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2017
Business Services Department
Version 17.0 REV. 09/30/2017
IIPP- Injury Illness Prevention Program
TABLE OF CONTENTS
Introduction
Sections
I. Policy
II.
Responsibility
III. Compliance
IV. Hazard Assessment
V. Accident/Exposure Investigation
VI. Hazard Correction
VII. Trainin
g
VIII. Communication
IX. Recordkeeping
X. Heat Injury Illness Prevention Plan
APPENDIX A
APPENDIX B
APPENDIX C
APPENDIX D
APPENDIX E
Appendixes
California Code of Regulations Title 8, Chapter 4, Subchapter 7, Section 3203
Mt. San Jacinto Community College Board Policy Section 7600
Supervisors Statement of Occupational Injury and Illness and Incident Report
Reference information on Workers' Compensation forms and District contact information
Employee Training Record
1
INTRODUCTION
The Mt. San Jacinto Community College District (MSJC) has developed the Injury & Illness Prevention
Program (IIPP) for all employees to follow in order to maintain a safe and healthy work environment. This
document describes the goals and the responsibilities of all employees at all campus locations. The current
campus locations are:
San Jacinto C
ampus (District Headquarters) Temecula Education Complex
1499 No
rth State S
treet
27447 Enterprise Circle West
San Jacinto, CA 92583
Menifee Valley Campus
28237 La Piedra Road
Menifee, CA 92584
Temecula, CA 92590
Temecula Higher Education Center
43200 Business Park Drive
Temecula, CA 92590
San Gorgonio Pass Ca
mpus
3144 West Westward Avenue
Banning, CA 92220
The IIPP document is divided into the following sections: I. Policy, II. Responsibility, III. Compliance, VI. Hazard
Assessment, V. Accident/Exposure Investigation, VI. Hazard Correction, VII.Training, VIII. Communication, IX.
Recordkeeping, and X. Heat Injury Illness Prevention Plan. The goal of the IIPP is to eliminate or reduce
occupational injuries and illnesses and if an incident occurs, to learn from those in order improve workplace
safety in the future.
I. POLICY
This IIPP has been developed and implemented as required under the California Code of Regulations Title 8,
Chapter 4, Subchapter 7, Section 3203 (See Appendix A). MSJC adopted Board Policy 7600 in an effort and
commitment to follow these State mandates in order to provide a safe and healthful workplace for all of its
employees (See Appendix B). The IIPP provides general guidelines on equipment use, safe work practices and
safe working conditions. While the environment of each workplace may vary, these basic guidelines should
be followed as closely as possible by all employees. Section 3203 of Cal/OSHA regulations also pertains to
policies as well as compliance with workplace safety applicable to this Program (See Appendix A).
It is intended that this policy always be a work in progress. To that end, the IIPP will be reviewed annually
and even more often, when and where immediate changes are needed to ensure a safe working environment
and safe work practices.
2
II. RESPONSIBILITY
a. Vice President of Business Services
The ultimate responsibility for establishing and maintaining effective health and safety policies specific to District
facilities and operations rests with the Vice President of Business Services. Thereto, the general policies, which
govern the activities and responsibilities of the IIPP resides under the Vice President of Business Services.
b.
Administrators and Deans
It is the responsibility of Administrators and Deans to develop procedures which ensure effective
compliance with the IIPP as well as any other health and safety policies related to operations under their
control.
c.
Directors and Supervisors
Directors and Supervisors are responsible for enforcement of this Program among the employees under their
direction by setting acceptable safety policies and procedures for each employee to follow. In addition, each
Director and Supervisor must confirm that safety responsibilities are clearly outlined in the job descriptions
that govern the employees under their direction and that appropriate job specific safety training is available
and completed.
Supervising others also carries the responsibility for knowing
how to safely accomplish the tasks assigned each
employee, for budgeting and purchasing appropriate personal protective equipment (PPE), and for evaluating
employee c
ompliance with the IIPP. As such, Supervisors have an integral role with the success of IIPP.
The generic responsibilities for Supervisors with the IIPP also include:
1. Taking any reasonable action necessary to prevent injuries where an immediate danger exists.
2. Taking responsibility for the safety of all employees even those not under their supervision but in the
supervisor’s work area.
3. Ensuring a clean and hazard-free work area.
4. Providing a safety orientation to new employees under their direction.
5. Planning, conducting, and documenting safety evaluations in assigned areas of responsibility.
7.
Conducting safety observations.
d.
Employees
It is critical that employees follow the guidelines as outlined in this document, attend training, and to adhere to
job specific IIPP protocols.
The generic responsibilities for employees include:
1. Reading and abiding to all of the requirements of the IIPP.
3
6.
Provide, plan and track specific training for employees.
2. Adhering to all safety rules and operating procedures established by the District.
3. Attending to all health and safety trainings pertaining to the college and to specific job duties.
4.
Wearing appropriate personal protective equipment (PPE) as required and provided by the District.
5. Inspecting and maintai
ning equipment for proper and safe operation.
6.
