SUBJECT:PAGE OF .gov



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 Attachments How 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 throughout the template. Review with all persons involved with safety and compliance in your organization. Edit the document to add, 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 workers’ compensation 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.The Ohio Bureau of Workers’ Compensation (BWC) provides this document to assist you in your risk reduction 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. BWC encourages you to conduct periodic workplace inspections and review written programs regularly. BWC does not endorse any specific companies or products mentioned for illustrative purposes in the document.The Ohio Bureau of Workers’ Compensation (BWC) provides this document to assist you in your risk reduction 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. BWC encourages you to conduct periodic workplace inspections and review written programs regularly. BWC does not endorse any specific companies or products mentioned for illustrative purposes in the document.Respiratory Protection ProgramPURPOSE - 1910.134(c) This is a Respiratory Protection Program for Employer Name that instructs and educates employees who must wear respirators during normal work and emergencies. This program follows 29 CFR 1910.134 and assigns responsibilities for managing the program.SCOPE This program ensures employees understand how Employer Name protects them from airborne chemical hazards at work. While engineering controls such as ventilation and substitution of less toxic materials are preferred protection methods, for some tasks and during emergencies respirators are necessary to protect employees. To protect respirator-wearing employees from airborne chemical hazards, Employer Name evaluates respiratory hazards to determine proper respirator selection, ensures employees are medically able to wear respirators, performs fit testing with proper respirators, trains employees to use and maintain their respirators, and evaluates this program periodically to verify program effectiveness.This policy provides guidance and understanding in the following:A. Program AdministrationB. Program Specific ElementsHazard Evaluations National Institute of Occupational Safety & Health (NIOSH) Certification Medical EvaluationsFit TestingRespirator Use Air Quality in Atmosphere Supplying Respirators Cleaning, Maintenance, Change Schedules, and Storage. Documentation and RecordkeepingC. Information and TrainingD. Program Evaluation & Updates ? AttachmentsProgram AdministrationEmployer Name Respiratory Protection Program is organized and administered in this section to identify affected employees and their responsibilities. The Job Title coordinates the program and may assign program duties to proper personnel. Supervisors implement the program in specific work areas and ensure employees follow the program and the training they receive. The following personnel have specific responsibilities for administering aspects of this program:List responsible parties and program specific responsibilities here.Job Title (i.e. Safety Director/HR Manager) serves as program administratorof the Employer Name Respiratory Protection Program. The program administrator has the following duties:Identify the work areas, processes, or tasks that require employees to wear respirators and evaluate the hazards.Select proper respirators for employees.Ensure employees use respirators with NIOSH certifications.Ensure employees receive respiratory protection training.Ensure employees store and maintain respirators properly.Manage respirator fit testing.Manage medical surveillance of employees.Maintain required rm contractors of the company’s respiratory protection requirements.Evaluate the program.Update the program when necessaryInclude any other job, facility, or task specific responsibilities hereSupervisors ensure the implementation of the Respiratory Protection Program in their work areas. Supervisors understand the requirements of this program and verify employees understand the requirements. At a minimum, supervisors have the following responsibilities:Ensure employees under their supervision have received proper training, fit testing, and medical evaluations.Ensure the right respirators and accessories are available.Know the tasks that require respiratory protection.Enforce the proper use of respirators.Ensure employees clean, maintain, and store respirators as required.Monitor work areas for respiratory hazards.Work with the program administrator to address respiratory hazards and other program concerns.Include any other job, facility, or task specific responsibilities hereEmployees must wear their respirators as trained and do the following:Care for respirators as instructed and store them in a clean sanitary rm their supervisor if the respirator no longer fits and request a new one that fits rm their supervisor or the program administrator about respiratory hazards or other concerns they have about the program.Include any other job, facility, or task specific responsibilities hereB. PROGRAM SPECIFIC ELEMENTS -- 1910.134(c) Hazard Evaluations *Attachment AThe program administrator follows Occupational Safety and Health Administration (OSHA) requirements to select respirators based on exposure hazards to employees. The program administrator conducts a hazard evaluation (Attachment A) for each work process