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INJURY & ILLNESS

PREVENTION PROGRAM

Cal/OSHA Title 8, Section 3203 & 1509 General Industry Safety Order

REVISIONS: 11-30-2011 06-29-201112-01-2011

02-13-2013

01-2015

WEST BAY SANITARY DISTRICT

California Code of Regulations Title 8 Section 3203

TABLE OF CONTENTS

Section TOPIC 1.0 INTRODUCTION AND PURPOSE 2.0 EVALUATING HAZARDS 3.0 RESPONSIBILITIES: District Manager WBSD Safety Committee Supervisors All Employees 4.0 IDENTIFYING WORKPLACE HAZARDS 4.1 Correcting Workplace hazards 5.0 COMMUNICATING WORKPLACE HAZARDS Material Safety Data Sheets (MSDS) Equipment Operating Manuals 6.0 INVESTIGATING INJURIES AND ILLNESSES: Non-Emergency Medical Treatment After Hour Medical Attention Supervisors Responsibility Employees Responsibility Employees Requiring Medical Attention Injury Investigation 7.0 RECORD KEEPING 8.0 EMPLOYEE HEALTH AND SAFETY TRAINING Initial IIPP Training Training on Specific Hazards Safety Videos 9.0 ENSURING COMPLIANCE 10.0 DISCIPLINARY PROCEDURES APPENDICES A-Job Safety Analysis Form B- Unsafe hazard, condition, near miss Report Form C- Hazard Correction Form D- Safety Committee Agenda/Minutes Form E- Safety Tailgate Agenda Form F- Safety Inspection Form G- Safety Meeting Sign In Sheet H- Employee Accident, Injury, Incident Report I- Supervisors Accident Report J- Training Log K- US HealthWorks Medical Facility Map L- Sequoia Hospital Map M- Pre-employment/Class-A Medical Facility Map N- WBSD Safety Inspection Form O- Last -3 years Safety Meeting-Tailgate & Incident Topics P- Current Year Training Calendar Q- New Employee Equipment Training Log

Revision history log

Date Section By Correction Made Original IIPP Prior to 2000, not tracked

6-29-11 Thru out Doc JRS 12-1-2011 “ JRS Based on Gap Analysis of August 2011 and

recent accident of November 10, 2011 09-25-2012 8.0 JRS Temporary Worker Initial Training Criteria

Appendix-J JRS Revised Training List, added SSMP & OERP 3.0 JRS Periodic Inspections/Observations schedule,

added to training calendar & performed on a quarterly basis

02-13-2013 Appendix-P JRS Training Schedule for 2013 Appendix-G JRS Name Changes

7-1-2013 3.0 JRS Safety Committee meets every other month or more often as needed.

8-11-2015 Appendix Q JRS Added unit 208 Operations

WEST BAY SANITARY DISTRICT INJURY & ILLNESS

PREVENTION PROGRAM

1.0 INTRODUCTION AND PURPOSE It is the policy of the West Bay Sanitary District (WBSD OR DISTRICT) to maintain a safe and healthful work environment for each employee (including, contract employees), and to comply with all occupational health and safety regulations. The WBSD Injury and Illness Prevention Program (IIPP) is intended to establish a framework for identifying and correcting workplace hazards within the District, while addressing legal requirements for a formal, written IIPP.

2.0 EVALUATING HAZARDS Before a task or job is to be started, an evaluation of the hazards associated with it needs to be completed. For example, a supervisor cannot task an employee to enter or even open a manhole cover without ensuring that the employee has been properly trained on the potential hazards of this task.

The employer, supervisors, managers, etc. must be aware of all hazards related to operating equipment or tasks being performed by their employees.

A tool that can be used in identifying and evaluating work place hazards is the Job Safety Analysis Form (Appendix-A).

When hazards need to be identified & evaluated:

i. When Safety Orders of the California Code of Regulations that govern the operation or activity (e.g. General Industrial Safety Orders, Construction Safety Orders, etc.) are revised.

ii. During the accident investigation process.

iii. When revealed during a routine inspection.

iv. Whenever new substances, processes, procedures, or equipment are introduced to the work place that represents a new safety hazard.

v. Whenever WBSD is made aware of a new or previously unrecognized hazard.

vi. When employee safety suggestions are made regarding a hazard.

This IIPP is not intended to cover all safety procedures at WBSD. WBSD has developed specific programs that may be found at each applicable department. These programs include, but are not limited to:

• Emergency Action Plan • Emergency Operations • Excavation and Trenching • Exposure Control Plan (Bloodborne Pathogens)

• Concrete Dust Generating Operations • Confined Spaces • Fall Protection • Hazard Communication Program • Hearing Conservation • Heat Illness Prevention • Hot work • Lockout/Tagout (Hazardous Energy Control) • Respiratory Protection

3.0 RESPONSIBILITIES The District Manager has primary authority and responsibility to ensure District implementation of the IIPP and to ensure the health and safety of the District’s staff. This is accomplished by communicating the District emphasis on health and safety, analyzing work procedures for hazard identification and correction, ensuring regular workplace inspections, providing health and safety training and encouraging prompt employee reporting of health and safety concerns without fear of reprisal.

SAFETY COORDINATOR The Safety Coordinator has the lead role in advising and assisting supervisors and managers in executing their safety-related responsibilities.

The Safety Coordinator for WBSD is:

John Simonetti, Sr., Regulatory Compliance Coordinator

Alternate Coordinator: Sergio Ramirez, Maintenance Superintendent

The Safety Coordinator’s responsibilities include:

i. Serve as Safety Committee Chair-Person

ii. Assuming the lead role and the general authority to supervise all aspects of the IIPP and other safety related matters.

iii. Utilizing all available resources to ensure hazards are reasonably resolved in a timely manner.

iv. Working with management to ensure that safety is compliant in all departments by periodic inspections, training or site visits.

v. Working and coordinating with any contracted safety consulting company to ensure safety compliance.

vi. Working with Managers and Supervisors to ensure that safety training is being properly scheduled.

vii. Ensuring that employees who fail to follow safe procedures outlined by WBSD are being disciplined.

viii. Working with management and the safety committee to make final decisions in responding to employee safety suggestions.

ix. Working with Managers and Supervisors to ensure that Cal/OSHA has been notified within 8 hours of any serious injury or death.

x. Ensure that any Cal/OSHA citation is being abated by working with management and Cal/OSHA.

xi. Coordinate and schedule safety training.

xii. Ensure that all affected employees are notified of upcoming safety classes.

xiii. Document and maintain training records for each employee.

xiv. Maintain all Cal/OSHA related documentation.

WBSD SAFETY COMMITTEE

The WBSD Safety Committee has the on-going responsibility to maintain and update this IIPP, to assess District Compliance with applicable regulations and to evaluate reports of unsafe conditions, hazards, near misses, accidents and to coordinate any necessary corrective actions. The Safety Committee meets the fourth Wednesday of every other month (or more often as needed) and includes representatives from Administration, the Maintenance Department and the Regulatory Compliance Coordinator. Each employee has a designated representative on the committee. Currently, the District’s Safety Committee consists of:

♦ John Simonetti, Regulatory Compliance Coordinator (RCC, Committee Chair-Person)

♦ Sergio Ramirez, Maintenance Superintendent ♦ Bill Kitajima, Project Manager

♦ Carrie Schultz, Administrative Aide

♦ Jed Beyer, Source Control Inspector

♦ Juan Coca, CCTV Supervisor

♦ Unsafe conditions & Hazards that cannot be immediately corrected by an employee or his/her supervisor shall be reported to the District RCC or any Safety Committee member by filling out and submitting an “Unsafe Condition or Hazard” report Form (Appendix-B). Timely correction of workplace hazards will be tracked, on the “Hazard Correction Report (Appendix-C) by the Safety Committee which will receive and review reports of unsafe conditions, hazards, accidents, injuries, near misses, workplace inspection reports, and suggested recommendations submitted by staff. Specifically, the Safety Committee will: ♦ Attend safety committee meetings, ♦ Transfer all safety related information to their supervisors so that each department is aware of

upcoming safety classes, safety inspections or otherwise, ♦ Support good housekeeping standards and cleanliness,

♦ Review the quarterly results of periodic, scheduled workplace inspections to identify any needed safety procedures or programs and to track specific corrective actions,

♦ Review Supervisor’s investigations of accidents, incidents, injuries and near misses to ensure that all causes have been identified and corrected,

♦ Where appropriate, submit suggestions to District Management for the prevention of future

incidents, ♦ Review alleged hazardous conditions brought to the attention of any Committee member,

determine necessary corrective actions and assign responsible personnel and correction deadlines, ♦ When determined necessary by the Committee, the Committee may conduct its own investigation

of accidents and/or alleged hazards in establishing corrective actions, ♦ Submit recommendations to assist management in the evaluation of employee safety suggestions. The Safety Committee shall prepare and make available to all District personnel written minutes of issues discussed at the meetings. The Committee meeting minutes will be documented on the Safety Committee Meeting Report/Minutes” Form (Appendix-D). Details of the Safety Committee Meeting shall be reported during the next scheduled Safety Tail-Gate Meeting by Safety Committee Members. To ensure communication outreach to personnel the Safety Committee Agenda Format is Identical to the Safety-Tail-Gate Agenda Format (Appendix-E).