On
ly operating equipment for which proper training and supervisor approval has been established.
7
. Reporting any safety hazards or defective equipment immediately to an area supervisor.
8. Immediately reporting all workplace injuries and/or illnesses.
e. District Safety Committee
The responsibility of the District Safety Committee is to provide a link of communication between employees
and management of the IIPP. In addition, the Safety Committee will monitor the effectiveness of the IIPP and
make recommendations to the appropriate parties on how to improve the document and the strategies
needed for its effective implementation.
The District Safety Committee should meet monthly and the agenda of the meeting will consist, in part, of
r
eviewing accidents and injuries, reporting hazardous conditions and reporting the findings of safety evaluations.
f. Business Services Depa
rtment
The Business Services Department provides leadership and oversight for developing and managing the IIPP
and will be responsible for ensuring the IIPP is accessible via the college website. The Business Services
department will review this document annually with information gathered and recommended by the District
Safety Committee.
III. COMPLIANCE
The District and all its employees are responsible for compliance with the IIPP and with Section 3203 of
Cal/OSHA regulations.
a.
District Compliance
MSJC is committed to providin
g all employees a safe and healthy work environment. The District is also
committed to providing all necessary PPE and safety training to emp
loyees at no cost. The District maintains
an open door policy allowing all employees to communicate safety concerns. Furthermore, the District is
committed to adhering to all Federal, State, an
d Local Health and Safety regulations and will provide full
cooperation with any applicable outside agency during the course of any inspection or audit.
b. Employee Compliance
MSJC believes that employee compliance should be encouraged at every opportunity. By taking a
proactive and positive attitute towards safety, everyone can help reduce workplace injury. To that end,
employee compliance with all rules and regulations is essential to maintaining a safe and healthy workplace.
Employees found to be out of compliance will be subject to retraining and may receive disciplinary action.
4
MSJC utilizes retraining for employees who do not follow District policies, rules and procedures. In the
event an employee violates any safety rule or requires any counseling as a result of unsafe work practices, the
District will follow the disciplinary procedures specified in the employee’s respective collective bargaining unit
agreement. Administrators, Deans, Directors and Supervisors may utilize the following: retraining, verbal
counseling, written warnings and other appropriate forms of disciplinary action depending on the severity of,
and risks associated with, any violation(s).
Administrators, Deans, Directors and Supervisors will also provide a variety of forms of positive reinforcement
or recognition to those employees who demonstrate safe work practices to further promote workplace safety.
IV. HAZARD ASSESSMENT
A health and safety inspection program is essential in order to establish, monitor and enhance safe workplace
environments. It is the responsibility of the Vice President of Business Services, working with the Director of
Risk Management and Support Services, to
ensure that appropriate college-wide safety inspections are
conducted periodically.
Scheduled Safety Inspections
Annual inspections will be performed on all campus areas. Semi-annual inspections will be performed of all
potentially hazardous areas such as shops, cafeterias, warehouses, gymnasiums, labs, and alike. Any workplace
hazards revealed will be documented, assessed, and corrected in a timely manner depending on the relative risk
to employees, students, or visitors. All inspections will be documented. With prior supervisor approval,
inspection reports may be modified or supplanted where needed for specialized workplace environments.
Inspections will occur district-wide and cover any and all workplace areas.
Unscheduled Safety Inspections
Additional safety inspections will be conducted whenever new equipment or changes in procedures are
introduced into the workplace that may present potential safety concerns. The Facilities Department will
conduct periodic unscheduled safety inspections of all potentially hazardous areas to assist in the maintenance
of a safe workplace.
V. ACCIDENT/EXPOSURE INVESTIGATION
Safety reviews will be conducted wh
en occupational accidents occur to identify and correct hazards that may
have contributed to the accident/exposure. Administrators, Deans, Directors and Supervisors will investigate
all accidents, injuries, occupational illnesses and near-miss incidents to identify the root cause of any incident.
Any corrective action, including appropriate repairs or procedural changes, will be implemented promptly to
correct the hazards associated in these incidents. A Supervisor’s Accident Investigation Report must be
completed for every accident/exposure that occurs on District property involving the injury or illness of a
District employee and/or student (See Appendix C).
Additionally, workers' compensation forms may need to be completed. Any questions about the workers'
compensation process or the forms for completion, please contact the Risk Management Coordinator (See
Appendix D for contact information and references).
5
VI. HAZARD CORRECTION
All hazards identified will be promptly investigated and alternate procedures implemented as indicated. The
District recognizes that hazards range from those of relatively low risk to imminent dangers. Likewise,
corrective actions or plans are implemented according to relative risk and include appropriate timetables for
completion. Hazard correction is the responsibility of the Administrator or Vice President of Business
Services working in conjunction with the Risk Management Coordinator.
