guidelines and policies. Preparing and distributing Protiviti s guidelines, policies and procedures on safety and health issues. Maintaining current information on local, state and federal safety and health regulations. Serving as liaison with governmental agencies. Planning, organizing and coordinating safety trainings. Arranging for safety and health inspections and follow up to ensure necessary corrective action is completed. Establishing, conducting and maintaining an injury/illness/accident report and investigation procedure. Reviewing injury and illness trends. Establishing a system for maintaining the records of inspection, hazard abatement and training. Providing a system to hold managers, supervisors, and employees accountable for their responsibilities under the safety and health program. 2.2 Managers Managers are responsible for ensuring that: Individuals under their management have the authority to implement appropriate health and safety policies, practices and programs. Areas under their management have adequate funding for health and safety programs, practices and equipment. Areas under their management are in compliance with Protiviti health and safety practices, policies and programs. Page 3 of 29

4 Clients provide site-specific health and safety training at the Clients sites. Temporary employees receive basic health and safety training pursuant to this Plan. Hazard Inspections are conducted as set forth by this Plan. Meet periodically to review health and safety activities, incidents and to determine necessary courses of action. All required health and safety notices and posters are properly posted. Within 24 hours, all reports of injury or workplace violence incidents must be completed. Supervisors notify OSHA and the appropriate state agency, as applicable, in the event of a Serious Accident (as defined in Section 6.0 below). 2.3 Supervisors Supervisors are responsible for implementing the Plan. This includes: Ensuring that workplaces and equipment are safe, well maintained, and in compliance with external agency regulations and Protiviti policies, programs and practices. Ensuring that workplace safety and health practices and procedures are clearly communicated and understood by employees through training programs. The attached Appendix D (Work Training and Instruction Record) is to be used by supervisors to keep record of names of employees and their dates of training. Enforcing health and safety rules fairly and uniformly related to job performance. Evaluating employees on compliance with safe work practices. Acknowledging employees who make a significant contribution to maintenance of a safe workplace and disciplining employees who fail to follow safe work practices. Encouraging employees to report workplace hazards without fear of reprisals. Ensuring that inspections/investigations and employee health and safety records are kept for the designated period(s) of time, including the recording and retaining of OSHA Forms 300 and 300A as required. Correcting negative actions and attitudes. Obeying the same rules as the rest of the workforce and leading by example. Notifying OSHA and the appropriate state agency, if applicable, in the event of a Serious Accident (as defined in Section 6.0 below). 2.4 Employees Employees are responsible for following the requirements of the Plan. This involves: Keeping themselves informed of conditions affecting their health and safety. Participating in training programs, as required. Adhering to healthy and safe practices in their workplace. Advising their supervisor of potential hazards in the workplace. In addition to immediately informing their supervisors of potential hazards, the attached Appendix E (Hazard Reporting Form) is to be used by employees to report hazards in writing to their supervisors. Page 4 of 29

5 2.5 Safety Committee In certain states, Protiviti may be required by local law to follow more formal procedures regarding safety meetings and safety committees. In Nebraska, Nevada, New Hampshire, Oregon and Washington, employees will be provided with instruction and information in a separate handout. Regardless of whether formal safety meetings or safety committees are implemented at a particular facility, Protiviti encourages all employees to take an active role in ensuring a safe working environment. 3.0 COMPLIANCE Responsibility for safety and health exists at all levels at Protiviti. All employees, including managers and supervisors, must know and understand their duties and are responsible for establishing and maintaining good health and safety practices. To ensure compliance: Employees are recognized for following safe and healthful work practices. Employees are trained and retrained, as necessary or required to correct unsafe behavior. Disciplinary actions with employees for failure to follow safe and healthful work practices are taken, when appropriate. Safety procedures are a key part of Protiviti s daily routine. Security Considerations To ensure employee s safety, all employees are responsible for adhering to the following security guidelines: When arriving at or departing from work during non-standard business hours, be aware of your surroundings and park in an area that is readily visible, preferably under sufficient lighting and close to the building s entrance. If you would like an escort to or from your car and your location offers onsite security, please contact the security management team. If onsite security is not available, you may also contact a colleague that is already on site. Be aware of your surroundings at all times. If you notice any of the following, do not hesitate to bring these issues to your Managers attention so that immediate action may be taken: o Parking lot and building premises- If you notice any vehicles that seem out of place or abandoned, contact property management or local law enforcement. o Building access- If the use of a badge is required for building or suite access, request to see the badge of any individual that is unknown to you or whose badge is not displayed. Do not permit the individual access if they do not have a badge. Refer them to the appropriate property management team. o Suspicious behavior- If you notice any suspicious behavior from employees or other individuals on or around the premises, alert management, building security Page 5 of 29