or area where airborne contaminants are present during routine operations or emergencies. The evaluation includes the following:Identification and development of a list of hazardous substances used in the workplace by department or work process.Review of work processes to determine where potential exposures to these hazardous substances may occur. These reviews are done by surveying the workplace, reviewing process records, and talking to employees and supervisors.Conduct air monitoring, through an industrial hygienist, to determine employee exposures in areas of concern.The program administrator revises and updates the hazard assessment any time there are changes in the workplace that may affect exposure. Employees who feel that respiratory protection is necessary must contact their supervisor or the program administrator. The program administrator evaluates the hazards and informs employees about the evaluation results. If respiratory protection is necessary, all elements of this program apply, and the program administrator updates the program accordingly.NIOSH Certification – 1910.134(d)(1)(ii)All respirators meet required NIOSH certification and are used only according to the terms of that certification. All filters, cartridges, and canisters have the correct NIOSH approval label; do not remove or deface the label.Medical Evaluations – 1910.134(e)*Attachments B & CEmployees who must wear respirators, or who choose to wear respirators other than filtering facepiece respirators (“dust masks”), must have a confidential medical evaluation to ensure that wearing a respirator does not pose a safety or health risk. The program administrator supplies affected employees with a medical evaluation form (Attachment B), the required OSHA questionnaire, found in Appendix C of 1910.134. Employees may complete the medical questionnaire on company time. The company aids employees who are unable to read the questionnaire. When this is not possible, employees will be referred to a Physician or Licensed Healthcare Professional (PLHCP) for medical evaluation. Our PLHCP (Insert Name of Physician or Licensed Healthcare Professional (PLHCP) will evaluate your medical questionnaire. All employees may speak to the PLHCP regarding their medical questionnaire. Follow-up medical exams will be performed as required by 1910.134 or when recommended by (insert name of PLHCP)The program administrator supplies (name of PLHCP) with the following information: A copy of this respiratory protection program, a copy of 1910.134, and a list of hazardous substances by work area.The name of each employee who needs a medical evaluation and their work area or job title.The employee’s proposed respirator type and weight.The length of time and how often the employee must wear the respirator.The employee’s expected physical workload (light, moderate, or heavy), potential temperature and humidity extremes of the work area, and a description of protective clothing the employee must wear.Employees are not allowed to wear respirators until a physician has determined they are medically able to do so and is documented with a medical release to wear a respirator (Attachment C- or equivalent). Any employee refusing a medical evaluation is not allowed to work in areas that require respirators.Any employee required to wear a negative-pressure air-purifying respirator, and who has a medical condition as determined by the PLHCP is provided with a powered air-purifying respirator (PAPR).Additional or follow-up medical evaluations are completed when:Any employee reports signs or symptoms related to their ability to use a respirator, such as shortness of breath, dizziness, chest pains, or wheezing.A supervisor, PHCLP, or the program administrator informs Employer Name that an employee needs to be re-rmation from this program, including observations made during fit testing and program evaluation, shows a need for employee re-evaluation.A change occurs in workplace conditions that may result in an increased physiological burden on the employeeInformation from medical examinations and questionnaires is confidential and shared only between the employee and the physician. See Section 8 – Documentation and Recordkeeping.Fit Testing – 1910.134(f) *Attachment DWe conduct fit testing before initial use, annually, or whenever a different respirator facepiece is used or a change in an employee's physical condition could affect respirator fit. If the respirator becomes unacceptable to the employee later (i.e., causes irritation or pain to the employee), employees are able to select a different respirator and be retested.Fit testing applies to employees who wear the following types of respirators: (identify the types of respirators). Employees who voluntarily wear respirators do not require fit testing.Employees are fit tested using the make, model, and size of respirator they wear for work. We offer several models and sizes of respirators so employees may find an ideal fit. Conduct fit testing of atmosphere-suppling respirators and tight-fitting powered air-purifying respirators in the negative pressure mode. (Insert name of fit testing person/organization) performs fit testing. All fit testing is documented on Attachment D.Respirator Use -- 1910.134(g) a. General Use Employees use their respirators as required by this program following training in a manner certified by NIOSH and the manufacturer. Employer Name supplies and pays for all respiratory protection approved under this