The District’s Regulatory Compliance Coordinator (RCC) is responsible for:

♦ Ensuring that the Safety Committee is aware of all reported incidents, near misses and

accidents/injuries which have occurred and all hazards which have been observed since the last meeting,

♦ Assisting in coordination of required health and safety training, ♦ Maintaining copies of Safety Committee minutes and other safety related records, The RCC may seek assistance from other employees of the District or outside agencies as necessary to meet these responsibilities.

MANAGERS, SUPERVISORS, FIELD SUPERVISORS, CREW LEAD WORKERS ♦ Communicating to their staff the District’s emphasis on health and safety, ♦ Ensuring periodic, documented inspection of workspaces under their authority, ♦ Promptly correcting identified hazards, ♦ Modeling and enforcing safe and healthful work practices,

♦ Providing appropriate safety training and personal protective equipment, ♦ Implementing measures to eliminate or control workplace hazards,

♦ Stopping any employees work that poses an imminent hazard to either the employee or any other

individual, ♦ Encouraging employees to report health and safety issues to the Safety Committee without fear of

reprisal,

♦ Not direct employees to perform tasks for which they have not received proper training,

♦ For those employees who work under the CISO, conduct “tailgate or toolbox” safety meetings at least every two weeks to ensure the safety mindset in every employee,

♦ Report any injury or near miss (non-injury incidents) to the next highest supervisor who will forward then forward any report to the Regulatory Compliance Coordinator (RCC),

♦ Ensure every employee required to attend safety training is in attendance and attentive, if an employee misses a class, work with RCC to ensure that said employee receives training prior to job assignment,

♦ Understand and be aware of all hazards associated with the job assignments.

It is the responsibility of ALL EMPLOYEES to comply with all applicable health and safety regulations, District Policies and established work practices. This includes but is not limited to:

♦ Attend all required safety classes. This includes participating and being attentive, ♦ Report all injuries and near misses to the immediate supervisor, ♦ Observing health and safety-related signs, posters, warning signals and directions, ensuring all

fellow employees to keep a safety mindset, ♦ Reviewing the Emergency Action Plan (DRP (NIMS/SEMS), WBSD Hazardous Material

Business Plan), ♦ Learning about the potential hazards of assigned tasks and work areas, ♦ Following all safe operating procedures and precautions,

♦ Using proper personal protective equipment, ♦ Warning co-workers about defective equipment and other hazards, ♦ Reporting unsafe conditions immediately to a Supervisor and stop work if an imminent hazard is

presented, if the employee feels that their observation is going unnoticed and the hazard still exists, the employee may contact Human Resources, the RCC or their Supervisor to explain the situation,

♦ Participating in workplace safety inspections, working with management in fine tuning the code of

safe practices or any other work practice so that the most up to date and comprehensive safety procedure is being followed ,

♦ Understand that an employee shall be disciplined for failure to follow safe practices.

4.0 IDENTIFYING WORKPLACE HAZARDS Regular, periodic workplace safety inspections must be conducted throughout the District. By law, the first of these inspections must take place when the IIPP is first adopted by the District.

The inspections shall be documented on the WBSD Safety Inspection Form (Appendix-F) and assigned with a Risk Assessment Code to determine a mitigation timeframe for repair/completion. The District will maintain copies of this documentation for at least one year. These inspections include; Annual Fire Marshal Inspections, Annual County Health Inspections, Annual Administration Building Inspection CSRMA Audits, and monthly Internal Inspection records (Corporation Yard monthly, running CIP projects monthly and fire extinguishers, emergency eyewash/shower, automated external defibrillator and hazardous material storage areas. The Bobcat has an attachment for fork lift use and is inspected when used for lifting purposes. These regular inspections will be supplemented with additional inspections whenever new substances, processes, procedures or equipment introduced into the workplace represent a new occupational safety and health hazard or whenever Supervisors are made aware of a new or previously unrecognized hazard. Generally, Supervisors are responsible for identification and correction of hazards that their staff may face and should ensure that work areas they exercise control over are inspected at least annually. Supervisors should check for safe practices with each visit to the workplace and should provide immediate verbal feedback where hazards are observed. The “Report of Un-safe Condition” Form (Appendix-B) should be filled out when a referral is made to the Safety Committee as a result of a condition discovered during an inspection for which the responsible Supervisor could not determine an immediate remedy. The “Report of Un-safe Condition” form can also be obtained from a Safety Committee member or the RCC, filled out and turned in anonymously. The Hazard Correction Report Form (Appendix-C) will be used in conjunction with IIPP Form -3 when correcting Unsafe Conditions.

Anonymous reports may be placed in the Safety Suggestion Box located in the Maintenance and Administration Buildings. The results of the reports shall be documented in the Safety Committee Minutes and posted for review. 4.1 CORRECTING WORKPLACE HAZARDS Hazards discovered by the Supervisor in control of the work area either as result of a scheduled periodic inspection or during normal operations must be corrected. Supervisors of affected employees are expected to correct unsafe conditions as quickly as possible after discovery of a hazard, based on the severity of the hazard. Specific procedure's that can be used to correct hazards include but are not limited to the following: ♦ Tagging unsafe equipment "Do Not Use Until Repaired," and providing a list of alternatives for

employees to use until the item is repaired, ♦ Stopping unsafe work practices and providing re-training on proper procedures before work

resumes, ♦ Reinforcing and explaining the need for personal protective equipment and ensuring it's

availability, limitations and proper use, ♦ Barricading areas that have chemical spills or other hazards and reporting the hazardous

conditions to their Supervisor. Supervisors should use the “Hazard Correction Report” Form (Appendix-C) to document corrective actions, including projected and actual completion dates. If necessary, Supervisors can seek assistance in developing appropriate corrective actions by submitting a "Report of Unsafe Conditions" (Appendix-B) to a Safety Committee member. If an imminent hazard exists, work in the area should cease, and the appropriate Supervisor contacted immediately. If the hazard cannot be immediately corrected without endangering employees or property, all personnel need to be removed from the work area except those qualified and necessary to correct the condition. These qualified individuals will be equipped with the necessary safeguards before addressing the situation. 5.0 COMMUNICATING WORKPLACE HAZARDS Supervisors are responsible for communicating with workers about safety and health issues in a form readily understandable by all workers. All District personnel are encouraged to communicate safety concerns to their Supervisor without fear of reprisal.

The Safety Committee is another resource for communication regarding health and safety issues for District employees. All employees have representation on the Committee and will be informed of hazard corrections and committee activities. Additionally, Safety Committee minutes and other safety related items are reported out to staff or posted in the Administration and Maintenance Buildings.

Employees will also be informed about safety matters by e-mail or by distribution of written memoranda. Occasionally, the Safety Committee may also sponsor seminars, speakers or coordinate other means to communicate with employees regarding health and safety matters. Supervisors are responsible for ensuring that employees are supplied access to hazard information pertinent to their work assignments. Information concerning the health and safety hazards or tasks performed by District staff is available from a number of sources. These sources include, but are not limited to, Material Safety Data Sheets, equipment operating manuals, the District RCC, container labels and work area postings. Material Safety Data Sheets (MSDS’s) provide information on the potential hazards of products or chemicals used in the District and are available for review in the maintenance building. If a MSDS is missing, a new one can be obtained by faxing a written request to the manufacturer. A copy of this request should be kept until the MSDS arrives (Refer to the Districts “Hazard Communication Program Manual” for additional information on the “Procedure & Procurement Process” at Tab-6). MSDS’s are also available over the internet from a variety of sources. They can be obtained by accessing the CSRMA web page (http://www.csrma.org), select “On-line Resources and select videos.” Videos and training on how to read and understand the information presented on MSDS are available from CSRMA and staff is trained as required per the “Hazard Communication Standard”.