6 or local law enforcement. This may include individuals lingering on the premises, solicitors, strange calls or individuals exhibiting odd or threatening behavior. Our company provides services to the public which can mean heavy foot traffic in and out of the office during the course of the day. Consider the below guidelines when handling office visitors, vendors, or callers: o Visitors, vendors, family and personal guests should remain in the reception area and not be granted access to the back office area. o Candidates should remain in the reception area until escorted into the interview rooms. They should not be granted access to the office area. o In an effort to ensure employees safety while at work or on a client site, do not discuss whether an employee is currently in the office or offsite. Tell the visitor or caller that individual is unavailable and that they are welcome to leave a message. 4.0 COMMUNICATION All managers and supervisors are responsible for communicating with their employees about occupational safety and health in a form readily understandable by all employees. Our communication system encourages employees to inform their managers and supervisors of hazards at the worksite without fear of reprisal. Protiviti uses various communication systems to relay information to all employees on matters relating to occupational safety and health, which include: New employee orientation including a discussion of safety and health policies and procedures informing employees what they need to know to perform their initial job assignments safely; Posted or distributed safety information and instructions; Anonymous and confidential hazard reporting; and An anti-reprisal policy. If an employee reasonably believes that his assigned work exposes him to a dangerous condition, he should not perform the work until the danger is abated and should notify his supervisor or manager immediately. Such refusal will not result in sanctions against the employee. Employees shall not be discharged or discriminated against in any manner for bona fide reporting of health and safety hazards to Protiviti or to appropriate governmental agencies. Supervisors shall inform employees of this policy and encourage reporting of workplace hazards to the management. 5.0 HAZARD ASSESSMENT Periodic inspections to identify and evaluate work place hazards are to be performed by a manager or supervisor. The attached Appendix C (Hazard Assessment Checklist and Corrective Action Report) provides a checklist of hazard assessments and corrective actions and is to be used by managers and supervisors when conducting such periodic inspections. This assessment is to be completed for each inspection and retained for a period of two years. Page 6 of 29

7 5.1 Inspection Schedule Inspections shall be conducted according to the following schedule: Upon initial establishment of the Plan. Annually, within the first six months of each calendar year. When new substances, processes, procedures, or equipment, which present potential new hazards, are introduced. When new, previously unrecognized hazards are identified. When occupational injuries or illnesses occur. Whenever workplace conditions warrant an inspection. When near misses occur (i.e. those events where injury or property damage does not occur, but could have if conditions were different). Special emphasis is placed on identifying all contributing factors to any near miss incident. 6.0 REPORTING OBLIGATIONS IMPORTANT PLEASE REVIEW CAREFULLY In the event a serious injury or illness ( Serious Accident ) occurs, the following reporting procedures shall be followed: Upon receipt of a report that a Staff or Temporary employee has been involved in a Serious Accident, the supervisor or manager receiving the report shall, as soon as practicable, take steps to notify appropriate emergency response personnel (e.g., paramedics, fire and/or police), if necessary. A manager or supervisor must notify the nearest Area Office of the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor, by telephone or in person, within eight (8) hours of a work-related incident that results in a fatality or the inpatient hospitalization of three (3) or more employees. Contact information for the nearest Area Office of OSHA can be found either at or by calling OSHA's nationwide hotline at OSHA (6742). If the nearest Area Office is closed, the notification must be made using OSHA s 800 number. States may require additional types of notices to state agencies. Please refer to Appendix J (Special State Reporting Obligations) for details and instruction on specific state reporting requirements. For example, in California, within eight hours of a Serious Accident, the manager or supervisor receiving the injury report must notify the California Division of Occupational Safety and Health ( DOSH ). In California, an injury or illness is serious if the employee is hospitalized for more than 24 hours other than for observation, an employee loses any part of the body or suffers permanent disfigurement. The contact information for the appropriate DOSH District Office is listed below, and also may be found at: If the manager or supervisor has any doubts about whether the accident at issue is serious enough to trigger a reporting obligation, s/he should contact the Program Administrator or the Legal Department. Page 7 of 29

