Accident Prevention Plan (Shatha Aldahban) TECH 462 –Industrial Safety Engineering March 16, 2015 Table of Contents Introduction Goal & Intentions Page 5 Company Presidents Statement Page 6 Management Responsibilities Manager Responsibilities Page 8 Supervisors Responsibilities Page 8-9 Employee Orientation How and When Page 11 Emergency Action Plan Page 12-24 Emergency Shutdown Procedures Page 25 Injury and Illness Procedures Procedures Page 27 Record Keeping Page 27 Supervisor Responsibilities Page 28 Report Form Page 29 Incident/Accident Investigation Procedures Procedure Steps Page 31 Worksheet Form Page 32 Incident/accident Table Page 33 Safety Guidelines General Guidelines Page 35-36 Equipment Specific Page 37 Individual Specific Page 38 Safety Disciplinary Policy Safety Disciplinary Policy Page 40 Safety Awareness Program Safety Committee Page 42 Safety Meetings Page 43 Safety Training Forms Page 43-44 Safety Award Program Page 45 Appendix A: Material Safety Data Sheet ( ACETOPHENONE ) MSDS Page 47 ( CALCIUM CARBONATE ) MSDS Page 48 Appendix B: State and Federal Posters (Job and Safety It’s the Law) Page 50 (In Case of Injury at Work) Page 51 (Fire Safety) Page 52 (Health and Safety at Work) Page 53 (Speak Up For Safety) Page 54 (Please Use Your Safety Gear) Page 55 Appendix C: OSHA Forms and Instructions OSHA Form Instructions Page 57 OSHA Form 300 Page 58 OSHA Form 300A Page 59 OSHA Form 301 Page 60 ADDITIONAL FORMS Page 61-73 Introduction SAFETY AND HEALTH POLICY FOR XYZ COMPANY XYZ COMPANY places a high value on the safety of its employees. XYZ COMPANY is committed to providing a safe workplace for all employees and has developed this program for injury prevention to involve management, supervisors, and employees in identifying and eliminating hazards that may develop during our work process. It is the basic safety policy of this company that no task is so important that an employee must violate a safety rule or take a risk of injury or illness in order to get the job done. The time during which employees are participating in training and education activities shall be considered as hours worked for purposes of wages, benefits, and other terms and conditions of employment. The training and education shall be provided at no cost to the employees. Members of the Safety/Health Committee will be allowed reasonable time to exercise the rights of the committee without any loss of pay or benefits. Employees are required to comply with all company safety rules and are encouraged to actively participate in identifying ways to make our company a safer place to work. Supervisors are responsible for the safety of their employees and as a part of their daily duties must check the workplace for unsafe conditions, watch employees for unsafe actions and take prompt action to eliminate any hazards. Management will do its pa.

1. Accident Prevention Plan
(Shatha Aldahban)
TECH 462 –Industrial Safety Engineering
March 16, 2015
Table of Contents
Introduction
Goal & Intentions
Page 5
Company Presidents Statement
Page 6
Management Responsibilities

2. Manager Responsibilities
Page 8
Supervisors Responsibilities
Page 8-9
Employee Orientation
How and When
Page 11
Emergency Action Plan
Page 12-24
Emergency Shutdown Procedures
Page 25
Injury and Illness Procedures
Procedures
Page 27
Record Keeping
Page 27
Supervisor Responsibilities
Page 28
Report Form
Page 29
Incident/Accident Investigation Procedures
Procedure Steps
Page
31

3. Worksheet Form
Page
32
Incident/accident Table
Page
33
Safety Guidelines
General Guidelines
Page
35-36
Equipment Specific
Page
37
Individual Specific
Page
38
Safety Disciplinary Policy
Safety Disciplinary Policy
Page
40
Safety Awareness Program
Safety Committee
Page
42
Safety Meetings
Page
43
Safety Training Forms

4. Page
43-44
Safety Award Program
Page 45
Appendix A: Material Safety Data Sheet
(
ACETOPHENONE
)
MSDS
Page 47
(
CALCIUM CARBONATE
) MSDS
Page 48
Appendix B: State and Federal Posters
(Job and Safety It’s the Law)
Page 50
(In Case of Injury at Work)
Page 51
(Fire Safety)
Page
52
(Health and Safety at Work)
Page

5. 53
(Speak Up For Safety)
Page
54
(Please Use Your Safety Gear)
Page
55
Appendix C: OSHA Forms and Instructions
OSHA Form Instructions
Page
57
OSHA Form 300
Page
58
OSHA Form 300A
Page
59
OSHA Form 301
Page 60
ADDITIONAL FORMS
Page 61-73

6. Introduction
SAFETY AND HEALTH POLICY FOR XYZ COMPANY
XYZ COMPANY
places a high value on the safety of its employees. XYZ
COMPANY is committed to providing a safe workplace for all
employees and has developed this program for injury prevention
to involve management, supervisors, and employees in
identifying and eliminating hazards that may develop during our
work process.
It is the basic safety policy of this company that no task is so
important that an employee must violate a safety rule or take a
risk of injury or illness in order to get the job done. The time
during which employees are participating in training and
education activities shall be considered as hours worked for
purposes of wages, benefits, and other terms and conditions of
employment.