EQUIPMENT OPERATING MANUALS All equipment is to be operated in accordance with the manufacturer’s instructions, as specified in the equipments operating manual. Copies of operating manuals shall be kept for each piece of equipment owned by the District.

Employees who are unfamiliar with the operation of a piece of equipment and its potential hazards must at a minimum read the operating manual prior to being trained by an experienced Operator or Supervisor.

6.0 INVESTIGATING INJURIES AND ILLNESSES AND RECORD KEEPING Employees who are injured at work must report the injury immediately to their Supervisor. Those who are not employees who are injured or involved in an accident should report the incident to their immediate Supervisor. In either case, if immediate medical treatment beyond first aid is needed, call 911. The injured party will be taken to the appropriate hospital or medical center. If non-emergency medical treatment for work related injuries or illnesses is needed and or Workers Compensation claims, follow up appointments, contact the Districts Human Resource Agent, Peggy Daniels, or their assigned representative, and they will call the District's Health Clinic, “U.S. Health Works Medical Group” located at 201 Arch Road, Redwood City, CA 94062, Ph # 650-556-9420, FAX# 650-568-9053, 7:30 am to 5 pm M-F. (Map @Appendix-K). If after hour medical attention is required, employees are directed to go to the “Sequoia Hospital Emergency Room”, located at 170 Alameda, in Redwood City, Ph 650-367-5541 (Map @ Appendix-L).

http://www.csrma.org/

For Pre-Employment exams, Class-A physicals and Medical Injections go to the “Palo Alto Medical Foundation” located at 795 El Camino Real, Palo Alto, CA 94301, First Floor, Lee Building, phone # 650-853-2970 (Map @ Appendix-M). Supervisors Responsibility The Supervisor of the injured employee must work with the Districts Human Resource Agent to ensure that the "Employer's Report of Occupational Injury or Illness" and/or "Worker's Compensation Claim Form" and related “Initial Injury” packet are completed properly. Employee’s Responsibility If an employee incurs a minor injury and declines medical attention, the Employee and their immediate Supervisor must fill out the Declination of Medical Treatment Form. Employee’s requiring medical attention If the injured employee must see a physician, the Supervisor shall provide the employee with a copy of the employee’s “Job Description” and a medical release form; “Employee Status Report” (located in the Initial Injury packet for the Physician to complete. Employees requiring medical attention must provide the tending Physician with a copy of their job description, the Employee Status Report form and return the completed form to their immediate Supervisor. This is the only means by which an employee may return to work. The health care provider may stipulate work tasks that must be avoided or work conditions that must be altered before the employee resumes his or her duties. The employee’s job description must be modified to include all “Restricted Duties” listed by the Physician. This task may be performed by the H.R. person or the RCC and documented on Cal-OSHA Form 300.

Injury Investigation The employee's Supervisor or Safety Committee Member(s) are responsible for performing an investigation to determine and implement corrective measures that caused the incident. Specific procedures that can be used to investigate workplace accidents and hazardous substance exposures include: ♦ Interviewing injured personnel and witnesses, ♦ Examining the injured employee's work station for causative factors, ♦ Reviewing established procedures to ensure they are adequate and were followed, ♦ Reviewing training records of affected employees, ♦ Determining all causes related to the injury, ♦ Taking corrective actions to prevent the injury/exposure from re-occurring,

♦ Recording all findings and actions taken. The Supervisor's findings and corrective actions should be documented and presented to the Safety Committee using “Supervisors Report of Accident or Incident & Basic Rules for Accident Investigation” Appendix-I. If the Supervisor is unable to determine the cause(s) and appropriate corrective actions, other resources should be sought. The Safety Committee will review each accident or injury report to ensure that the investigation was thorough and that all corrective actions are completed. Investigations and/or corrective actions that are found to be incomplete will be routed back to the Supervisor for further follow-up, with specific recommendations noted by the committee. The District Manager will bring corrective actions that are not implemented in a reasonable period of time to the attention of the RCC.

REPORTING TO OSHA WBSD shall report immediately by telephone or telegraph to the nearest District Office of the Division of Occupational Safety and Health any serious injury or illness, or death, of an employee occurring in a place of employment or in connection with any employment.

Immediately means as soon as practically possible but not longer than 8 hours after a manager or higher knows or with diligent inquiry would have known of the death or serious injury or illness. If WBSD can demonstrate that exigent circumstances exist, the time frame for the report may be made no longer than 24 hours after the incident. A serious injury is defined as: an injury or illness which requires hospitalization for more than 24 hours for other than medical observation or in which an employee suffers a loss of any member of the body or suffers any serious degree of permanent disfigurement.

Exception: An injury is not reportable if it occurs during a crime (penal code violation), or on a public roadway (vehicle accident). If uncertain whether the accident was a “vehicle accident”, notification to Cal/OSHA is advised.

During normal work hours, employees who report a serious injury shall immediately notify a supervisor. If a supervisor is not immediately reachable, the employee shall call Human Resource/or the Safety Coordinator to notify them of the situation. Once notified of the serious injury, the supervisor, Human Resource office, or Safety Coordinator is to notify the nearest Cal/OSHA Enforcement District Office of the serious injury or death no longer than 8 hours after the incident. A full listing of district offices is online at http://www.dir.ca.gov/dosh/DistrictOffices.htm. The Cal/OSHA office that is closest to WBSD, at which notification is to be made is the Cal/OSHA Enforcement District Office at:

Foster City 1065 East Hillsdale Blvd.,

Ste. 110, Foster City 94404 (650) 573-3812

fax (650) 573-3817

i. If a contractor is injured, the contractor’s employer must notify Cal/OSHA.

ii. When making notification the reporting party shall include the following information, if available:

I. Time and date of accident.

II. Employer's name, address and telephone number.

III. Name and job title, or badge number of person reporting the accident.

IV. Address of site of accident or event.

V. Name of person to contact at site of accident.

VI. Name and address of injured employee(s).

VII. Nature of injury.

VIII. Location where injured employee(s) was (were) moved to.

IX. List and identity of other law enforcement agencies present at the site of accident.

X. Description of accident and whether the accident scene or instrumentality has been altered.

CAL/OSHA RECORD KEEPING

i. Whenever an Employer's Report of Occupational Injury or Illness Form 5020 is filed, an entry will be made in the Cal/OSHA Form 300 by Human Resources or the RCC.

ii. Human Resources and or the RCC will also complete the Cal/OSHA Form 301. 7.0 RECORD KEEPING Documents related to IIPP are located in the Administration Building, Maintenance building and with the RCC. By law, certain documents related to the IIPP must be kept by the District for at least one year. These records include: Records of scheduled and periodic workplace inspections, including the persons conducting the inspection, any identified unsafe conditions or work practices and corrective actions, Employee safety training records, including the names of all attendees and instructor(s), the training date and material covered (Appendices K & E or equivalent). Other documents related to the IIPP that shall be kept on file include: Reports of “Unsafe Conditions, Hazards or Near Miss” (Appendix-B),

“Safety Committee Meeting Documentation (Appendix-D), “Hazard Correction Reports” (Appendix-C), “Accident, Injury, Incident or Illness Report(s), (Appendix-N), Cal-OSHA 300 & 300A Logs. 8.0 EMPLOYEE HEALTH AND SAFETY TRAINING Employee safety training is provided at no cost to the employee and is conducted during the employee’s normal working hours. Safety training is presented by a knowledgeable Supervisor, other District personnel or by outside resources. Regardless of the instructor, all safety training must be documented using the “Safety Training/Tailgate Attendance Record” (Appendix-G) or an equivalent record that includes all the information on IIPP Form 6. By law, this documentation must be retained by the District for at least one year.

Initial IIPP Training When the IIPP was first implemented, all District employees were trained on the structure of the IIPP, including individual responsibilities under the program and provided with a copy of the written program.

Training is also provided on how to report unsafe conditions, how to access the Safety Committee and where to obtain information on workplace safety and health issues.

New employees are trained on this material during their first week of employment by the RCC or appropriate Supervisor prior to performing their assigned work. Also, additional training sessions will be documented using “New Employee Equipment Training (Appendix-Q) or equivalent. This document must also be kept with District for at least one year with a copy placed in the new employees personnel file.

Training on Specific Hazards Supervisors are required to be trained on the hazards to which the employees under their immediate control may be exposed. This training aids a Supervisor in understanding and enforcing proper protective measures.