VII. TRAINING
Effective dissemination of safety information lies at the very heart of a successful any IIPP. All employees must
be trained in general safe work practices. In addition, specific instruction with respect to hazards unique to
each employee’s job assignment will be provided. All new employees of MSJC are scheduled to attend a new
hire orientation. The trainings offered will be documented and placed in the employee’s personnel file. Safety
training will be conducted both in person and through other appropriate outside sources such as the Keenan
Safe Colleges program. Listed below is a snapshot of safety training offered to employees (additional training is
available):
Fire Safety, Evacuation and Emergency Procedures
Bloodborne Pathogens
Hazard Communication (SDS)
Injury & Illness Prevention Program (IIPP)
Other training may be requir
ed of certain employees may include:
Job specific safety training
Bloodborne pathogens
Injury Reporting
Mandated Reporting
Summoning for emergency help
Chemical Hygiene
Immediate response to emergencies
General Safe Work Practices
Job specific training at a minimum entails how to use workplace equipment, safe handling of hazardous
materials and use of PPE. Training must be completed before beginning to work on an assigned piece of
equipment and whenever new hazards or changes in procedures are implemented.
The Vice President of Business Services, or designee, is responsible for providing Administrators, Deans,
Directors and Supervisors with the training necessary to familiarize themselves with the safety and health
hazards their employees might find themselves exposed to. It is the responsibility of each Administrator, Dean,
Director and Supervisor to make themselves aware of this training opportunity to be familiar with the hazards
related to their employee’s job tasks.
D
irectors and Supervisors
w
ill
en
sure that employees are trained whenever new substances, processes,
procedures or equipment are introduced to the workplace which may create new hazards and when hazards
are brought to a supervisor’s attention.
All training will be documented and kept in employee files. The Employee Training Record Form is an
example of what may be used for this purpose (See Appendix E).
6
VIII. COMMUNICATION
Effective two-way communication, which involves employee input on matters of workplace safety, is essential
to maintaining an effective IIPP. To foster better communication, the following guidelines will be implemented:
1.
Administrators, Deans, Directors and Supervisors will provide time at periodic staff meetings to
discuss safety topics. Status reports will be given on safety inspections, hazard correction projects, and
accident/exposure investigation results, as well as feedback to previous employee suggestions.
Employees will be encouraged to participate and give suggestions.
2.
Additional communication methods to be used as a way to dispense important information will
be done through posters, meetings, manuals, newsletters, bulletins and warning labels.
3. Employees are encouraged to bring to the District’s attention any potential health or safety hazard
that may exist in the workplace. This can be done by simply alerting the Supervisor, the District
Maintenance and Operations Supervisor, the Director of Risk Management and Support Services, or the
Risk Management Coordinator. Supervisors will follow up all on these safety concerns and use effective
two-way c
ommunication with all interested parties to correct the potential hazard to workplace safety.
IX.
RECORDKEEPING
Many standards and regulations of Cal/OSHA contain requirements for the maintenance and retention of
records for occupational injuries and illnesses, medical surveillance, exposure monitoring, inspections, and other
activities relevant to occupational health and safety. To comply with these regulations, as well as to
demonstrate that the critical elements of the IIPP are being implemented, the District Office will keep on file
copies of all accident/exposure investigations and Safety Committee meeting agendas for a period of no less
than five years. Training documents are to be kept on file for at least one year (or sometimes longer).
The District
will ensure that these files are available to Cal/OSHA or other appropriate regulatory agency
representatives
upon request. A review of these records will be conducted by Risk Management personnel
during routine inspections to confirm compliance with the Program.
X. HEAT INJURY A
ND ILLNESS PREVENTION PLAN
a. Purpose
The purpose of Heat Illness Prevention Plan (HIPP) is to meet the requirements set forth in the California
Code of Regulations, Title 8, and also to serve as a supplement to the Mt. San Jacinto Community College
District’s Injury and Illness Prevention Plan (IIPP). This information is intended, and must be used in
conjunction with the IIPP. The intent of this plan is to establish procedures and provide information
necessary to ensure that employees of the District are knowledgeable in the prevention, recognition, and
first aid treatment of heat related injury.
Heat related illnesses are avoidable if the employees are trained and the right actions are taken before, during
and after working in
high temperature workplace environments. Elevated temperatures, especially combined
with high humidity, can tax the body’s ability to cool itself making heat illness a great concern while working in
7
Southern California. Heat related injury occurs in three progressively severe forms known as heat cramps, heat
exhaustion, and heat stroke.
b.
Heat Cramps
Heat cramps are the most common type of heat related injury. Heat cramps are muscle spasms, which usually
affect the arms, legs or stomach. Heat cramps are caused when water and/or salts are not replaced quickly
enough to offset that which is lost through sweating. To avoid heat cramps, drink electrolyte solutions such as
sports drinks or plenty of water during the day in combination to with foods containing salts. Just drinking
copious amounts of water without electrolytes can also cause cramps and trick someone into even drinking
more water and thus exasperate cramping. Avoid caffeine, as this may make the condition worse.
c.