program.Employees conduct user seal checks each time that they wear tight-fitting respirators. Employees use the procedure recommended by the manufacturer or the positive and negative pressure check as specified in Appendix B-1, 1910.134.Employees do not wear tight-fitting respirators if they have conditions such as facial scars, facial hair (beards), or missing dentures that prevent them from achieving a good seal. Facial hair must not contact sealing surfaces or interfere with the valve function. Employees do not wear headphones, jewelry, or other articles that may interfere with the facepiece-to-face seal.Voluntary Use 1910.134(c)(2) *Attachment ETight-Fitting and Loose-Fitting RespiratorsVoluntary use of respirators allows employers the flexibility to permit employees to use respirators when the hazard/exposure assessment does not indicate the need, without requiring a full respirator program. Employees who voluntarily wear a respirator are subject to the medical evaluation, cleaning, maintenance, and storage requirements of this program, and are provided with the information specified in this section of the program (all requirements except for fit-testing). Employees receive training on the provisions noted in Appendix D of the Respiratory Protection standard.Filtering Facepieces aka “Dust Masks”Employees who voluntarily wear filtering facepieces or “dust masks” are not subject to the medical evaluation, cleaning, storage, and maintenance provisions of this program. The only requirement for voluntary use of filtering facepieces is training on the provisions noted in Appendix D of the Respiratory Protection standard. The program administrator allows voluntary use of respirators as requested by all other employees on a case-by-case basis, depending on workplace conditions and medical evaluation results. This includes any employee-supplied respirators. Voluntary use of respirators approval is documented on Attachment E.Escape Respirators -- 1910.134(d)(2)(ii) (May not be applicable for every workplace, remove as necessary)Escape respirators are for emergencies only. (Competent Person or insert inspection company here) inspects these before placing them into the workplace. When the emergency alarm sounds, employees in (identify work locations) must immediately don emergency escape respirators, shut down equipment, and evacuate to designated safe areas. The Employer Name emergency action plan describes emergency evacuation procedures. We conduct a certified inspection monthly for all escape respirators. Respirator Malfunction -- 1910.134(k)(1)(iii)Employees immediately remove respirators from service that are defective or have defective parts. Inform your supervisor immediately who gives the defective equipment to the program administrator. The program administrator decides whether to take the respirator out of service, fix it on the spot, or dispose of it.If the replacement respirator is not from the same manufacturer, model and size, the program administrator fit tests the employee on the new respirator.e. Locations Immediately Dangerous to Life or Health (IDLH) -- 1910.134(d)(2) *Attachment F (May not be applicable for every workplace, remove as necessary)The program administrator has identified the following locations as IDLH (Attachment F): (Identify IDLH Locations here)Where any atmosphere presents an immediate threat to life, would cause irreversible adverse health effects, or would impair an individual's ability to escape from a dangerous atmosphere, trained personnel do the following:Immediately notify the program administrator or another designated person before an emergency responder enters the IDLH atmosphere.For permit-required confined space (PRCS), refer to company PRCS program for added guidance. At least one person stays outside the IDLH atmosphere to respond to emergencies.The person entering the IDLH atmosphere and the person outside the IDLH atmosphere keep visual, voice, or signal contact.The person outside the IDLH atmosphere has been trained and equipped to respond to the emergency.The person outside the IDLH atmosphere uses a positive-pressure SCBA or positive-pressure supplied-air respirator with auxiliary SCBA and rescue retrieval equipment.There are always at least two trained firefighters stationed outside during interior structural firefighting, who are equipped and prepared to enter if necessary, to rescue the (at least two) firefighters inside. (May not be applicable for every workplace, remove as necessary)Include any other IDLH job, facility, or task specific responsibilities hereAir Quality in Atmosphere Supplying Respirators – 1910.134(i) (May not be applicable for every workplace, remove as necessary)We use only Grade D breathing air for Atmosphere-supplying respirators. The program administrator coordinates deliveries of compressed air with the vendor. When using breathing air compressors, we ensure they meet the requirements of 1910.134(i)(5).Cleaning, Maintenance, Change Schedules, and Storage -- 1910.134(h)Cleaning – 1910.134(h) (1)Respirators are regularly cleaned and disinfected at the respirator cleaning station (Identify cleaning location(s)) as often as necessary to keep them sanitary. Shared respirators are cleaned after each use. (Remove if not applicable) Clean and disinfect each atmosphere supplying and emergency use respirators after each use. (Remove if not applicable)Follow manufacturers’ cleaning instructions or the following procedure for cleaning and disinfecting