SUBJECT:PAGE OF - Ohio
Welcome to the BWC sample policy template page! After downloading this sample, please remove the language on this page. Replace the Ohio Bureau of Workers’ Compensation (BWC) logo with your company logo and implement an effective date with management approval signature.This is a general guidance document to help your organization develop a written safety policy. Some items in this guide will not apply to your workplace. Please reference any applicable standard(s) to ensure you meet all requirements. For added convenience there is a document at the end of this template with resource links. This sample written program has example language, but you must change it so that it is site-specific and meets expectations of your organization. Delete the DSH Helper Comments after creating your policy.For ease of use, every sample provided by BWC follows this format: A.? Program Administration B.??Program Specific Elements C.? Information and Training D.??Program Evaluation and Updates??? ?????????????? ???? AttachmentsHow to use this template:Save this template and name it for your own reference. Make this template specific to your organization by changing all text in red. Review with all persons involved with safety and compliance in your organization. Edit the document to add to, remove or adjust language to ensure it is specific to your organization.Review again with all persons involved with safety and compliance in your organization.Finalize the document.Prepare training based on your new or updated policy content.Conduct and document training (general and specific) as required by standard and policy.Schedule and document policy reviews and updates (if any).Retrain when there are any changes within the organization, updates to policy, deficiencies, or employee needs. For further assistance with development of this and other policies and programs, please contact your local Safety Consultant, or call 1-800-644-6292. Your BWC Policy includes a wide range of services for all industries including Safety Consultations, Safety Education & Training and the BWC Safety & Video Library at no additional cost. ??-315310144079The information included in this document is intended to assist you in your compliance efforts. This document may not address all the actions necessary to ensure compliance with federal, state, or local laws, regulations, codes, and standards. Use of the information in this document does not guarantee you have satisfied all legal obligations.BWC does not make any representation or warranty, express or implied, that your workplace is safe, free of occupational hazards or in compliance with all applicable laws, regulations, codes, or standards.? You are encouraged to conduct periodic workplace inspections and review written programs regularly.? References to specific companies or products are provided for illustrative purposes only and are not intended as endorsement of those companies or products by the Ohio Bureau of Workers’ Compensation.00The information included in this document is intended to assist you in your compliance efforts. This document may not address all the actions necessary to ensure compliance with federal, state, or local laws, regulations, codes, and standards. Use of the information in this document does not guarantee you have satisfied all legal obligations.BWC does not make any representation or warranty, express or implied, that your workplace is safe, free of occupational hazards or in compliance with all applicable laws, regulations, codes, or standards.? You are encouraged to conduct periodic workplace inspections and review written programs regularly.? References to specific companies or products are provided for illustrative purposes only and are not intended as endorsement of those companies or products by the Ohio Bureau of Workers’ Compensation.First Aid ProgramFirst Aid PolicyPURPOSE - 1910.151Accident and Incident Reporting & AnalysisPURPOSEThis is the Accident and Incident Reporting Policy for Employer Name. This policy describes our process for reporting, investigation, analysis, prevention, and recordkeeping of all accidents, incidents, illnesses, and all property damage occurrences. We investigate every occurrence and use the results to determine root causes, and to implement prevention measures. SCOPE This policy applies to all employees, contractors, or guests who have experienced any injury, illness, near miss, property damage, or other incident while working in facilities or at job sites for Employer Name. This policy applies to all physical, equipment, or property incidents that resulted in, or may have resulted in, an injury, illness, or property damage and informs you about: A.? Program Administration B.??Program Specific Elements1. Incident/Accident/Near Miss – Definition2. Incident/Accident - How-to Report3. Incident/Accident/Near Miss to Visitors/Contractors – How-to-Report4. Near-miss incidents – How-to-Report5. Employee Actions and Responsibilities6. Supervisor/Management/Leadership Actions/Responsibilities7. Human Resources/Personnel Management8. Post Incident/Accident Drug & Alcohol Protocol