Heat Exhaustion
Heat exhaustion is more serious than heat cramps. Severe cramping, red skin color, and profuse sweating
characterize heat exhaustion. Additional symptoms may include headache, intense thirst, dizziness, fatigue, loss
of coordination, nausea, vomiting, impaired judgment, loss of appetite, hyperventilation, anxiety and a rapid
heart rate. The First Aid for an employee suffering these symptoms is to move to a cooler location such as a
shaded area or an air-conditioned building. Have the victim lie down, loosen their clothing, apply cool wet
towels and/or fan the person. Have the victim drink water or electrolyte drinks. In the event that some needs
medical attention due to heat illness, Call 911 (or dial 8-911 from a District phone) and contact Campus Safety at
x5188.
d. Heat Stroke
Heat stroke is a very serious medical emergency which may lead to death if not treated immediately. It occurs
w
hen the victim has lost the ability to sweat sufficiently and the core body temperature rises enough to cause
organ damage. The organ at greatest risk is the brain. A heat stroke victim may first suffer heat cramps and/or
heat exhaustion before progressing into heat stroke. It is very important to note that some victims go directly
into heat stroke without first having heat cramps or heat exhaustion. In addition, heat stroke is sometimes
mistaken for a heart attack. It is therefore very important to be able to recognize the potential causes and
symptoms of heat stroke anytime an employee collapses while working in a hot/humid environment.
Symptoms of heat stroke include a high body temperature (103 degrees Fahrenheit); a distinct lack or absence
of sweating; flushed skin; rapid pulse that in later stages and more severe cases becomes slower; difficulty
breathing; and any or all of the signs or symptoms of heat exhaustion such as dizziness, headache, nausea,
vomiting, or confusion. In more severe cases victims may become altered mentally and have a seizure, collapse,
and fall into a prolonged coma. Immediately Call 911 (or dial 8-911 from a District phone) to get the victim
medical attention as soon as possible. First Aid is also vital and focused towards lowering victim’s body
temperature. To lower the body temperature, get the victim out of the heat and into a cooler environment,
pour cool water on the person, fan them, and/or apply cold packs to the neck or armpits. Quick actions can
mean the difference between life and death in heat stroke.
e.
High Heat Protocols
When the temperature equals or exceeds 95
degrees Fahrenheit
,
the
District
will implement
High Heat
protocols that include a pre-shift meeting to review high heat procedures. The Heat Injury Illness
8
Prevention Plan is to be applied both outdoors and indoors. Employees must notify their supervisor
immediat
ely with any heat concerns, even if it is after
normal business hours. Supervision should not exceed
more than 20
employees during high heat weather conditions. Employees during these times use a mandatory
buddy system and/or maintain regular communication with sole employees via radio or phone. The supervisor
will designate one or more employees on each worksite as authorized to call for emergency medical services
but emphasize that all employees they are able to call for emergency service if needed without prior approval.
The supervisor will also remind all employees throughout the work shift to drink
plenty of water and stay
hydrated.
f.
Emergency Response Protocols
The District will train supervisors and employees to recognize the signs and symptoms of heat related illness
and how to take steps immediately to prevent the progression of heat illness. The training will include basic
First Aid. It is also important to train employees that heat illness victims should not be left alone nor sent
home without first aid and/or emergency medical services in accordance within the District’s guidelines
because severe heat related injury may mean that the victim is not able to make rational medical decisions
that are in their best interests.
g.
Precautions to Prevent Heat Illness
The District provides access to shade to allow the employee to cool down. Shade may be provided by any
natural or artificial means that does not expose employees to unsafe or unhealthy conditions and also does not
deter or discourage its access or use. The District maintains areas of shades throughout all sites where
employees are working and shade is made available during meal periods as well. Employees shall be allowed
and encouraged to take a preventative cool down rest in the shade when they feel the need to do so to
protect themselves from overheating. An individual employee who takes a preventative cool down rest shall
be monitored and asked if he or she is experiencing symptoms of heat illness. Employees are to be encouraged
to remain in the shade and shall not be ordered back to work until any signs of symptoms of heat illness have
abated for a period of time not less than 5 minutes in the shade. The District shall provide appropriate First Aid
or emergency medical care when employee exhibits signs or symptoms of heat illness.
HYDRATION
Hydration as a continuous process and should not be delayed until thirst sets in. Thirst typically means that a
person is already dehydrated. It is important to take breaks often during high temperature days and physical
exertion and to drink often during those breaks. Electrolyte drinks are good for replacing both water and salts
lost through sweating. Employees should avoid caffeinated beverages such as coffee, soda or energy drinks as
these liquids can have the opposite effect and can actually increase the level of dehydration.
Employees shall have access to potable drinking water, including but not limited to the requirements that it be
fresh, pure, suitably cool, and free of charge. The water shall be located as close as practicable to the areas
where employees are working. Employees will be allowed to take frequent breaks especially if any early
warning signs start to show up such as a headache or thirst.
ACCLIMATIZATION
Acclimatization is a process by which the body adjusts to increased heat exposure. The body needs time to
adapt when working in hotter environments and this may take hours to several days depending on the
employee and the particular day. Employees should condition themselves for working in hot environments by
9
starting slowly and then building up to higher temperature days and more physically demanding work. Of course,
when possible, employees should attempt the
physically demanding part of a particular job during the cooler parts
of the day. Preferably, in the morning to avoid the fatigue that follows the cooler late afternoon times.