8 Employees shall report accident/exposure to a manager or supervisor as soon as possible. 7.0 INJURY AND ILLNESS INVESTIGATIONS At Protiviti, procedures for investigating occupational injuries, illnesses and accidents shall include the following: Employees should report accident/exposure to supervisors as soon as possible. A manager or supervisor interviews injured workers and witnesses. A manager or supervisor examines the workplace for factors associated with the accident or exposure. A manager or supervisor takes corrective action to prevent the accident/exposure from recurring. A manager or supervisor records the findings and corrective actions taken. A manager or supervisor shall complete the attached Appendix F (Accident/Exposure Investigation Report). The Program Administrator shall record any injuries, illnesses or accidents on OSHA Forms 300 and 301 as required. A manager or supervisor shall take precautions to control any remaining hazards in the area before the investigation team enters. Protiviti employees are to report any accident or injury immediately after it occurs to the client s supervisor and seek immediate medical attention if required. As soon as is reasonable, the employee will call the local Protiviti office and report the accident to a Manager of HR. In the event of an accident or report of an unsafe working conditions, a local Protiviti Manager of HR will begin an immediate investigation tailored to the nature of the complaint and, if necessary, will visit the client workplace. If Protiviti determines the client s facility is unsafe and could lead to further accidents or injuries, Protiviti will remove all employees until the condition causing the accident is remedied by the client. 8.0 HAZARD CORRECTION Protiviti has a commitment to correct unsafe or unhealthy work conditions in a timely manner. Hazards shall be corrected according to the following procedures: When observed or discovered. When an imminent hazard exists which cannot be immediately abated without endangering employee(s) and/or property. All exposed personnel will be removed from the area, except those necessary to correct the existing condition. Employees necessary to correct the hazardous condition shall be provided with the necessary safeguards. Page 8 of 29

9 8.1 Identification of Hazardous Materials Protiviti shall identify hazardous gases, chemicals, or materials used on-the-job, if any, and provide instruction about the safe use and emergency action to take after accidental exposure. 9.0 TRAINING AND INSTRUCTION 9.1 Safety Orientation All employees shall receive a safety orientation. The orientation will provide information about our formal written prevention program and basic safety rules. 9.2 Basic Safety Rules Never do anything that is unsafe in order to get the job done. If a job is unsafe and you reasonably believe that you are exposed to a dangerous condition, stop work and report it to your supervisor. We will find a safer way to do the job. Do not remove or disable any safety device! Keep guards in place at all times on operating machinery. Never operate a piece of equipment unless you have been trained and are authorized. Use your personal protective equipment whenever it is required. Obey all safety warning signs. Working under the influence of alcohol or illegal drugs or using them at work is prohibited. Do not bring firearms or explosives onto company property. Smoking is only permitted outside the building away from any entry or ventilation intake. Horseplay, running and fighting are prohibited. Clean up spills immediately. Replace all tools and supplies after use. Good housekeeping helps prevent accidents. 9.3 Training All employees, including managers and supervisors, shall have training and instruction on general and job-specific safety and health practices. Training and instruction is provided: When the Plan is first established. To all new employees. To employees given new job assignments for which training has not previously been provided. Page 9 of 29