C.? Information and Training D.??Program Evaluation and Updates??? ?????????????? ???? Attachments A.PROGRAM ADMINSTRATION & RESPONSIBILITIES The Job Title/Program Administrator coordinates and implements this Accident and Incident policy for Employer Name. They ensure employees understand the program and how to report incidents, injuries, accidents, or illnesses. The Job Title/Program Administrator assigns program duties to proper personnel. Assigned responsibilities include training, investigations, evaluations, recommendations, corrective action, and follow up. The following personnel have specific responsibilities for administering aspects of this program:List responsible parties here. See full program specifics for each member or group below.Supervisors ensure employees follow the program and the training they receive and participate fully in the incident/accident investigation process.B.PROGRAM SPECIFIC ELEMENTS Incident/Accident/Near miss – Definition(s)An accident is an unfortunate incident that happens unexpectedly and unintentionally, resulting in damage or injury, or an event that happens by chance or that is without apparent or deliberate cause.A near miss is a narrowly avoided occurrence that would have resulted in damage or injury.An incident is an unplanned/unwanted event or occurrence that adversely effects the completion of a task.Unsafe Act/behaviors - actions taken by individuals that directly caused or contributed to the accident/incident. Unsafe condition – Surroundings that contribute to the incident including housekeeping, lighting, poorly designed equipment/tools, or inadequate ventilation.(Insert Company Specific definitions and guidelines here regarding “what” is to be reported)Incident/Accident - How-to Report ATTACHMENTs A-D To ensure proper and timely first aid or medical care, if you experience an injury/illness/near miss, stop and notify your immediate supervisor, or other member of management, or member of human resources (insert specific personnel here) They ensure you receive prompt medical treatment when needed, and assist you with report forms and other steps.Our incident/accident forms collect all information needed to ensure proper treatment and allow us to conduct thorough and effective incident/accident analysis reviews. Incident report forms are located: (Insert locations of report forms here. Provide multiple locations for ease of access) You complete the employee portion(s) of the (insert name(s) of your report form(s). Your immediate supervisor, or other member of management aids you with completing incident/accident documents as needed. Your immediate supervisor, or other member of management, completes their own report forms and collects or completes other documents as necessary.If you are involved in, or witness, any property or equipment damage stop and notify your immediate supervisor, or other member of management, or member of human resources, (insert specific personnel here) You may be asked to complete a witness form. Attachment C.If you need medical assistance (Insert procedures for medical or first aid here). For non-life-threatening injuries, Employer Name uses INSERT NAME of Occupational Health Care provider and procedure for getting to and from clinic.Incident/Accident/Near Miss to Visitors/Contractors – How-to-ReportThe Job Title/Program Administrator and Supervisors provides visitors and contractors with information regarding reporting of incidents/accidents.If you witness, or are involved in, any incident/accident involving a visitor or contractor, stop and notify your immediate supervisor, or other member of management, or member of human resources (insert specific personnel here). You may be asked to complete a witness form. Attachment C.Near-miss incidents – How-to-ReportThe investigation procedures for near-miss incidents (insert examples of near misses) follow a similar investigation process as an injury/illness under this policy. Stop and notify your immediate supervisor, or other member of management, or member of human resources (insert specific personnel here) of all near misses.Employee Actions/ResponsibilitiesEmployees attend training in incident/accident reporting with the Job Title/Program Administrator or their Supervisor. Employees report all incidents (insert your specific reporting period guidelines here – Caution see DSH comment) to their immediate supervisor, or other member of management or human resources or (insert personnel here). Employees complete the employee portion of the incident/accident form and assist with accident analysis as needed.Our safety committee is made up of employees, managers, supervisors, and human resources (insert specific personnel here). They may assist in the incident/accident analysis process through the review of forms and reports, participation in scene accident analysis and/or incident re-creation, and the development of corrective action recommendations.Employer Name takes safety seriously and we encourage an open-door policy for employees to report unsafe conditions and other safety concerns they feel could result in accidents or incidents. Please