During acclimatization, a supervisor (or designee) should closely observe all employees during a heat wave. For
purposes of this section only, a “heat wave” means any day in which the predicted high temperature for the day
will be at least 80 degrees Fahrenheit and at least ten
degrees Fahrenheit higher than the average high daily
temperature in the preceding five days. New employees will also be closely observed for the first 14 days of
employment to ensure they are adjusting to the high heat area. Particular viligence needs to take into account
the person's size, weight, physical condition and number of hours or days working in high heat environments.
Fluid and electrolyte imbalances and heat injury risk can be progressive in nature.
TRAINING
The training should be provided when an employee is initially hired. Heat-related illness training must also be
provided before the beginning of work with refresher training as needed during the times of expected elevated
temperatures/humidity. The training will be offered in the language so employees can understand and fully
comprehended the dangers and care of heat related injury. All training records will be kept on file in
accordance and as specified in the California Code of Regulations, Title 8, Section 3203 (Injury Illness
Prevention Program).
In conclusion, a safe and healthy workplace must be the goal of everyone at Mt. San Jacinto College and
likewise the responsibility is for everyone regardless of position or status. If you have any questions regarding
the Injury & Illness Prevention Program (IIPP), please contact the Director of Risk Management and Support
Services or the Risk Management Coordinator.
10
Determine the cause of the accident/exposure
Understanding the root cause of an accident/exposure will allow management to prevent similar accidents from
recurring. Determining the root cause may be a difficult or arduous task. A diligent, honest and impersonal
investigation will allow management to understand the root cause.
Take corrective action to prevent the accident/exposure from recurring
C
omplete the Accident
Investigation
R
eport
11
It is the responsibility of the immediate supervisor to investigate all injuries or near misses and report on the
District’s Accident Investigation form. Supervisors will retain a copy and supply a copy to the Risk Management
Department.
Procedures for investigating employee injuries include:
Visit the accident/exposure scene as soon as possible
This will allow the supervisor to evaluate and report the scene of the accident/exposure before any alterations to
the scene can be made. I
t also allows the supervisor to be visible and available to employees in the area.
Interview injured workers and witnesses
Several points of view may be helpful in determining the actual cause of an accident/exposure. Always include
statements in the accident investigation report.
Examine the workplace for factors associated with the accident/exposure
ACCIDENT/EXPOSURE INVESTIGATION
It is essential to inspect the scene of the accident/exposure to determine if any hazards are present that may
cause future accidents.
Documenting the findings and corrective actions taken by completing the Supervisor's Accident Investigation
form. Attach all necessary information to the accident investigation report.
This information is provided free of charge by the Department of Industrial Relations from its web site at
www.dir.ca.gov. These regulations are for the convenience of the user and no representation or
warranty is made that the information is current or accurate. See full disclaimer at
http://www.dir.ca.gov/od_pub/disclaimer.html.
Subchapter 7. General Industry Safety Orders
Group 1. General Physical Conditions and Structures Orders
Introduction
Return to index
New query
§3203. Injury and Illness Prevention Program. ETOOL
Cal/OSHA Workplace Injury and Illness Prevention Program, with checklists for self-inspection || (
printable version)
Prevention Model Program for High Hazard Employers || ( printable version)
Prevention Model Program for Non-High Hazard Employers || ( printable version)
Prevention Model Program for Employers with Intermittent Workers || ( printable version)
Prevention Model Program for Employers with Intermittent Workers in Agriculture || (
printable version)
Prevention Model Program for Workplace Security || ( printable version)
(a) Effective July 1, 1991, every employer shall establish, implement and maintain an effective Injury
and Illness Prevention Program (Program). The Program shall be in writing and, shall, at a minimum:
(1) Identify the person or persons with authority and responsibility for implementing the
Program.
(2) Include a system for ensuring that employees comply with safe and healthy work practices.
Substantial compliance with this provision includes recognition of employees who follow safe
and healthful work practices, training and retraining programs, disciplinary actions, or any other
such means that ensures employee compliance with safe and healthful work practices.
(3) Include a system for communicating with employees in a form readily understandable by all
affected employees on matters relating to occupational safety and health, including provisions
designed to encourage employees to inform the employer of hazards at the worksite without fear
of reprisal. Substantial compliance with this provision includes meetings, training programs,
posting, written communications, a system of anonymous notification by employees about
hazards, labor/management safety and health committees, or any other means that ensures
communication with employees.
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APPENDIX A
Exception: Employers having fewer than 10 employees shall be permitted to communicate to and
instruct employees orally in general safe work practices with specific instructions with respect to
hazards unique to the employees' job assignments as compliance with subsection (a)(3).
(4) Include procedures for identifying and evaluating work place hazards including scheduled
periodic inspections to identify unsafe conditions and work practices. Inspections shall be made
to identify and evaluate hazards:
(A) When the Program is first established;
Exception: Those employers having in place on July 1, 1991, a written Injury and Illness Prevention
Program complying with previously existing section 3203.