All Supervisors must ensure that the personnel they supervise receive appropriate training on the specific hazards of work they perform and the proper precautions for protection of those hazards. Training is particularly important for new employees and whenever a new hazard is introduced into the workplace. Such hazards may include new equipment, hazardous materials or procedures. Health and Safety training is also required when employees are given new job assignments on which they have not been previously trained and/or when a Supervisor is made aware of a unrecognized hazard.

Specific topics which may be appropriate to District personnel include but are not limited to the following: ♦ Fire prevention techniques and fire extinguisher use, ♦ Obtaining emergency medical assistance and first aid, ♦ Respiratory Protection, ♦ Excavation, Trenching and Shoring, ♦ Traffic Control & Flagger Operations, ♦ Hearing Conservation, ♦ Bloodborne Pathogens, ♦ Lock-out, Tag-out, Try-out, ♦ Overflow Emergency Response Program, ♦ Disaster preparedness and response, including building evacuation procedures, NIMS/SEMS

Program, ♦ First Aid-CPR & AED certification (every 2-years) ♦ Health and Safety for computer users, ♦ Back care, body mechanics and proper lifting techniques, ♦ Hazard communication, including training on MSDS’s, chemical hazards and container labeling, ♦ Proper housekeeping, ♦ Chemical spill reporting procedures.

Safety Videos Workplace safety videos are available for borrowing from CSRMA. Videos are available on wide range of topics, including hazard communication, chemical safety and various hazards. You can read descriptions of the videos and order them on-line via the CSRMA web-site at http://www.csrma.org by clicking on Resources then select “Videos”. Videos should be used to supplement, not replace, face to

http://www.csrma.org/

face safety instruction, so that trainees have an opportunity to ask questions of a knowledgeable instructor. 9.0 ENSURING COMPLIANCE All District personnel have the responsibility for complying with safe and healthful work practices, including applicable regulation(s), safety procedures and District policy. Overall performance in the maintenance of a safe and healthful work environment should be recognized by the Supervisor and noted in performance evaluations. Employees will not be discriminated against for work related injuries and injuries may not be included in performance evaluations, unless the injuries were the result of an unsafe act on the part of the employee. All personnel will be given instruction and an opportunity to correct unsafe behavior. Repeated failure to comply or willful and intentional non-compliance may result in disciplinary measures up to and including termination. 10.0 DISCIPLINARY PROCEDURES Employees who fail to comply with WBSD’s safety policies and procedures will be subject to disciplinary action, up to and including, termination. Employees should understand that the actions of managers and supervisors through the disciplinary process are intended to positively redirect their behavior toward the achievement of WBSD’s goals and objectives. While management wants to remain as positive as possible, management must properly address the adverse actions of employees. The disciplinary policy is detailed in the Personnel Procedure Manual and the District’s MOU.

APPENDIX-A JOB SAFETY ANALYSIS Job:

Example

Date:

JOB SAFETY ANALYSIS FORM

Title of Person who does Job:

Title of Supervisor: Analysis by:

Department:

Division/section: Reviewed by:

Required personal protective equipment:

Required material safety data sheets: Approved by:

SEQUENCE OF BASIC JOB STEPS POTENTIAL ACCIDENTS OR HAZARDS

RECOMMENDED SAFE JOB PROCEDURE

Break the job down into its basic steps, e.g. what is done first, what is done next, and so on. You can do this by 1) observing the job, 2) discussing it with a knowledgeable person, 3) drawing on your knowledge of the job, or 4) a combination of the three. Record the steps in the normal order of occurrence. Describe what is done, not the details of how it is done. Usually three or four words are sufficient to describe each basic job step.

For each job step, ask yourself what accidents could happen to the person doing this job step. You can get the answers by, 1)observing the job, 2) discussing it with a knowledgeable person, 3) recalling past accidents, or 4) a combination of the three. Ask yourself, can the person be struck by or contacted by anything, can the person strike against or come in contact with anything; can the person be caught in, on or between anything, can the person fall, can the person overexert, does the step require repetitive motions; is the person overexposed to anything injurious, such as hazardous chemicals, noise, extreme temperatures, etc.?

For each potential accident or hazard, ask yourself how the person should do the job step to avoid the potential accident, or what should the person do or not do to avoid the accident. You can get your answers by, 1) observing the job for leads, 2) discussing precautions with a knowledgeable person, 3) drawing on your personal experience, or 4) a combination of all three. Be sure to describe specifically the precautions a person must take. Don't leave out important details. Number each separate recommended precaution with the same number as the potential accident or hazard. Use specific do and don't statements. Where appropriate, include the use of personal protective equipment, and safety apparatus, materials, and facilities that would mitigate the hazard.

Job:

Date:




Department:


APPENDIX-A JOB SAFETY ANALYSIS

Job:

Date:




Department:


Required personal protective equipment:

Required material safety data sheets: Approved by:

SEQUENCE OF BASIC JOB STEPS POTENTIAL ACCIDENTS OR HAZARDS RECOMMENDED SAFE JOB PROCEDURE

APPENDIX-B Near Miss Unsafe Hazard Report IIPP Form-1 Unsafe Condition Report IIPP Form-3

Date: Time: Task being performed: Work crew involved: Description: Corrective Measure(s) Implemented: Employee Signature: Date Time Superintendent Notified: Date Time RCC Notified: Date Time Safety Committee Review: Date Time District Manager Notified: Date Time Tailgate meeting set for

APPENDIX-C HAZARD CORRECTION REPORT

Department: This form should be used in conjunction with the “Report of Unsafe Condition” form (IIPP Form 1 & 3), as appropriate, to track the correction of identified hazards. All hazards should be corrected as soon as possible, based on the severity of the hazard. If a serious imminent hazard cannot be immediately corrected, remove personnel from the area and restrict access until the hazard can be addressed.

Supervisor/RCC Name:

______________________________________ _________________________________ Supervisor/RCC Signature Date

Identified Problem Comments Target Repair Date

Completion Date

Tailgate / Safety Meeting Date: Comments from staff at completion:

APPENDIX-D

SAFETY COMMITTEE GROUP MEETING WEDNESDAY, Month, Day, Year @ 0830-1000 HOURS

AGENDA

1) CALL TO ORDER & ROLL CALL: John Simonetti, RCC (Chairperson) Start Time: Sergio Ramirez, Mtc. Supt. Bill Kitajima, PM Bob Scheidt, Ast. Mtc.Supt. George Sanchez, Pump Mechanic (2-yr, 05-26-12) Alberto Patino, Field Supervisor (05-26-11 Start Date) Brian Chu, CCTV Tech II (05-26-11 Start Date)

Carrie Schultz, Admin.-Aide 2) . : 3) REVIEW OF AND UPDATE ON 2011 TRAINING SCHEDULE: 4) REVIEW OF ACCIDENT, INCIDENT & NEAR MISS RREPORTS: 5) DEVELOPMENT OF S.O.P.’s: 6) REVIEW OF DRAFT S.O.P.’s: 7) UNSAFE AND HAZARD REPORT MITIGATION REVIEW: 8) QUARTERLY SAFETY INSPECTION REVIEW & AUDITS: 9) SSO’S, PSA’S, M/L STOPPAGES & SMART COVER ALARMS: 10) ITEMS TO BE PLACED ON FUTURE AGENDA: ACTION ITEMS: NEXT MEETING DATE: Month Day, Year ADJOURNED AT: ACTION ITEMS Safety Committee Group: N:\ IIPP 2011 \ Reports \ Safety Meetings \ Safety Committee \ Month, Year\

APPENDIX-E

Safety Meeting Report

SAFETY MEETING TAIL-GATE MEETING

MEETING OF Month Day, Year

Start Time: AGENDA

1) TODAYS TRAINING TOPIC: 2) REVIEW & UPDATE OF 2011 SAFETY TRAINING SCHEDULE: 3) REVIEW OF ACCIDENT, INCIDENT & NEAR MISS REPORT(S): 4) DEVELOPMENT OF S.O.P’s: 5) REVIEW OF DRAFT S.O.P’s: 6) UNSAFE, HAZARD REPORT REVIEW: 7) QUARTERLY SAFETY INPSECTION REVIEW & AUDIT: 8) SSO’s, PSA’s, M/L STOPPAGES & SMART COVER ALARMS: 9) ITEMS TO BE PLACED ON FUTURE AGENDA: ACTION ITEMS: NEXT MEETING DATE & TOPIC: MEETING ADJOURNED AT:

APPENDIX-F

West Bay Sanitary District Safety Inspection

DATE: Inspection conducted by: The following are violations of Cal/OSHA regulations, California Fire Code, California Building code, other standards, or are hazardous conditions that may cause injury or illness to employees at the WBSD, or possibly cause negative environmental impact, or interrupt the WBSD’s ability to do business. These conditions require corrective action to ensure a safe and healthful workplace for employees and employer.