report all safety concerns to your immediate supervisor, the Job Title, or any member of management or human resources.Management/Leadership/Supervisor Actions/ResponsibilitiesLeadership: Our leadership team supports the Job Title/Program Administrator, supervisors, and safety team in their efforts under this policy. They ensure effective and prompt incident/accident reporting and review all incident/accident documentation and participate in the audits of this policy.Managers and Supervisors: Receive training to promote the health and safety of all employees. They actively support the incident/accident investigation policy by attending training in incident/accident investigation, ensuring prompt reporting and investigations, implementing corrective actions, and follow up. (Insert specific reporting period and process guidelines for supervisors here and incorporate in to training)Human Resources/Personnel Management Reporting & Recordkeeping - The Job Title works with Human Resources or Personnel Management to review incident report forms, accident investigation results, and medical documentation. Human resources and the Job Title work with our medical provider to ensure prompt medical treatment and follow up care. Reporting and recordkeeping requirements apply to all accidents or incidents that result in treatment above basic first aid, work-related fatalities, work-related injury, or illness resulting in loss of consciousness, days away from work, restricted work, or transfer to another job. Human Resources, or the Job Title, reports, records, and keeps incident/accident reporting and recordkeeping information. Human Resources, or the Job Title, keeps all records, which are confidential.(See DSH Assistant Comment and resource document for more information, guidance, and links for recordkeeping and reporting.)Note - We record needlesticks, or exposures of any potentially contaminations with bloodborne pathogens or other potentially infections materials (O.P.I.M) as an injury on (OSHA or PERRP) forms. The Job Title keeps this information and it is confidential.Post Incident/Accident Drug & Alcohol Protocol (Delete if not applicable:) (Insert company specific drug testing protocol here or create a separate policy and train accordingly.)C. INFORMATION & TRAINING ATTACHMENTs E-F All employees receive information and training on the elements of this Accident and Incident Reporting policy at the time of their hiring and any time deficiencies are noted in employee knowledge.(Definitions – insert company specific training, definitions, and terms here)Employee information and training includes but is not be limited to:How to report an accident, injury or near miss.How to seek medical attention.Location of reporting forms.How to report hazards.Accident analysis process.Post-accident/incident/injury/illness process (medical attention, light duty, corrective or prevention action, re-training etc.).Supervisor/Leadership information and training includes but is not limited to:1. Incident investigation analysis process.2. Securing the scene/taking photos & measurements.3. Location of reporting forms/incident/accident kit.4. Interviewing techniques.5. Proper report writing.6. Process for reporting to OSHA or PERRP.7. Post-accident/incident/injury/illness process (medical attention, light duty, prevention action, re-training etc.).8. Implementing prevention/corrective actions and follow up.We provide employee training and information through formal classroom training, handouts, and periodic safety meetings. The Job Title documents all training and keeps sign-in sheets.The Job Title trains Supervisors/Safety Committee in accident analysis and investigation of incidents, and we conduct a thorough review of all occurrences. We use the details gathered during the investigation to develop prevention actions and follow up. D. PROGRAM EVALUATION & UPDATESWe conduct [time period] reviews of the Employer Name written Accident and Incident Reporting policy for compliance with any federal regulations and our internal requirements to assure quality and effectiveness.This review includes:Employee awareness of this policy.Employee knowledge of how to report accident, incidents, injuries, and illnesses.Proof of training – employees, supervisors, managers, contractors etc.Proof of post incident corrective actions. Proof of updates or corrective actions for deficiencies in this policy.The Job Title keeps the findings of the review and the plans to improve the policy.ATTACHMENTSIncluded here are forms, definitions, inventory, logs, maps, training documents, policy review sign offs, action plans, sample docs, corrective action, etc.Attachment A.1 – Private Employer SAMPLE Report FormAttachment A.2 – Private Employer SAMPLE Report Form 2Attachment B – Public Employer Report Forms WorkbookAttachment C – Witness Detail SAMPLE Report FormAttachment D – SAMPLE Accident Investigation ProcessAttachment E – Training Sign in SheetAttachment F – SAMPLE DefinitionsAdditional Resources – Accident and Incident Reporting Resources Document ................
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