(B) Whenever new substances, processes, procedures, or equipment are introduced to the
workplace that represent a new occupational safety and health hazard; and
(C) Whenever the employer is made aware of a new or previously unrecognized hazard.
(5) Include a procedure to investigate occupational injury or occupational illness.
(6) Include methods and/or procedures for correcting unsafe or unhealthy conditions, work
practices and work procedures in a timely manner based on the severity of the hazard:
(A) When observed or discovered; and,
(B) When an imminent hazard exists which cannot be immediately abated without endangering
employee(s) and/or property, remove all exposed personnel from the area except those necessary
to correct the existing condition. Employees necessary to correct the hazardous condition shall be
provided the necessary safeguards.
(7) Provide training and instruction:
(A) When the program is first established;
Exception: Employers having in place on July 1, 1991, a written Injury and Illness Prevention
Program complying with the previously existing Accident Prevention Program in Section 3203.
(B) To all new employees;
(C) To all employees given new job assignments for which training has not previously been
received;
(D) Whenever new substances, processes, procedures or equipment are introduced to the
workplace and represent a new hazard;
(E) Whenever the employer is made aware of a new or previously unrecognized hazard; and,
(F) For supervisors to familiarize themselves with the safety and health hazards to which
employees under their immediate direction and control may be exposed.
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(b) Records of the steps taken to implement and maintain the Program shall include:
(1) Records of scheduled and periodic inspections required by subsection (a)(4) to identify
unsafe conditions and work practices, including person(s) conducting the inspection, the unsafe
conditions and work practices that have been identified and action taken to correct the identified
unsafe conditions and work practices. These records shall be maintained for at least one (1) year;
and
Exception: Employers with fewer than 10 employees may elect to maintain the inspection records
only until the hazard is corrected.
(2) Documentation of safety and health training required by subsection (a)(7) for each employee,
including employee name or other identifier, training dates, type(s) of training, and training
providers. This documentation shall be maintained for at least one (1) year.
EXCEPTION NO. 1:Employers with fewer than 10 employees can substantially comply with the
documentation provision by maintaining a log of instructions provided to the employee with respect
to the hazards unique to the employees' job assignment when first hired or assigned new duties.
EXCEPTION NO. 2: Training records of employees who have worked for less than one (1) year for
the employer need not be retained beyond the term of employment if they are provided to the
employee upon termination of employment.
EXCEPTION NO. 3: For Employers with fewer than 20 employees who are in industries that are not
on a designated list of high-hazard industries established by the Department of Industrial Relations
(Department) and who have a Workers' Compensation Experience Modification Rate of 1.1 or less,
and for any employers with fewer than 20 employees who are in industries on a designated list of low-
hazard industries established by the Department, written documentation of the Program may be
limited to the following requirements:
A. Written documentation of the identity of the person or persons with authority and responsibility for
implementing the program as required by subsection (a)(1).
B. Written documentation of scheduled periodic inspections to identify unsafe conditions
and work practices as required by subsection (a)(4).
C. Written documentation of training and instruction as required by subsection (a)(7).
ExceptionNo. 4: Local governmental entities (any county, city, city and county, or district, or any
public or quasi-public corporation or public agency therein, including any public entity, other than a
state agency, that is a member of, or created by, a joint powers agreement) are not required to keep
records concerning the steps taken to implement and maintain the Program.
Note1: Employers determined by the Division to have historically utilized seasonal or intermittent
employees shall be deemed in compliance with respect to the requirements for a written Program if
the employer adopts the Model Program prepared by the Division and complies with the requirements
set forth therein.
Note2: Employers in the construction industry who are required to be licensed under Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code may use records
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relating to employee training provided to the employer in connection with an occupational safety and
health training program approved by the Division, and shall only be required to keep records of those
steps taken to implement and maintain the program with respect to hazards specific to the employee's
job duties.
(c) Employers who elect to use a labor/management safety and health committee to comply with the
communication requirements of subsection (a)(3) of this section shall be presumed to be in substantial
compliance with subsection (a)(3) if the committee:
(1) Meets regularly, but not less than quarterly;
(2) Prepares and makes available to the affected employees, written records of the safety and
health issues discussed at the committee meetings and, maintained for review by the Division
upon request. The committee meeting records shall be maintained for at least one (1) year;
(3) Reviews results of the periodic, scheduled worksite inspections;
(4) Reviews investigations of occupational accidents and causes of incidents resulting in
occupational injury, occupational illness, or exposure to hazardous substances and, where
appropriate, submits suggestions to management for the prevention of future incidents;
(5) Reviews investigations of alleged hazardous conditions brought to the attention of any
committee member. When determined necessary by the committee, the committee may conduct
its own inspection and investigation to assist in remedial solutions;
(6) Submits recommendations to assist in the evaluation of employee safety suggestions; and
(7) Upon request from the Division, verifies abatement action taken by the employer to abate
citations issued by the Division.