10 Whenever new substances, processes, procedures or equipment are introduced to the workplace and represent a new hazard. Whenever the employer is made aware of a new or previously unrecognized hazard. To supervisors to familiarize them with the safety and health hazards to which workers under their immediate direction and control may be exposed. Protiviti staff will receive general safety training. Each Staff member will sign a Staff Safety Training Acknowledgment form. A copy of this form is attached as Appendix A. When any new personal protective equipment or different work practice is used on existing hazards. In-house temporary employees will receive a general safety orientation. Each temporary employee will sign a Safety Orientation Acknowledgment form, a copy of this form is attached as Appendix B. The time during which employees are participating in training and education activities shall be considered as hours worked for the purposes of wages, benefits, and other terms and conditions of the employment. The training will be provided by Protiviti at no cost to the employees. 9.4 Safety Practices General workplace safety and health practices include, but are not limited to, the following: Implementation and maintenance of the Plan. Employees have the right to refuse work in various circumstances when health or safety is in danger including unsafe work conditions or threat of workplace violence. Emergency action and fire prevention plan. Provisions for medical services and first aid including emergency procedures. Prevention of repetitive motion musculoskeletal injuries, including proper lifting techniques. Proper housekeeping, such as keeping stairways and aisles clear, work areas neat and orderly, and promptly cleaning up spills. Prohibiting horseplay, scuffling or other acts that tend to adversely influence safety. Proper storage to prevent stacking goods in an unstable manner, unsafe height or storing goods against doors, exits, fire extinguishing equipment and electrical panels. Proper reporting of hazards and accidents to supervisors. Hazard communication, including worker awareness of potential chemical hazards, and proper labeling of containers. Proper storage and handling of toxic and hazardous substances including prohibiting eating or storing food and beverages in areas where they can become contaminated EMERGENCY ACTION AND FIRE PROCEDURE PLAN 10.1 Workplace Violence Page 10 of 29

11 In the event of observation or knowledge of actual or potential workplace violence, employees must contact their immediate supervisor, another Protiviti manager, their Managing Director, Corporate Legal, the Employee Relations hotline, local law enforcement, and/or appropriate security management so that prompt and effective action can be taken Fire Procedures In the case of fire, employees shall determine the extent of the fire, attempt to extinguish the fire only if safe to do so, and notify a manager or supervisor immediately of the fire. If the fire cannot be extinguished safely, the employee should call for emergency services by dialing 911 or other appropriate number. The building should be evacuated. All employees are to exit the building following the evacuation maps located at the emergency exits of their area. No one is to use an elevator when exiting the building. All employees will report to the front end of the building for a head count and receive further instructions. No one is to re-enter the building until directed to do so by the proper authority Fire Extinguishers All fire extinguishers are checked regularly. Extinguisher locations are shown on the evacuation map posted within each work area Earthquake Procedures In case of an earthquake, employees are to find cover away from all windows. When it is safe, all individuals are to exit the building following the evacuation maps located at the emergency exits of their area. No one is to use an elevator when exiting the building unless instructed to do so by emergency response personnel. All employees will report to the front end of the building for a head count and receive further instructions. No one is to re-enter the building until directed to do so by the proper authority Evacuation Plan During an evacuation, designated employees will be stationed at the exits to help implement the evacuation procedures. Evacuation routes showing primary and secondary routes for employees evacuation to a safe predetermined location for a head count, the location of exits, fire extinguishers, and first-aid kits are posted within each work area. All exits are clearly marked with lit exit signs and all doors are left unlocked (from the inside) during business hours. Monthly inspections of all access and egress aisles will be conducted to determine they are clear, unobstructed and operable. If an emergency should arise and an evacuation of the premises is necessary, it is the responsibility of each manager or supervisor to alert his/her staff immediately. Page 11 of 29

12 10.6 First Aid Kits A First-Aid Kit should be located in an easily accessible location. A list of emergency phone numbers (fire, police, and hospital) is available at the first aid kit and at the receptionist s desk. We encourage supervisors to have first aid/cpr training Emergency Training and Response Employees are instructed to report any and all minor injuries and mishaps to their immediate supervisor. Employees are also instructed to report unsafe conditions and practices to their immediate supervisor. In the event of major injury, 911 is to be called and a manager or supervisor is to be notified. A list of emergency phone numbers (fire, police and hospital) is located at the receptionist s desk RECORD KEEPING Record keeping Records of hazard assessment inspections, including the persons conducting the inspection, the unsafe conditions and work practices that have been identified and the action taken to correct the identified unsafe conditions and work practices, are recorded on a Hazard Assessment Checklist and Corrective Action Report as attached in Appendix C. Each item shall be checked during the periodic inspections and a copy of the list shall be retained by Protiviti for not less than two years. All conditions or items deemed to be out of compliance shall be immediately abated, unless circumstances beyond the control of Protiviti requires a longer period of time. Documentation of safety and health training for each employee, including the employee's name or other identifier, training dates, type(s) of training, and training providers are recorded on a Work Training and Instruction Record, as attached in Appendix D. Safety and Health Inspection records and training documentation shall be maintained for at least one year (For NV: Safety and Health Inspection records shall be maintained for the duration of employment for each employee.) Employees are encouraged to report any unsafe conditions or practices. Forms for recording and reporting such hazards are attached at Appendix E (Hazard Reporting Form). Page 12 of 29