Findings which may not be directly traceable to an enforceable code or regulation are given in italics. Note that failure to abate these hazards may still put the WBSD at risk of injury and/or loss, civil litigation, citation under the General Duty Clause (California Labor Code Section 6400), or other action.

Item # Finding Description Risk Rating Work Order Number

Date Fixed Initials

The following items were previously identified and still need to be resolved.


Date Fixed Initials

Please initial and date corrections as they are completed.

Risk Assessment Class Class 1 - Critical (may cause death, serious injury, significant environmental impact, or substantial financial losses) and/or is likely to occur soon.

Class 2 - Serious (may cause injury, occupational illness, or environmental or property damage) and/or probably will occur in time.

Class 3 - Minor (probably would not affect personnel or environmental safety or health, but is a violation of specific criteria).

APPENDIX-G

IIPP Form-2 & Form-6

ο SAFETY MEETING ο TAIL-GATE MEETING

SIGN IN SHEET

DATE: TIME: TO TOPIC:

TRAINER: VIDEO:

HANDOUT (S):

COLLECTION SYSTEM PERSONNEL

P A Name Signature P A Signature ο ο Sergio Ramirez ο ο Bob Scheidt ο ο Juan S. Coca ο ο Brian Chu ο ο Heath Cortez ο ο Orion Valentine ο ο Richard Kinder ο ο David Martinez ο ο Robert Hulsmann ο ο George Sanchez ο ο Alberto Patino ο ο A. Hildebrand ο ο Henry Santos ο οRupert Sandoval ο ο Mark Praturlon ο ο Keith E. Brown ο ο Jed Beyer ο ο ο ο ο ο ο ο ο ο

ADMINISTRATION

ο ο Phil Scott ο ο Bill Kitajima ο ο John Simonetti Sr. ο ο Carrie Schultz ο ο Peggy Daniels ο ο Liz Bahrami ο ο Todd Reese ο ο Sam Wong

Visitors ο ο ο ο

Notes from meeting:

APPENDIX-H

Employee Report of: Accident, Injury or Illness IIPP Form-5

Note: This form is intended to serve only as a local record of the investigation conducted within the department. Also, an IIPP Form 3, "Hazard Correction Report" must be completed in conjunction with any accident, injury or illness. Instructions: Please print & fill-in all blanks. If a blank does not pertain to your accident, injury or illness write "N/A" in that blank. When completed return this form to your supervisor. Name: Department: � Male � Female Age: Address: Phone: Employment start date: Time in present job: Job Title: Supervisor: Date & Time of Accident: Location of accident: Task being performed: Name of witness: Name of witness: Name of witness: Describe the accident:

What caused the accident:

What could of prevented the accident:

Date & Time you first sought medical attention:

Name of Hospital or Doctor:

Were you using required safety equipment:

Do you have a job at another company:

The information I have provided either in my own handwriting or verbally for the purpose of this form is true and correct. I understand that providing false or misleading information or omission of information on this report or any other form relating to this claim of injury/accident may result in the termination of my employment. Signature of Employee: Date: Signature of Witness: Date:

APPENDIX-I

Supervisor’s Report of: Accident, Incident, Injur y

Employee Name: Basic Rules for Accident Investigation

1. Find the cause to prevent future accidents – Use an unbiased approach during the investigation. 2. Interview witnesses & injured employees at the scene – conduct a walkthrough of the accident. 3. Conduct interviews in private – Interview one witness at a time. 4. Get signed statement from all involved. 5. Take photos or make a sketch of the accident scene to accident. 6. Ensure hazardous conditions are corrected immediately. Date & Time Location

Tasks Performed Witnesses Resulted In � Injury � Fatality

� Property Damage Property Damage

Describe accident facts & events:

Supervisor’s Root Cause Analysis – Check All that apply to this accident Unsafe Acts Unsafe Condition

Yes No Yes No � � Improper work technique � � Poor Workstation design � � Safety rule violation � � Unsafe operation method � � Improper PPE � � Improper maintenance � � PPE not used � � Lack of direct supervision � � Operating without authority � � Insufficient training � � Failure to warn or secure � � Lack of experience � � Operating at improper speeds � � Insufficient knowledge of job � � By-passing safety devices � � Slippery conditions � � Protective equipment not in use � � Excessive noise � � Improper loading or placement � � Inadequate guarding of hazards � � Improper lifting � � Defective tools / equipment � � Servicing machinery in motion � � Poor housekeeping � � Horseplay � � Insufficient lighting � � Drug or alcohol use � �

<<<UNSAFE ACTS REQUIRE A WRITTEN WARNING & RE-TRAINING ON S.O.P. OF TASK IN QUESTION>>> Yes No Date Yes No � � Re-training Assigned � � Unsafe condition guarded � � Re-training completed � � Unsafe condition Corrected Supervisor Signature: Date: Maintenance Superintendent: Date: Safety Director: Date: Accident Report Review by Safety Committee on Comments: District Manager: Date:

APPENDIX-J EMPLOYEE: DATE OF HIRE:

EMPLOYEE TRAINING LOG

DATE TEMPORARY WORKER INITIAL TRAINING REQUIREMENT PRIOR TO FIELD DUTY ASSIGNMENT

CalOSHA 3203, CCR Title 8 �__________ Injury Illness Prevention Program New employees and/or introduction of new hazards, Initially & on-going On the job injuries are documented by office staff and reported as required. CalOSHA 5193 Fed.OSHA 1910.130 � __________Bloodborne Pathogens- Designated First Responders / Initially and Annually � __________Bloodborne Pathogen Exposure Control Plan � __________ Sanitary Sewer Management Program (SSMP) � __________Overflow Emergency Response Plan (OERP) � __________ WBSD Disaster Response Plan All employees/ initiall, annually not Cal-OSHA required CalOSHA 5192 Fed.OSHA 1910.120 �__________ Emergency Response (HAZMAT) Personnel expected to respond / Initially and Annually CalOSHA 3220 Fed.OSHA 1910.38 (A) �__________ Emergency Training All employees / Initially, annually not CalOSHA required CalOSHA 5194 Fed.OSHA 1910.1200 (h)(1 & 2) �__________ Right to Know All employees exposed to chemical, biological or similar hazards. Annually(MSDS TEST) Fed.OSHA 1910-146 Title 8, CCR �__________ Confined Space Entry All employees initially and annually, Pre-Test and Post testing annually. �__________ Confined Space Ventilation �__________ Confined Space Rescue �__________ Gas Monitors CalOSHA 5144 �__________ Respiratory Protection All employees who are required to wear respirators of any type. Initially / Annually �__________ Respiratory Fit Test CalOSHA 2320 Fed.OSHA 1910.147 (J) �__________ Lockout-Tagout-Tryout All employees who are required to wear respirators of any type. Initially / Annually CalOSHA 1919.332 �__________ Electrical Safety All employees who reasonably face risk of electrical shock. Initially WBSD: Lockout-Tagout requirement and procedure CalOSHA 6151 Fed.OSHA 1910.157 (g) �__________ Fire Extinguishers Designated employees, Initially / annually

CalOSHA 3221 �__________ Fire Prevention All employees. Initially WBSD: Tailgate performed annually. CalOSHA 5099 Fed.OSHA 1910.1200 (h)(1 & 2) �__________ Occupational noise exposure Employees working in high noise areas, 85 dB’s/8hrs. Initially & Annually CalOSHA 4799 Fed.OSHA 1910.252 �__________ Welding, cutting, brazing All employees who perform welding. Initially and annually Cal-OSHA 1599 All employees, certification every 2 years �__________ Traffic Control and Flagger Training Cal-OSHA CISO 1540(b) �__________ Cave In: Trenching and Shoring Rehabilitation Crew, certification every two years �__________ Working around Cranes Cal-OSHA 1675 �__________ Ladder Safety �__________ Asbestos Awareness �__________ Staying on the Safe side of the street: �__________ Maintenance Safety �__________ Drive for Life Series: Defensive and emergency situations �__________ Forklift Safety �__________ Workplace Violence �__________ Sexual Harassment Series: What Employees and Supervisors need to know �__________ Personal Protective Equipment: On going training through out the year. �__________ First Aid & CPR: WBSD staff participates in training every other year. Recipients are awarded certification cards. Training performed every other year. �__________ Ergonomics �__________ D.O.T �__________ PESTICIDE APPLICATION