7. The training and education shall be provided at no cost to the
employees.
Members of the Safety/Health Committee will be allowed
reasonable time to exercise the rights of the committee without
any loss of pay or benefits.
Employees are required to comply with all company safety rules
and are encouraged to actively participate in identifying ways to
make our company a safer place to work.
Supervisors are responsible for the safety of their employees
and as a part of their daily duties must check the workplace for
unsafe conditions, watch employees for unsafe actions and take
prompt action to eliminate any hazards.
Management will do its part by devoting the resources
necessary to form a safety committee composed of management
and elected employees.
We will develop a system for identifying and correcting
hazards.
We will plan for foreseeable emergencies. We will provide
initial and ongoing training for employees and supervisors.
And, we will establish a disciplinary policy to insure that
company safety policies are followed.
Letter From The President
The purpose of this policy is to create a high criterion of safety
all the way through operations of XYZ Company,
and to make certain that no employee is expected to work under
any conditions, which are risky or unhygienic.
We know that each employee has the right to obtain personal

8. satisfaction from their job and the prevention of occupational
injury and illness is of such significance to this belief that it
will be given top priority at all times.
It is our goal here at ZYX Company to begin and maintain
complete accident prevention and safety training programs.
Each distinct individual from upper management to the working
person is accountable for the safety and health of those persons
that are in charge and their coworkers around them, our
employee’s.
Signed,
The Company President
Management Responsibilities

9. Responsibilities for safety and health include the establishment
and maintenance of an effective communication system among
workers, supervisors and management officials.
To this end, all personnel are responsible to assure that their
messages are received and understood by the intended receiver.
Specific safety and health responsibilities for company
personnel are as follows:
A.
Management Officials
Active participation in and support of safety and health
programs is essential.
Management officials will display their interest in safety and
health matters at every opportunity.
At least one manager (as designated) will participate in the
safety and health committee meetings, incident investigations
and inspections.
Each manager will establish realistic goals for implementing
instructions for meeting the goals.
Goals and implementing instructions shall be within the
framework established by this document.

10. Incentives will be included as part of the instructions.
B.
Supervisors
The safety and health of the employees they supervise is a
primary responsibility of the supervisors.
To accomplish this obligation, supervisors will:
1.
Assure that all safety and health rules, regulations, policies and
procedures are understood and observed.
2.
Require the proper care and use of all required personal
protective equipment.
3.
Identify and eliminate job hazards quickly through job safety
analysis procedures.
(See the sample Job Safety Analysis form attached to this
document.)
4.
Inform and train employees on the hazardous chemicals and/or
procedures they MAY encounter under normal working
conditions or during an emergency situation.
(See the sample hazard communication program.)

11. 5.
Receive and take initial action on employee suggestions, awards
or disciplinary measures.
6.
Train employees (new and experienced) in the safe and efficient
methods of accomplishing each job or task as necessary.
7.
Review injury trends and establish prevention measures.
8.
Participate in incident investigations and inspections.
9.
Promote employee participation in the safety and health
program.
10.
Actively follow the progress of injured workers and display an
interest in their rapid recovery and return to work.

12. Employee Orientation
How and When
Safety is everyone's job at Small Business Notes. Small
Business Notes provides a clean, hazard free, healthy, safe
environment in which to work in accordance with the
Occupational Safety and Health Act of 1970. As an employee,
you are expected to take an active part in maintaining this
environment. You should observe all posted safety rules, adhere
to all safety instructions provided by your supervisor and use
safety equipment where required. Your workspace should be
kept neat, clean and orderly.

13. EMERGENCY ACTION PLAN for: XYZ COMPANY
Facility Name: ____________________
Facility Address: ___________________
DATE PREPARED: ___/_____/______
EMERGENCY PERSONNEL NAMES AND PHONE NUMBERS
DESIGNATED RESPONSIBLE OFFICIAL (Highest Ranking
Manager at
_____________site, such as __________, ___________, or
____________):
Name: Phone: (________________)
EMERGENCY COORDINATOR:
Name: Phone: (______________)
AREA/FLOOR MONITORS (If applicable):
Area/Floor: Name: Phone: (_______________)
Area/Floor: Name: Phone: (_______________)
ASSISTANTS TO PHYSICALLY CHALLENGED (If
applicable):
Name: Phone: (_______________)
Name: Phone: (________________)
Date ____/____/____

14. EVACUATION ROUTES
•
Evacuation route maps have been posted in each work area. The
following information is marked on evacuation maps:
1. Emergency exits
2. Primary and secondary evacuation routes
3. Locations of fire extinguishers
4. Fire alarm pull stations’ location
a. Assembly points
• Site personnel should know at least two evacuation routes.
EMERGENCY PHONE NUMBERS
FIRE DEPARTMENT: ________________
PARAMEDICS: _______________
AMBULANCE: _______________
POLICE: ________________
FEDERAL PROTECTIVE SERVICE: ________________
SECURITY (If applicable): _________________
BUILDING MANAGER (If applicable): ________________
UTILITY COMPANY EMERGENCY CONTACTS
(Specify name of the company, phone number and point of
contact)
ELECTRIC
: _____________________
WATER
: _______________________
GAS (if applicable):
__________________________
TELEPHONE COMPANY:
_______________________
Date: ___/____/_____
EMERGENCY REPORTING AND EVACUATION
PROCEDURES

15. Types of emergencies to be reported by site personnel are:
• MEDICAL
• FIRE
• SEVERE WEATHER
• BOMB THREAT
• CHEMICAL SPILL
• STRUCTURE CLIMBING/DESCENDING
• EXTENDED POWER LOSS
• OTHER (specify)___________________________________
MEDICAL EMERGENCY
• Call medical emergency phone number (check applicable):
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