13 In the event that an accident does occur, a responsible supervisor will complete an Accident/Exposure Investigation Report, the form of which is attached at Appendix F. In the event that an incident of workplace violence does occur, a responsible supervisor will complete an incident report attached at Appendix G. Within seven days of Appendix G being completed, the Branch Manager will need to complete Appendix H. Contact information for state occupational safety and health agencies are attached at Appendix I (State Occupational Safety and Health Contact Information). Special state reporting obligation requirements are attached at Appendix J (Special State Reporting Obligations). Records relating to injury (accident) and illness investigations, including OSHA Form 300, Form 300A, and Form 301 Incident Reports, shall be maintained for five years following the end of the calendar year that these records cover. During the storage period, the stored OSHA 300 forms shall be updated to include newly discovered recordable injuries and illnesses and to show any changes that have occurred in the classification of previously recorded injuries and illnesses PROGRAM REVIEW Protiviti will review the entire safety program once a year. Program evaluation shall include review of: Documentation created in the last year, accident investigation reports, and reports from safety committees or supervisor inspections. Employee and supervisor interviews. Simple observation by management. After the evaluation process is complete, Protiviti will update the safety program accordingly to reflect the real procedures used at Protiviti and to set new goals for the organization to achieve. Responsibility for making the changes will be assigned to a specific person and implementation due dates will be assigned. Changes to the program, goals and procedures will be communicated to all Protiviti employees. Page 13 of 29

14 APPENDIX A NEW STAFF EMPLOYEE SAFETY TRAINING ACKNOWLEDGEMENT I participated in safety orientation training on (date) at (location). I have received a copy of the Injury and Illness Prevention Program and I am familiar with the general safety policies, rules and guidelines contained therein. 1) I have received training on accident, injury and hazard reporting and investigation. I am familiar with the investigation report form and the procedures for investigating and reporting an accident or hazard at a client s facility and at my workplace. 2) My signature certifies that I have received and understand the Health and Safety Program and agree to abide by it. Employee s Name (Print) Employee s Signature Date Page 14 of 29

15 APPENDIX B IN-HOUSE TEMPORARY EMPLOYEE SAFETY ORIENTATION ACKNOWLEDGMENT I participated in safety orientation training on (date) at (location). I have received a copy of the Injury and Illness Prevention Program and I am familiar with the general safety policies, rules and guidelines contained therein. 1) In case I am injured while in the course of my work, I will report the injury to my job-site supervisor immediately and to Protiviti as soon as practicable. 2) I have received training on accident, injury and hazards reporting. I am familiar with the forms and reports and the procedures for reporting accidents, injuries and hazards at a client s facility 3) My signature certifies that I have received and understand the Injury and Illness Prevention Program and agree to abide by it. Employee s Name (Print) Employee s Signature Date Page 15 of 29

16 APPENDIX C HAZARD ASSESSMENT CHECKLIST AND CORRECTIVE ACTION REPORT General Worksites are clean and orderly When lunches are eaten on the premises, they are eaten in areas where there is no exposure to toxic materials or other health hazards All work can be performed without eye strain or glare to the employees Employees are instructed in the proper manner of lifting heavy objects Work can be done without twisting or overly bending the lower back Sanitation Lunchroom/kitchen area clean Food preparation areas clean Restrooms and washrooms are clean and sanitary Paper and waste properly disposed of Floors Spilled materials or liquids are cleaned up immediately Holes in floor/carpeting are repaired properly and made safe Stairways and Aisles Aisles and passageways are kept clear of obstructions Aisles marked and visible Stairways well lighted Handrails, handholds in place Material Storage Material neatly and safely stored Materials stacked on desks or cabinets Storage shelves or drawers not overloaded Large or heavy objects stored on lower shelves or bottom drawers Desk and file drawers kept closed when not in use Office accessories in secure places Lighting Work areas and parking areas are properly illuminated Are bulbs missing Are any areas dark Electrical Electrical appliances are grounded properly Extension cords used have grounding conductors Cord, cable and raceway connections are intact and securely fastened in place Electrical enclosures such as outlets have cover plates Equipment Work surfaces are kept dry Instruments are positioned so work can be done comfortably Pieces of furniture are adjustable, positioned and arranged to minimize strain on all parts of the Page 16 of 29