DATE CONFERENCES-MEETINGS CERTIFICATION C.E.U. �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N

�__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N �__________ �Y �N

Employee: Hire Date OSHA 1910.134 (b) (10) Spirometry �__________ Respiratory, lung capacity test (annually) �__________ Hearing, audiogram (annually)

�__________ Hepatitus B, 3-shot series 1. �__________ 2. �__________ 3. �__________

�__________ Hepatitus B antibodies ( 3-6 months after 3-shot series ) � Re-active � *Non-reactive � *Booster required ___________ �__________ Tetanus / Diphtheria (Td) once every 3 years �__________ Typhoid (optional) �__________ Class A physical

APPENDIX-K

IN THE EVENT OF AN EMERGENCY* DIAL 9-1-1

IN THE EVENT OF A NON-EMERGENCY WORK-RELATED INJURY OR ILLNESS:

INFORM YOUR SUPERVISOR & COMPLETE AN INITIAL INJURY PACKET

Seek Medical Attention at: U.S. Medical Healthworks Medical Group 201 Arch Street, Redwood City, CA 94062

Ph: 650-556-9420 / Fax: 650-568-9053 HOURS: 7:30am – 5:00pm, Monday – Friday

FROM HIGHWAY 101: Take the Bayshore Freeway (Hwy 101) to Redwood City Exit at Whipple Avenue Turn Left on Whipple Avenue Cross El Camino Real Turn Left on Arch Street Follow to 201 Arch Street Turn Left into parking lot

From HIGHWAY 280: Take Hwy 280 towards SF Exit at Farm Hill Blvd. Turn Right (East) on Farm Hill Blvd. Turn Left on Alameda de las Pulgas Turn Right on Arch Street Turn Left into parking lot

APPENDIX-L

IN THE EVENT OF AN EMERGENCY* DIAL 9-1-1

DURING AFTER HOURS OR ON WEEKENDS

CALL / NOTIFY A SUPERVISOR & COMPLETE AN INITIAL INJURY PACKET

Seek Medical Attention at: *Sequoia Hospital - Emergency Room

170 Alameda de Las Pulgas Redwood City, CA 94062

Ph: 650-367-5541 – ER Dept.

FROM HIGHWAY 101: Take the Bayshore Freeway (Hwy 101) to Redwood City Exit at Whipple Avenue Turn Left on Whipple Turn Right on Alameda de Las Pulgas

From HIGHWAY 280: Take Hwy 280 towards SF Exit at Edgewood Road Turn Right on Alameda de Las Pulgas

APPENDIX-M

APPENDIX-N

West Bay Sanitary District Safety Inspection

DATE Inspection conducted by: XXXXXX

The following are violations of Cal/OSHA regulations, California Fire Code, California Building code, other standards, or are hazardous conditions that may cause injury or illness to employees at the WBSD, or possibly cause negative environmental impact, or interrupt the WBSD’s ability to do business. These conditions require corrective action to ensure a safe and healthful workplace for employees and employer.

Findings which may not be directly traceable to an enforceable code or regulation are given in italics. Note that failure to abate these hazards may still put the WBSD at risk of injury and/or loss, civil litigation, citation under the General Duty Clause (California Labor Code Section 6400), or other action.

For explanation of Risk Assessment Codes see the last page.


Date Fixed Initials

The following items were previously identified and still need to be resolved.


Date Fixed Initials

Please initial and date corrections as they are completed.

Risk Assessment Class Class 1 - Critical (may cause death, serious injury, significant environmental impact, or substantial financial losses) and/or is likely to occur soon.

Class 2 - Serious (may cause injury, occupational illness, or environmental or property damage) and/or probably will occur in time.

Class 3 - Minor (probably would not affect personnel or environmental safety or health, but is a violation of specific criteria).

SAFETY TRAINING 2013

W Date N/M INC SM TG Topic Presenter TimeframeI/H Hours Off -Site

12/18/2013 x Sexual Harassment Prevention Employees Chris Nihil Assit-U 1

12/18/2013 x Sexual Harassment Prevention Supervisors Chris Nihil Assit-U 2

12/4/2013 x Bloodborne Pathogens S. Pierre DuAll Safety 1

11/29/2013 x SSS-WDR SAC- Workshop CWEA 6

11/21/2013 x Mobile Overhead Crane Safety R. DeBusk, DuAll Safety 4

11/20/2013 x Draft Spill Calculation Sheet JRS

11/19/2013 x MSDS Review-Test B. Chu 0.5

11/14/2013 x OERP-MRP Changes Part-1 J. Simonetti 1

11/12/2013 x SSO- Basic Volume Estimation J. Beyer 0.5

11/5/2013 x Leadership Training CWEA 6

11/4/2013 x Haz. Wst. Management DuAll 2.25

10/23/2013 x Northern Safety Day CWEA 8

10/17/2013 x California Shake-Out, Earthquake and Fire Drill DuAll 1.25

10/15/2013 x Maintenance TCP Cwea 6

10/14/2013 x PG & E Construction Safety PG & E Gerry Kohlman 1.25

10/7/2013 x Hot Stick Manual Review Bob Scheit 0.25

10/7/2013 x Respiratory Protection DuAll Safety 1

10/2/2013 x MSDS- Surtec Liquid Enzymes & BioCircle Brian Chu 0.25

10/2/2013 x SSO Response Questionairre P.Scott 1

9/26/2013 x 207 Terminal Ave Incident - Review J. Simonetti 0.5

9/19/2013 x 207 Terminal Avenue, PG&E mismark USA

9/23/2013 x First Aid-CPR-AED DuAll 6

8/30/2013 Academy X Excel Academy X 6

8/30/2013 NRTC - CWEA 6

8/29/2013 Academy X Excel Academy X 6

8/29/2013 NRTC - CWEA 6

8/28/2013 NRTC - CWEA 6

8/21/2013 x MSDS- Mega Clear & Unleaded Gasoline Brian Chu 0.5

8/12/2013 x Hz.Comm Sys & EAP DuAll 1

8/5/2013 x Confined Space Entry DuAll Safety 4.75

7/24/2013 x MSDS-Natural Way & Air Shield Brian Chu 0.25

7/22/2013 x Traffic Control & Flagger Operations DuAll Safety 7

7/15/2013 x Hearing Conservation DuAll Safety 1


6/27/2013 x PG & E Utility 1-call safety locating S.Ramirez 0.5

6/25/2013 Academy X Microsoft Word Academy X 6

6/24/2013 Academy X Microsoft Word Academy X 6

6/19/2013 x Vehicle collision, minor ding (ah)

6/12/2013 x MSDS, BioBarrier, Diesel#2 B. Chu 0.25


6/11/2013 x Slip & fall, contusion, lost footing (jb)

6/10/2013 x LOTO DuAll Safety 1.75

6/5/2013 x Accident Investigation, Safety Committee Group DuAll Safety 2.5

5/30/2013 x Emergency By-Pass Training Baker Tanks 3

5/22/2013 Plan Reading Seminar CWEA 6

5/20/2013 x x Tote bin placed on trailer, cover fell off in street (jb)

5/15/2013 x MSDS, Sani Clean, Hot Mix Asphalt B. Chu 0.25

5/13/2013 x Workplace Violence DuAll Safety 1.75

5/7/2013 x Clay Pipe 1

4/25/2013 x MSDS, Utility Paint, Wht, Grn & Commander B. Chu 0.25

4/8/2013 x Worksite Safety DuAll 1.75

4/3/2013 x MSDS, Razor Rooter B. Chu 0.25

3/27/2013 x MSDS, Speed Plug, MegaPower B. Chu 0.75

3/26/2013 x Garret Metal Detector S. Ramirez 0.5

3/20/2013 x CCTV Training J. Coca 0.75

3/20/2013 x Slip caught balance. Stiff shoulder later in day (sw)

3/12/2013 x CWEA Pump & Valve Seminar CWEA 8

3/4/2013 x Confined Space Refresher DuAll Safety 4

2/26/2013 x Drove to close to gate striking mirror (rek)

2/26/2013 x Stretching spring, cut finger, unit 204 (dm)

2/25/2013 x Smart Covers J. Simonetti 0.5

2/22/2013 x Cut left thumb, wrong tool for job (bc)

2/18/2013 x Root Saw Cutter, Mtc & Operation S. Ramirez 0.25

2/18/2013 x Twisted knee exiting truck (rek)

