Injury and Illness Prevention Program eTool

http://www.dir.ca.gov/DOSH/etools/09-031/how.htm[1/10/2013 1:04:03 PM]

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How to Create Your Written IIPP - QuestionsStep 1 - What Have You Already Been Doing for Safety?Step 2 - Review the Sample Model ProgramStep 3 - Answer the IIPP Questions

Step 1 - What Have You Already Been Doing for Safety?

To answer this question gather up information on your current safety rules, policies, and practices. Use this information to answer the IIPP questions below tocreate or improve your written IIPP.

Once you have gathered information on your current rules, policies, and practices you can develop an IIPP that is:

Specific to your workplace, and

Addresses all of the 8 required elements, and

Specifies how you will put your program into practice

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Step 2 - Review the Sample Model Program

To save time, a sample model program is provided as a reference when developing or improving your IIPP. The numbers in the sample model program correspondto the IIPP questions listed below. Before you start, review the sample model program and IIPP questions.

Step 3 - Answer the IIPP Questions

To develop your own written IIPP customized to your workplace, answer the IIPP questions below. Eachquestion you answer will automatically appear underlined in your written Injury and Illness Prevention Program.To produce a complete written IIPP which is specific to your workplace you must fully answer all the IIPPquestions. Your answers must be specific to your work place policies and procedures and the workactivities your employees actually perform. In addition to your answers to these questions, all of the otherIIPP requirements will also automatically be included in your written IIPP when it is printed.

For some of the IIPP question below, (examples) of answers are included. These examples are intended to helpby giving you an idea of what other employers have in their written IIPP programs. Depending on yourworkplace policies and procedures and the work activities your employees actually perform, theseexamples may or may not be appropriate for you to use when answering the IIPP questions.

Remember that an effective IIPP is not just a paper program. For your IIPP to be effective you must fully put it into practice in yourworkplace.

IIPP Questions

Please read before you begin: When navigating away from this page after you have started to fill out the questionnaire below,click the browser back button to get back to the form so your answers will NOT be cleared.

1. Responsibility

1.) The name, title and contact information for the person(s) that has overall responsibility for ensuring that our company has an effective IIPP is:

2.) The name of our company is:

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Injury and Illness Prevention Program eTool

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3.) Copies of our IIPP are available at the following locations:

2. Compliance

4.) We recognize our employees that consistently perform safe and healthful work practices by - Examples:

5.) Our disciplinary process is - Examples:

6.) Other means (e.g., peer mentoring) in addition to those listed in the Compliance section of our written IIPP that we use to ensure employee compliance with safeand healthful work practices include - Examples:

3. Communication

7.) We hold safety meetings on the following schedule - Examples:

8.) We arrange for our employees to anonymously notify management of safety and health concerns without fear of reprisal by - Examples:

9.) Other means (in addition to those listed in the Communication section of our written IIPP) we use to ensure communication with employees include - Examples:

10.) Our organization elects to use a labor/management safety and health committee meeting all the requirements of T8CCR 3203 (7)(c)(1) - (7) to comply with thecommunication requirements of subsection (a)(3) of T8CCR 3203 [enter yes or no].

11.)Our organization has less than ten employees and complies with the requirements of subsection (a)(3) of T8CCR 3203 by communicating and instructing

Injury and Illness Prevention Program eTool

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employees orally [enter yes or no].

4. Hazard Assessment

12.) The name of the person(s) conducting periodic inspections to identify and evaluate workplace hazards is(are):

13.) We conduct our periodic workplace inspections on the following schedule (e.g., daily, weekly, monthly, etc.) - Examples

To help you evaluate your workplace for hazards, use the Hazard Assessment Checklist under "Tools" of this eTool.

5. Accident/Exposure Investigation - Examples

14.) The name of the person(s) conducting investigations of our workplace injuries, illnesses and accidents, hazardous substance exposures and near-misses is(are):

To help you conduct investigations and take corrective actions for accidents, hazardous substance exposures and near-misses in your workplace use theInvestigation/Corrective Action Report under "Tools" of this eTool.

6. Hazard Correction - Examples

To help you correct hazards you have identified in your periodic inspections (see 4. Hazard Assessment ) refer back to your Hazard Assessment Checklist and usethe Identified Hazards and Correction Record under "Tools" of this eTool.

7. Training and Instruction

To help you train employees and supervisors use the List of Training Subjects and the Worker Training and Instruction Record under "Tools of this eTool. To helpyou provide effective training see the Effective Workplace Training etool.

8. Recordkeeping

Written IIPP and Documentation Requirements - PUT AN 'X' IN ONE OF THE FOLLOWING EXCEPTIONS IF APPLICABLE.

Our organization has ten or more employees and keeps records of scheduled and periodic inspections meeting the full record keeping requirements of T8CCR3203(7)(b)(1).

(15) Exception - Our organization has fewer than ten employees and chooses to keep inspection records only until the hazard is corrected?

YES?

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Our organization keeps documentation of safety and health training meeting the full requirements of T8CCR 3203 (7)(b)(2)

(16) EXCEPTION 1 - Our organization has fewer than ten employees and maintains a log of instructions provided to employees with respect to hazards unique totheir job assignments when first hired or they are assigned new duties?

YES?

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(17) EXCEPTION 2 - Our organization retains training records for the term of employment of employees who work for us for less than one (1) year. These recordsare provided to the employee(s) upon termination of their employment.

YES?

What's next

Injury and Illness Prevention Program eTool

http://www.dir.ca.gov/DOSH/etools/09-031/how.htm[1/10/2013 1:04:03 PM]

Copyright © 2013 State of California

After you have printed out your written program then:

1. Use the Sample forms and checklists provided to help you put into place your written program and document the various elements of your IIPP.

2. After you have put your program into place answer the Effectiveness Questions to help you determine if your program is effective and what else you need todo.

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