17 body All pieces of furniture (e.g., chairs, desks, file cabinets, partitions, personal computers) are in safe working condition Emergency Tools/Equipment Contacts- The following numbers are posted at the first aid kits, reception area, or other location accessible in case of an emergency or threat of violence: Emergency telephone numbers Names of individuals trained in first aid or CPR Safety committee names First aid kits are easily accessible to each work area, all necessary supplies are available, and are periodically inspected and replenished as needed Employees are instructed in proper emergency procedures Hazardous Substances Material Safety Data Sheets (MSDS) are in the branch safety records for all toner cartridges and any miscellaneous cleaning chemicals onsite Building Directions to exits, when not immediately apparent, are marked with visible signs Signs concerning exiting from the suite and building are posted where appropriate Building and suite evacuation maps for suite and building are in a visible location Fire alarm system installed Building fire extinguishers are mounted in readily accessible locations and kept clear Building fire extinguishers are charged and noted on the inspection tags Elevators Elevators contain emergency phone or call button Emergency response procedure posted Corrective action taken and date accomplished (specify in detail and use additional sheets if necessary): By: (Signature) Name: Title: Date of Inspection: Send copy to: Manager of HR Kim Lampo- Sr. Manager, HR Compliance- Corporate Page 17 of 29

18 APPENDIX D WORK TRAINING AND INSTRUCTION RECORD EMPLOYEE NAME TRAINING DATES TYPE OF TRAINING TRAINERS Page 18 of 29

19 APPENDIX E HAZARD REPORTING FORM DATE EMPLOYEE'S NAME (optional): DEPARTMENT (optional): PHONE# (optional): UNSAFE CONDITION OR PRACTICE: LOCATION: SUGGESTION FOR IMPROVING SAFETY: Has this matter been reported to your supervisor? Yes No Employees are advised that it would be illegal for an employer to take any action against an employee in reprisal for exercising rights to participate in reporting safety issues. FOR BRANCH MANAGER USE ONLY CORRECTIVE ACTION TAKEN: MANAGER COMPLETING ACTION: DATE: FORWARD THIS REPORT TO: Manager of HR Kim Lampo- Sr. Manager, HR Compliance- Corporate Page 19 of 29

20 APPENDIX F ACCIDENT/EXPOSURE INVESTIGATION REPORT (TO BE FILLED OUT BY SUPERVISOR OR WORKER REPRESENTATIVE AFTER OCCURRENCE) Non-critical Injury- to be completed within 24 hours after occurrence Critical Injury- to be completed within eight hours of occurrence 1. Date of Accident: Time of Accident: am/pm 2. Location of Accident (Bldg., Rm.#, etc.): 3. Accident Description (Include the sequence of events preceding accident and machinery or equipment involved): 4. Description of bodily injury sustained: 5. Employees involved and witnesses (List all names, addresses and job titles): 6. Identify any unsafe condition, acts or procedures that may have contributed to the accident: Preventive Action Recommendation: Corrective Action Taken: Was First Aid administered: Yes No If yes, by whom? Medical care refused Yes No Were Emergency Medical Personnel Called Yes No Hospitalization required? Yes No If yes, name of hospital: Location: Relative or other Emergency contact person called? Yes No Did employee return to work the same day? Yes No Name and address of physician or surgeon by whom the injured was or is being attended to for the injury: _ Page 20 of 29

21 Person investigating accident (Name and Job Title): Manager Responsible: Date Completed: Non-critical Injuries- send copy to: Manager of HR Kim Lampo- Sr. Manager, HR Compliance- Corporate Critical Injuries- send copy to: Manager of HR Kim Lampo- Sr. Manager, HR Compliance- Corporate Corporate Legal Department Upon Request- provide copy to: Accident Inspector State Health & Safety Director Page 21 of 29