Note: Authority cited: Sections 142.3 and 6401.7, Labor Code. Reference: Sections 142.3 and 6401.7,
Labor Code.
HISTORY
1. New section filed 4-1-77; effective thirtieth day thereafter (Register 77, No. 14). For former
history, see Register 74, No. 43.
2. Editorial correction of subsection (a)(1) (Register 77, No. 41).
3. Amendment of subsection (a)(2) filed 4-12-83; effective thirtieth day thereafter (Register 83, No.
16).
4. Amendment filed 1-16-91; operative 2-15-91 (Register 91, No. 8).
5. Editorial correction of subsections (a), (a)(2), (a)(4)(A) and (a)(7) (Register 91, No. 31).
6. Change without regulatory effect amending subsection (a)(7)(F) filed 10-2-92; operative 11-2-92
(Register 92, No. 40).
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7. Amendment of subsection (b)(2), ExceptionNo. 1, new ExceptionNo. 3 through ExceptionNo. 4,
Note2, and amendment of subsection (c)(2) filed 9-13-94; operative 9-13-94 pursuant to Government
Code section 11346.2 (Register 94, No. 37).
8. Editorial correction of subsections (a)(6)(A) and (a)(7)(A) (Register 95, No. 22).
9. Amendment of subsections (b)(1)-(2) and (c)(2) filed 6-1-95; operative 7-3-95 (Register 95, No.
22).
10. Editorial correction of subsection (a)(4) (Register 2002, No. 46).
Go Back to General Industry Safety Orders, Introduction
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Book Board Policies
Section Chapter 7 - Human Resources
Title Safety
Number BP 7600
Status Active
Cross
References
Administrative Procedure 7600
Adopted April 10, 2003
Last Revised September 13, 2007
Last Reviewed July 10, 2017
The Chief Human Resources Officer shall establish administrative procedures to ensure the
safety of employees and students on District sites, including the following:
(A) Compliance with the United States Department of Transportation regulations
implementing the Federal Omnibus Transportation Employee Testing Act of 1991.
Specifically, the District shall comply with the regulations of the Federal Highway
Administration (FHWA) and, if applicable, the Federal Transit Administration (FTA).
Compliance with these policies and procedures may be a condition of employment.
(B) Establishment of an Injury and Illness Prevention Program in compliance with
applicable OSHA regulations and state law. These procedures shall promote an active
and aggressive program to reduce and/or control safety and health risks.
(C) Establishment of a Hazardous Material Communications Program which shall include
review of all chemicals or materials received by the District for hazardous properties,
instruction for employees and students on the safe handling of such materials, and
proper disposal methods for hazardous materials.
(D) Prohibition of the use of tobacco in all public buildings.
$33(1',;%
MT. SAN JACINTO COMMUNITY COLLEGE DISTRICT
1499 North State Street
San Jacinto, CA 92583
(951) 487-3000
(951) 654-6236 Fax
MSJC - WC SUPERVISOR STATEMENT 07/13/2017
SUPERVISOR STATEMENT OF OCCUPATIONAL INJURY OR ILLNESS
Department/School Site: ________________________________________________________________
Name of injured employee: ______________________________________________________________
Occupation: __________________________________________________________________________
Date of injury or illness: ____ ______________ Time: _ AM PM_____
Was medical treatment offered? Yes _ No _ Was treatment refused? Yes No_X__
Was employee given a claim form? Yes ___ No _______
What type of medical treatment was given?
First aid _ Paramedics Emergency room ___
Hospitalization Clinic _ Authorized ____
Was employee required to leave work due to this injury or illness? Yes ____ No ___________
Date
Has employee returned to work? Yes _ returned: _______ No, still off work ______
Date last worked _____________________________________
Name of person to whom the injury or illness was reported: _________________________________
Timeliness of reporting: If the accident was not reported immediately, why not?
_____________________________________________________________________________________
Location where accident or exposure occurred: ______________________________________________
Was the injury or exposure witnessed? Yes __ ___ No ________
WITNESS INFORMATION
Name: ___________ Name: __________________________________
Address: _____________________________________ Address: ________________________________
City/State/Zip: __________________________City/State/Zip:_ ___________________________
Telephone: ___________ Telephone: ______________________________
APPENDIX C
MT. SAN JACINTO COMMUNITY COLLEGE DISTRICT
1499 North State Street
San Jacinto, CA 92583
(951) 487-3000
(951) 654-6236 Fax
MSJC - WC SUPERVISOR STATEMENT 07/13/2017
Body part injured (check all that apply and indicate left and/or right):
Head _ Upper back Finger (which?) Ankle
Face __ Lower back Upper leg Foot
Eye Arm Lower leg Toe (which?)