respirators:Remove filters, canisters, or cartridges. Disassemble respirator and facepiece including speaking diaphragms, valve assemblies, hoses, or any components recommended by the manufacturer.Wash the facepiece and parts in warm water (110 degrees F maximum) with a mild detergent or cleaner recommended by the respirator manufacturer. Rinse completely in clean warm water.If the cleaner in step 2 does not have a disinfectant, immerse the respirator in a hypochlorite solution or aqueous iodine solution as outlined in Appendix B-2 or use a cleanser of disinfectant quality as approved by the manufacturer.Air dry the respirator in a clean area, or hand dry with a clean lint-free cloth. The respirator must be thoroughly dried before reassembly.Reassemble the respirator, inspect it, and replace defective parts. Test the respirator to ensure all components work properly.The program administrator ensures an adequate supply of proper cleaning and disinfection materials. Employees should contact their supervisor or the program administrator when supplies are low. b. Maintenance - 1910.134(k) (1) (v) *Attachment GMaintain respirators to ensure they work properly. Maintenance involves a thorough visual inspection for cleanliness and defects. Replace worn or deteriorated parts. Make no replacement of repair of components except with those recommended by the manufacturer. The manufacturer repairs the regulators or alarms of atmosphere-supplying respirators. c. Change Schedules - 1910.134(d) (3) (iii) (B) (2) *Attachment HReplace air-purifying particulate filters, cartridges, or filtering facepieces when breathing resistance increases, there is a contaminated cartridge surface, detected breakthrough, or damaged filter. The program administrator determines and documents breakthrough times and end-of-service life for filters and cartridges on Attachment H. d. Storage - 1910.134(h)(2)To prevents facepiece or valves from becoming deformed, store respirators following the manufacturer’s recommendations. Protect your respirator against physical damage, contamination, excessive moisture, extreme temperatures, sunlight, damaging chemicals, contamination, dust, extreme temperatures, excessive moisture, damaging chemicals, or other destructive conditions. Store cartridges in airtight containers. Remove cartridges from the facepiece or store entire respirator in an airtight container.Store escape use respirators in compartments or in covers, both of which are clearly marked as holding the escape respirators. (Remove if not applicable)Documentation and Recordkeeping – 1910.134(m)A written copy of this program and 1910.134 are available for review in the program administrator’s office. The program administrator also keeps copies of training and fit-test records and updates them when training new employees, when employees receive refresher training, and when conducting new fit tests. The program administrator updates these records annually.Employer Name makes an employee's fit testing records available to that employee and to designated representatives per 1910.1020. Medical questionnaires and the physician’s documented findings are confidential and remain at (Location of Medical Records). The program administrator keeps only the physician’s written recommendation for each employee to wear a respirator.C. INFORMATION & TRAINING – 1910.134(k) *Attachment IThe Job Title and work area supervisors provide employees with information and training in respiratory protection. Employee information and training includes training prior to use of respirator, at least annually, or whenever they change jobs or respirators and we document training on Attachment I. We provide retraining if program issues are found. The program administrator and supervisors ensure employees understand training through methods such as hands-on exercises and a written test. The program administrator keeps training records, including the type, model, and size of respirator for which each employee has been trained and fit tested. D. PROGRAM EVALUATION & UPDATES – 1910.134(l) *Attachment J Employer Name conducts time period reviews of this written Respirator Protection Program for compliance with federal regulations and our internal requirements to assure quality and effectiveness and we document this review on Attachment J.In addition to the review of this written policy, our program evaluations include regular consultations with employees who use respirators and their supervisors, site inspections, air monitoring, and records reviews. Deficiencies discovered during evaluations are kept in an inspection log maintained by the program administrator, and reviewed with management, including recommended corrections.The Job Title keeps the findings of all reviews and the plans to correct deficiencies in the program.AttachmentsIncluded here are forms, definitions, inventory, logs, maps, training documents, policy review signoffs, action plans, sample documents, corrective action, etc. Attachment A – Respiratory Hazard AssessmentAttachment B – Medical QuestionnaireAttachment C – Medical ReleaseAttachment D – Fit Test ResultsAttachment E – Voluntary Use Sign-OffAttachment F – IDLH LocationsAttachment G – Respirator Maintenance Inspection ChecklistAttachment H – Respirator Filter Change ScheduleAttachment I – Training LogAttachment J – Program Evaluation DefinitionsAdditional ResourcesRespiratory Protection Resources Document ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download