22 APPENDIX G INCIDENT REPORT FOR WORKPLACE VIOLENCE (TO BE FILLED OUT BY SUPERVISOR OR WORKER REPRESENTATIVE WITHIN 24 HOURS OF INCIDENT) 1. Date of Incident: Time of Incident: am/pm 2. Location where incident occurred (Bldg., Rm.#, etc.): 3. Employees involved and witnesses (List all names, addresses and job titles): 4. Incident Description (Include the sequence of events preceding incident): 5. Identify any area of vulnerability for employees as a direct result of the incident: 6. Recommendation to prevent future incidents: Name and address of contact if further incidents arise: Person investigating incident (Name and Job Title): Manager Responsible: Date Completed: Send copy to: Manager of HR Kim Lampo- Sr. Manager, HR Compliance- Corporate Corporate Legal Department Page 22 of 29

23 APPENDIX H INCIDENT REPORT FOR WORKPLACE VIOLENCE (TO ACCOMPANY APPENDIX G AND BE COMPLETED BY BRANCH MANAGER AND ZONE ATTORNEY WITHIN SEVEN DAYS OF WORKPLACE VIOLENCE INCIDENT) 1. Date and brief description of incident: 2. Prevention recommendations from Appendix G: 3. Corrective action by Branch Manager to secure premises: 4. Corrective action taken by management to prevent future incidents: 5. Description of any new procedural or safety measures implemented: Manager Responsible: Date Completed: Send copy to: Manager of HR Kim Lampo- Sr. Manager, HR Compliance- Corporate Corporate Legal Department Page 23 of 29

24 APPENDIX I STATE OCCUPATIONAL SAFETY AND HEALTH CONTACT INFORMATION The following list provides contact information for local workplace safety agencies in the states covered by this Plan. For all other states, not including CA, NV, NE, NH, OK, OR, WA, please contact (866) for instructions on reporting requirements. CALIFORNIA California Division of Safety and Health 2424 Arden Way, Ste. 410 Sacramento, California Telephone: (800) InfoCons@dir.ca.gov Website: NEBRASKA Nebraska Workforce Development Nebraska Department of Labor Labor & Safety Standards 301 Centennial Mall South P.O. Box Lincoln, Nebraska Telephone: (402) Website: NEVADA Nevada Division of Industrial Relations Occupational Health and Safety Enforcement 1301 North Green Valley Parkway, Ste. 200 Henderson, Nevada Telephone: (702) Website: NEW HAMPSHIRE New Hampshire Department of Labor State Office Park South Spaulding Building 95 Pleasant Street Concord, New Hampshire Telephone: (603) Website: OKLAHOMA Oklahoma Department of Labor 4001 N. Lincoln Boulevard Oklahoma City, Oklahoma Telephone: (405) or (888) Website: OREGON Oregon Occupational Safety & Health Division 350 Winter Street NE, Rm. 430 Salem, Oregon Telephone: (800) or (503) Page 24 of 29

25 Website: WASHINGTON Washington Department of Labor and Industries WISHA Services Division PO Box Olympia, Washington Telephone: (800) Website: Page 25 of 29

26 APPENDIX J SPECIAL STATE REPORTING OBLIGATIONS IMPORTANT PLEASE REVIEW CAREFULLY Under federal OSHA requirements, all employers are required to notify the nearest Area Office of the Occupational Safety and Health Administration, U.S. Department of Labor, within eight hours of a workrelated incident that results in a fatality or the in-patient hospitalization of three or more employees. Contact information for the nearest Area Office of OSHA can be found at or by calling OSHA s nationwide hotline at OSHA (6742). Some states also require notifications to be made to state agencies. The following states also require additional types of notices to state agencies. For all other states, not including CA, NV, NE, NH, OK, OR, WA, please contact (866) for instructions on reporting requirements. CALIFORNIA Within eight hours of a Serious Accident, the manager or supervisor receiving the injury report must notify the California Division of Occupational Safety and Health ( DOSH ). An injury or illness is serious if the employee is hospitalized for more than 24 hours other than for observation, an employee loses any part of the body or suffers permanent disfigurement. The contact information for the appropriate DOSH District Office is listed below, and also may be found at: When reporting an occupational injury to DOSH, information should be limited to factual points such as who was injured, when the injury occurred, who has been contacted, etc. The individual reporting the accident should not speculate on any issues, including but not limited to: the cause of the accident, who may have witnessed the accident, etc. In the event of major injury, 911 is to be called and a manager or supervisor is to be notified. A manager or supervisor shall notify appropriate personnel at the California Division of Occupational Safety and Health. Contact Information for Reporting Injuries: California has multiple Cal/OSHA district offices, and accidents should be reported to the nearest district office. Contact information for the local district office for California facilities may be obtained by going to and entering the zip code or name of the city in which the facility is located. NEVADA Within eight hours of a work-related fatality or the hospitalization of three or more employees, the manager or supervisor receiving the injury report must notify Nevada s division of industrial relations. Contact Information: Nevada Division of Industrial Relations Occupational Health and Safety Enforcement 1301 North Green Valley Parkway, Ste. 200 Henderson, Nevada Telephone: (702) Website: Page 26 of 29