2/13/2013 x Review of last 5 Tailgate meetings J. Simonetti 0.5

2/12/2013 x OERP J. Simonetti 0.5

2/11/2013 x OERP, pages 4-9 J. Simonetti 0.5

2/7/2013 x Element 4 FOG J. Simonetti 0.5

2/6/2013 x SSO Forms J. Simonetti 0.5

2/5/2013 x IIPP J. Simonetti 0.5

2/4/2013 x Traffic Control, Refresher DuAll Safety 7

2/1/2013 x Samshed thumb with tailgate (ah)

2/1/2013 Academy X Power Point Academy X 6

1/31/2013 Academy X Power Point Academy X 6

1/29/2013 x Competent Person Excavation Safety Center 8

1/17/2013 x Slip and fall, Icy pavement

1/15/2013 x Fire Extinguishers, hands on Ace Fire Service 2

1/10/2013 x Collection System Training S. Ramirez 2.5

77.75 98hours hours

In house Off Site


W Date N/M INC SMR TG Topic Presenter TimeframeI/H Hours Off -Site

12/18/2012 x Air Monitoring Industrial Scientific 0.75

12/10/2012 x Bloodborne Pathogens DuAll Safety 1.25

11/19/2012 x Fall Protection DuAll Safety 2

11/13/2012 x After Call Outs JRS - SR 0.5

10/29/2012 x Medical Evaluations, Respiratory Protection FROST

10/23/2012 x Basic electricity I & 2, (ah, gs, ) CSRMA 8

10/22/2012 x Respiratory Protection Refresher & SAR DuAll Safety 1.5

10/17/2012 x Contractor did not monitor air b4 removing cover

10/11/2012 x Utility Marker Paint, MSDS review J.Simonetti 0.25

10/4/2012 x x Employee Safety, shootings in EPA J Simonetti

9/20/2012 x FA, Screwjack Injury

9/7/2012 x Title 22 Training DuAll Safety 2

8/24/2012 x Hazard Communications DuAll Safety 1

8/14/2012 x Trench Safety Rescue (hc,bh,gs,bs,sr,jb) MPFPD 24


7/13/2012 x Confined Space Refresher DuAll Safety 6

6/27/2012 x Recent shootings in EPA

6/22/2012 x Annual Hearing Tests Center for Hearing Health

6/15/2012 x LOTO DuAll Safety 1.25

6/1/2012 x Code of Safe Practices J.Simonetti 0.25

5/18/2012 x Rodder Operations A.Patino 0.75

5/14/2012 x Post Spill Assessment J.Simonetti 0.5

5/4/2012 x PPE, Hot Work, SOP Review DuAll Safety 1

4/6/2012 x Heat Illness Prevention DuAll Safety 1

4/1/2012 x Electrical Safety Bobby Hulsmann 1

3/27/2012 x Utility Knife cut requiring stich

3/22/2012 x CCTV Operations J.Coca 0.75

3/16/2012 x Cal-Osha Essentials (sr,bs,jc,rs,ap) CSRMA Webinar 1.25

3/15/2012 x ACP Training (kr,ah,bh,gs,hc,mfp,ov,sr,) CSRMA 8

3/9/2012 x Emergency Action Plan DuAll Safety 1

2/24/2012 x Update staff on Safety Committee Meeting J.Simonetti 0.5

2/20/2012 x Mics. Safety Topics J.Simonetti 0.5

2/10/2012 x IIPP Review DuAll Safety 1

2/10/2012 x Contractor tree trimming while on limb not ladder

2/6/2012 x Employee driving while on the phone

1/27/2012 x Safety Responsibilties for Supervisors DuAll Safety 1.75

1/13/2012 x Hands On Fire Extinguishers Ace Fire Service 2

1/4/2012 x SSO Spill Response Times, Site Safety Assessment J.Simonetti

1/4/2012 x Contractor found not wearing PPE for CSE

SUB-TOTAL HOURS 30.75 40

In-House Off Site

Combined TTL Hours 70.75

West Bay Sanitary District

2013 Environmental Health, Safety & Vocational Training Schedule Developed January 9, 2013; Updated January 15, 2013

Date Class SOP Review

MSDS Review

Facilitator Start-End

1Q-Site Safety Assessment(s) WBSD & CIP 1/15/2013 Fire Extinguisher Training Ace Fire Svc. 0800-0915 1/16/2013 Safety Committee Meeting John Simonetti 0715-0830 1/29/2013 Competent Person Excavation, Trenching and

Shoring Safety Center 0800-1630

0715-0830 2/4/2013 Work Zone Safety (Traffic Flagger) Training Bill Buckman, Du-All 0715-0215 2/27/2013 Safety Committee Meeting John Simonetti 0715-0830 February SOP Review, MSDS#-Review WBSD

3/4/2013 Work Zone Safety (Traffic Flagger) Training Bill Buckman, Du-All 0715-0215 March CCTV Operation Juan Coca 0715-0830 3/27/2013 Safety Committee Meeting John Simonetti 0715-0830 March SOP Review, MSDS#-Review WBSD 0715-0830

April 2Q-Site Safety Assessment(s) WBSD & CIP WBSD 4/8/2012 Construction Worksite Safety Training Jose Mora, Du-All 0715-0830 4/24/2013 Safety Inspection: Pump Stations, Operations, and

Administration Building Joe Moulton, Du-All 0830 - 0400

TBD Disaster Response Plan Review John Simonetti 0715-0830 4/24/2013 Safety Committee Meeting John Simonetti 0715-0830 April SOP Review, MSDS#-Review WBSD

5/13/2013 Workplace Violence Training Kerry Harris, Du-All 0715 - 0830 TBD Rodder & Hydro-Flusher Operations Alberto Patino 0715-0830 5/22/2013 Safety Committee Meeting – Accident

Investigation Training John Simonetti/ Steve Pierre, Du-All

0715-09:30

May SOP Review, MSDS#-Review WBSD

June Annual Lockout Tagout Program Review Bill Buckman, Du-All 0930 - 1130 6/10/2013 Lockout Tagout and Silica Dust Training Bill Buckman, Du-All 0715-0930 6/26/2013 Safety Committee Meeting John Simonetti 0715-0830 June SOP Review, MSDS#-Review WBSD

July 3Q-Site Safety Assessment(s) WBSD & CIP WBSD 7/8/2013 Confined Space Entry Training – Annual Refresher Dana Price, Du-All 0715 - 0300 7/23/2013 Hearing Conservation Training James Cole, Du-All 0800 July Hearing Conservation Annual Audiograms Center for Hearing 0715-0830 7/24/2013 Safety Committee Meeting John Simonetti 0715-0830 July SOP Review, MSDS#-Review WBSD

8/5/2013 Confined Space Entry Training – Annual Refresher Dana Price, Du-All 0715 – 0300 TBD Eel, Hand Rodding & Spartan Operation Safety Unit 208

SOP’s WECO 0715-0830

8/12/2013 Hazard Communication – Global Harmonized System and Emergency Action Plan

Joe Moulton, Du-All 0715-0830

TBD Working Around Cranes (08-24-2012) TBD 0715-0830 8/28/2013 Safety Committee Meeting John Simonetti 0715-0830 August SOP Review, MSDS#-Review WBSD

9/9/2013 First Aid, CPR, AED Training Jose Mora, Du-All 0715 – 0130 9/23/2013 First Aid, CPR, AED Training Jose Mora, Du-All 0715 – 0130 TBD Ditch-Witch O&M Training H. Cortez 0715-0830 9/25/2013 Safety Committee Meeting John Simonetti 0715-0830 September SOP Review, MSDS#-Review WBSD

October 4Q-Site Safety Assessment(s) WBSD & CIP WBSD 10/18/2013 Earthquake and Evacuation Drill: 10:18 AM

California Shake Out Joe Moulton, Du-All 1018 - 1130

10/7/2013 Respiratory Protection Training Bill Buckman, Du-All 0715-0830 October Medical Surveillance & Quantitative Fit Testing FROST 0715-0830 10/23/2012 Annual Respiratory Program Review Joe Moulton, Du-All 0830 - 0930 10/23/2013 Safety Committee Meeting John Simonetti 0715-0830 October SOP Review, MSDS#-Review WBSD

11/4/2013 Title 22 Hazardous Waste Management Training James Cole, Du-All 0715-0830 11/27/2013 Safety Committee Meeting John Simonetti 0715-0830 November SOP Review, MSDS#-Review WBSD