Neck Wrist Knee Other_____________________
Nature of injury or illness:
Scrape Burn Fracture Cold-related problem
Cut _ Sprain/strain Skin problem Loss of consciousness
Puncture Foreign body Chemical-related problem Respiratory
Bruise Poisoning Heat-related problem Other _____________
What was employee doing at the time of injury or exposure?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Person, object or substance that directly injured employee: ____________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Check any of the following unsafe actions which apply:
Haste/unsafe speed Improper procedure Unsafe lifting
Not authorized Unsafe equipment usage Unsafe position
Disregard of instructions Defective equipment/tools Running/jumping
Lack of knowledge/skill/training Inattention Poor Housekeeping
Failure to use proper equipment Assault Act of other
Inadequate protective gear Horseplay Physical handicap
Carelessness Alcohol/drugs Other
__
__
I know the injury occurred on duty.
I have no specific knowledge that the injury occurred on duty.
What steps have been taken or recommended to prevent a recurrence?
_____________________________________________________________________________________
_____________________________________________________________________________________
Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
Supervisor's signature: ___________ _____________________________________ Date: _________
This document revised on 6/29/17 - NP
Report of Incident
Male
Student
Employee
So the District can respond effectively, please report all incidents immediately
to the person to whom you report. If you are unsure who to contact, the
Office of Instruction at any location or Risk Management are able to assist.
REQUIRED INFORMATION
Female
Other
Visitor
1.
Contact Name ____________________________________________________________________
2.
Address
Number Street City
Zip Code
3.
Cell Phone
4. Home Phone
5.
Student ID (if available)
6.
Email Address _________________________________
7.
Insurance Coverage
a.
Name of Insurance Company
b.
Insurance Address
c.
Policy Number
Group Policy
8.
Accident Time and Date
Month Day Year
Time
9.
Description of Accident, Damage or Injury:
Individual Policy
10.
Location where Accident Happened
d.
If Off-Campus, what Facility?
11.
Action taken by District Representative:
/
AM
PM
RISK MANAGEMENT
APPENDIX C
This document revised on 6/29/17 - NP
Email/Phone
Report completed by:
Date
SUPPLEMENTARY
INFORMATION IF KNOWN:
13.
Additional Contact:
14.
Action taken:
15.
Campus Safety/Sheriff/Risk Management notified by:
Action taken by emergency personnel or staff:
16.
Did individual receive medical treatment?
Yes
No
Description
17.
Was individual admitted to the hospital?
Yes
No
Name of Hospital
18.
How was Injured Party transported to Doctor, Hospital or Home:
Submit this form to Risk Management or any location's Office of Instruction:
Please email this form directly to riskmanagement@msjc.edu or mail to:
MSJC, Attn: Risk Management, 1499 N. State Street, San Jacinto, CA 92583.
Incident Report - Page 2
Name
Name Title
Date
Email/Phone
Name
12. Witnesses, if any:
Risk Management (District)
San Jacinto (SJC)
Menifee Valley (MVC)
Temecula Education Center (TEC)
San Gorgonio Pass (SGPC)
(951) 487-3135 or (951) 639-5131
(951) 487-3400
(951) 639-5400
(951) 506-6752
(951) 922-1327
If you have any questions regarding the approved clinics listed, please contact Nicole Piña, Risk Management
Coordinator via phone at Menifee (951) 639-5131 or San Jacinto (951) 487-3135 or via email at npina@msjc.edu.
WORKER’S COMPENSATION AT MSJC
Step 1: Report WC injury immediately to your supervisor and then call Company Nurse:
1-877-518-6702
Immediately following phone call to Company Nurse, Risk Management will be
alerted to the injury and a Treatment Authorization form will be sent to the clinic
to authorize and expedite your care.
Step 2: After your medical office visit, please submit all paperwork to your direct
supervisor and the Risk Management department.
Step 3: Your supervisor will provide you with workers’ compensation (WC) forms. To
process your claim, please complete the forms and return to your supervisor.
Once Risk Management receives the workers’ compensation forms, they will
process through the insurance provider, Keenan & Associates, which will assist
with the coordination of treatment during your workers’ compensation injury.
Important Tips:
• If you have questions about work restrictions, please ask the physician for clarification.
• Attend all scheduled follow up appointments.
• WC injury appointments include but are not limited to: initial injury, follow-up or physical
therapy and should always be communicated to your immediate supervisor. Time
away from work for WC related appointments will be reported on an absence request
form and included on your timesheet as workers’ compensation leave.
WORKER’S COMPENSATION CONTACTS
Name Phone Ext. Email Mailing Address
Nicole Piña
951-487-3135
951-639-5131
npina@msjc.edu 1499 N. State Street
San Jacinto, CA 92583
Kara McGee 951-487-3131
951-689-5131
kmcgee@msjc.edu 1499 N. State Street
San Jacinto, CA 92583
Jennifer Fahringer 951-715-0190 X1187 jfahringer@keenan.com P.O. Box 79991, Riverside, CA 92513
Amanda Castaneda 951-715-0190 X1108 acastaneda@keenan.com P.O. Box 79991, Riverside, CA 92513
APPENDIX D
EMPLOYEE TRAINING RECORD
EMPLOYEE NAME TRAINING DATES TYPE OF TRAINING TRAINERS
APPENDIX E
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