27 NEW HAMPSHIRE Within eight hours of a work-related fatality or the hospitalization of three or more employees, the manager or supervisor receiving the injury report must notify New Hampshire s state commissioner of labor. Contact Information: OREGON New Hampshire Department of Labor State Office Park South Spaulding Building 95 Pleasant Street Concord, New Hampshire Telephone: (603) Website: Within eight hours of a work-related fatality or catastrophe, the manager or supervisor receiving the injury report must notify Oregon s Occupational Safety and Health Division. Within 24 hours of an overnight hospitalization, the manager or supervisor receiving the injury report must notify the nearest Oregon OSHA field office. Contact Information: Oregon OSHA Telephone: (800) or (503) Field Offices: Salem Central Office: (800) or (503) Eugene: (541) Medford: (541) Portland: (503) Bend: (541) Pendleton: (541) Website: WASHINGTON Within eight hours of a work-related fatality or probable fatality, or the hospitalization of two or more employees, the manager or supervisor receiving the injury report must notify Washington s Department of Labor. Contact Information: Washington Department of Labor and Industries WISHA Services Division PO Box Olympia, Washington Telephone: (800) 4-BE SAFE ((800) ) Website: Page 27 of 29

28 INJURY AND ILLNESS PREVENTION PROGRAM SAFETY COMMITTEE SUPPLEMENT (Oregon and Washington) Introduction Protiviti Inc. is dedicated to providing a safe working environment for employees. In states that require more formal procedures regarding safety meetings and safety committees, the Protiviti Safety Committee ( Safety Committee ) was established to meet those needs and to promote a safe working environment. Safety Committee Members The Safety Committee is to be comprised of Protiviti management and non-management employee members, with a designated Safety Committee Chairperson position alternating between members of Protiviti management and non-management employees each year. Safety Committee members will serve one-year terms and meet on a quarterly basis. Time spent attending meetings is counted as time worked. Written records of meetings will be retained for three years. (WA sites only Add the following: The records will available for review by safety and health consultation personnel of the Department of Labor and Industries.) HR Leads from each office will appoint an equal number of management members and non-management members based on selection procedures established by the individual office. The total number of Safety Committee members per office is in the discretion of the HR Lead, as office needs may vary office to office due to variation in size and circumstances. For example, one office may have one management member and one non-management employee member, whereas another office may have three management members and three non-management members. General Duties Due to the nature of Protiviti s industry and services, exposure to workplace hazards and risks may be minimal when compared to other industries. However, Protiviti is dedicated to maintaining a safe working environment for all employees. Duties of the Safety Committee may include: Reviewing the Protiviti Inc. Injury and Illness Prevention Program ( IIPP ); Assisting Managers and Supervisors in coordinating workplace safety trainings, meetings, and inspections; Assisting Managers and Supervisors in accident investigations, carrying out interviews with employees in conjunction with inspection of worksites and accident investigations, and performing job hazard analysis; Reviewing safety and health inspection reports to help correct safety hazards. Evaluating the accident investigations conducted since the last meeting to determine if the cause(s) of the unsafe situation was identified and corrected. Page 28 of 29

29 Coordinating periodic fire and evacuation drills in conjunction with worksite/office property management; Acting as office Safety Captains for emergency evacuations, facilitating evacuations, and keeping track of Protiviti employees during evacuations; Bringing employee safety and health concerns and complaints to Managers and Supervisors for correction; Making recommendations to Protiviti for improvement of the IIPP. Such recommendations shall be advisory only, and Protiviti retains full authority to administer the IIPP and all worksites. Protiviti encourages all employees to take an active role in ensuring a safe working environment. Employees of Protiviti are welcome to provide feedback and concerns regarding work safety to Protiviti Managers, Supervisors, or Safety Committee members. Page 29 of 29