12/4/2013 Blood-borne Pathogen Exposure Control Training Steve, Pierre, Du-All 0715-0830 TBD Bob-Cat, Articulating Equipment Safety H. Cortez 0715-0830 12/18/2013 Safety Committee Meeting John Simonetti 0715-0830 December SOP Review, MSDS#-Review WBSD

Updated 10-04 2 F/MGMT/Training//Coll training manualxx

Job Related Duties Trainer Trainees Initials

Beginning Date

Completion Date

CHECK FOR NEW USA'S & PRINTER STOCKCHECK FOR INCOMPLETE USA'S ON 208'S HALLWAY CLIIPCHECK FOLLOW UP BOX IN BREAKROOMCOLLECT GAS DETECTOR, FIELD RADIO, PPE, AND 208 CELL PHONECOMPLETE VEHICLE CHECK OFF SHEETTURN ON TRUCK FIELD RADIO

1ST RESPOND TO CALLS IN ORDER TAKEN2ND USA'S

3RD ROUTINES

CONFIRM ADDRESS & CROSS STCHECK UP & DOWN STREAM MANHOLECHECKS & UNDERSTANDS MLO BOOKSERVICE PLCO TO MAIN LINEFLUSH LATERAL WHILE BRINGING BACK TOOL

CLEAN DEBRIS OVERFLOW, VACUUM SPILL IN STREET, SPRAY ENZYME

CONTACT CUSTOMER: LEAVE DOOR MAGNET, DOOR HANGER & PUBLIC OUTREACH MATERIALS

ABILITY TO READ AND UNDERSTAND DIRECTIONS ON U.S.A. PRINTOUTSUNDERSTANDING OF HOW TO PROPERLY MARK STREETS FOR U.S.A. (i.e. STRING LINE, SPRAY PAINT, PHOTOGRAPH, LOG )

KNOWS HOW TO USE LOCATORKNOWS TO USE CONE/CONES WHEN MARKING IN STREET ALONE

UNDERSTANDS HOW TO FOLLOW & LOG THE WORKORDERKNOWS HOW TO IMPUT DATA ENTRY

UNDERSTANDS ORDER OF IMPORTANCE

New Employee Training Form

Trainee Name: _______________________ Date of Hire: ______________

MORNING ROUTINE BEFORE DEPARTURE

USA MARKING

208 OPERATIONS PG.1

CUSTOMER SERVICE REQUEST CALL PROCEDURE

ROUTINES

UNDERSTANDING OF DISTRICT MAPS


ABILITY TO READ STREET INDEX AND BASIN MAPS KNOWLEDGE OF MAJOR STREETSUNDERSTANDING OF MANHOLE LOCATIONS, FLOW DIRECTION, GRAVITY MAIN, FORCE MAIN, MAIN SIZE,LAMPHOLE, STUB,etc.

Job Related Duties Trainer Trainees Initials

Beginning Date

Completion Date

KNOWS HOW TO PROGRAM AND USE GPS

RED SSO FORMYELLOW FOLLOW UP WORK FORMWHITE FOLLOWUP WORK FORM UNIT 208 DAILY WORKSHEETSERVICE REQUEST FORM

BUILDING SEWER MAINTENANCE DATA FORM

LATERAL INSPECTIION FORM

SERVICE REQUEST

BUILDING SEWER MAINTENANCE DATA

CONFIRM ADDRESS & STREET

CALL OUT MAIN LINE TRUCKSCALLSOURCE CONTROLTAKE PHOTO ASAPCONTAIN SPILL

ABILITY TO UNDERSTAND & FILL OUT WRITTEN RECORDS

208 OPERATIONS PG.2

Trainee Name: _______________________ Date of Hire: ______________

UNDERSTANDING OF GPS

UNDERSTAND SSO SPILL RESPONSE

New Employee Training Form

ABILITY TO ENTER DATA ENTRY


LOCATE FIRST EMPTY MH REPORT UPSTREAM & DOWNSTREAM MH PG# AND MH ID'SLOG CREW ARRIVAL TIMESLOG TIME STOPPAGE RELIEVEDKNOWS SPILL CALCULATIONKNOWN WHAT CATEGORY 1, 2, & 3 IS AND PROCEDURE FOR EACH ONETHE SSO 5 C,s - CONTROL, CONTAIN, CLEANUP, CALCULATE, AND CALL IT IN.

UNDERSTANDS SURCHARGE ALERTUNDERSTANDS INTRUSION ALERTKNOWS PROPER REMOVAL & REPLACEMENT OF SMART COVER LIDKNOWS HOW TO RETRIEVE S.C. CELL PHONE ALERT

KNOWS HOW TO SAFELY OPERATE LIFTGATEKNOWS HOW TO OPEN , CLOSE, & SECURE LIFT GATE

MARCO RODS- KNOWS USE & MAINTENANCESPARTAN - KNOWS HOW TO OPERATE & MAINTAIN IT.

SPARTAN - KNOWS HOW TO REPLACE THE CABLE

SPARTAN - KNOWS HOW TO REPLACE THE BLADE

EEL - KNOWS HOW TO OPERATE & MAINTAIN IT.

EEL- KNOWS HOW TO USE 8' CABLE EXTENTIONS

EEL- KNOWS HOW TO REPLACE BLADES

KNOWS HOW TO USE THE BLOW BAG

KNOWS OPERATIONKNOWS DANGER OF DAMAGING CABLEKNOWS HOW TO APPLY CAMERA SKIDKNOWS HOW TO USE FLASHDRIVE, SD CARD etc. ON COMPUTER TO VIEW AND DOCUMENT LATERAL INSPECTION

KNOWS HOW TO CALCULATE R.O.W. FORMULAKNOWS HOW TO LOCATE R.O.W. ON STREETSKNOWS HOW TO LOCATE R.O.W. ON COURTS

KNOWS HOW TO LOCATE R.O.W. FOR EASEMENTS

UNDERSTANDS WHAT AN EASEMENT IS

KNOWS THE PROPER USE OF FRONT AND REAR ARROW BOARDS

KNOWS HOW TO USE AMBER EMERGENCY LIGHTS

LIFT GATE OPERATION

CLEANING EQUIPMENT

BLOW BAG

SMART COVER

PLCO CCTV CAMERA

RIGHT OF WAY PROCEDURES

LIGHT OPERATION


KNOWS HOW TO USE WORK & FLOOD LIGHTS

KNOWS TO CHECK MH WITH CONE/CONESKNOWS HOW TO USE MH HOOK & REMOVE LIDKNOWS TO CHECK FOR DEFECTS & OBSTRUCTIONSKNOWS WHAT A PARTIAL STOPPAGE IS & AND SIGNS OF A MAIN THAT WAS HOLDINGKNOWS TO CHECK FOR I&IKNOWS NAMES OF MANHOLE COMPONENTS: INVERT ,CROWN, SHELF, etc.KNOWS WHAT A INSIDE & OUTSIDE DROP ISKNOWS HOW TO CHECK MAINLINE HISTORYKNOWS WHAT HOT SPOTS TO CHECK ON FRIDAYS AND MH's TO POUR NATURAL WAY IN

KNOWS HOW TO PRINT BASIC MAPSKNOWS TO ASK FOR ASSISTANCE IN HAZARDOUS TRAFFIC CONDITIONSKNOWS TRUCK RADIO OPERATIONKNOWS HOW TO USE THE FIELD RADIOKNOWS TO DO A WALKAROUND, SECURE STORAGE DOORS LATCHES & LIFT GATE BEFORE LEAVING AFTER EACH USEKNOWS FUELING PROCEDUREKNOWS NEVER LEAVE KEYS IN VEHICLE & TO LOCK UP VEHICLE WHEN OUT OF SIGHTKNOWS WHERE BACKUP ALARM SWITCH IS LOCATED IN CABKNOWS KEYPAD CODE FOR YARD GATEKNOWS HOW TO ARM & DISARM YARD ALARMKNOWS HOW TO ARM & DISARM TP ALARM AT 1700 MARSH RDHAS A KEY PHAB & KNOWS HOW TO USE IT

KNOWS HOW TO RETRIEVE & DELETE AFT HRS SERVICE CALLSKNOWS HOW TO OPERATE PAGERKNOWS TO ALWAYS HAVE CELL PHONE AND PAGER ON HAND BEFORE CONTROLL FOUR STARTS THEIR SHIFTKNOWS TO NOTE TIME OF CALL, CUSTOMER NAME, & STREET ADDRESS IF CALL WAS RETRIEVED FROM CELL PHONE & TO CALL CUSTOMER WITH ETA

MANHOLE INSPECTIIONS

208 BASICS etc.

CELL PHONE OPERATION