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J J ~ d ~ .. - - - SECTION I - SECTION II SECTION III - SECTION IV - SECTION V - SECTION VI SECTION VII - SECTION VIII - SECTION IX - - - - /ill - /ill /ill - TOWN OF WAPPINGER SAFETY MANUAL TABLE OF CONTENTS Safety Program Fire Protection, Flammables and Hazardous Materials Personal Hazards and Protective Gear Driving Rules and Regulations Departmental Safety Meetings Safety Reviews Accident, Injury and Incident Reporting Injuries and Illnesses Log Guidelines Procedures for Bomb Threats - - FORWARD - - The purpose of the Safety Manual for the Town of Wappinger . is to provide employees and supervisors employed by the Town with basic information and guidelines so that they may have a better knowledge of what is expected and required of them when confronted with various safety related situations. - - The Town of Wappinger Supervisor has prepared this manual for use by employees. It attempts to answer basic Sons and acknowledge various situations involving county employees, and his/her safety rights and . ations on the job. - The safety procedures manual should be viewed as a guideline and if any passages are in conflict with any local, state or federal laws or existing legal precedents, they should be modified to comply with those law.s." - - .. - - . - - . . . .. - - SAFETY POLICY AND PROCEDURE MANUAL - PURPOSE - The Town of Wappinger Policy and Procedures Manual sets forth policies, procedures, and guidelines for planning, organizing, and conducting an effective accident prevention program to preclude incidents and occurrences which result in personal injury or monetary losses in the form of property damage or work stoppage. - SCOPE - - The Town of Wappinger Safety Policy and Procedures Manual is published for the information and guidance of all employees and is designated to promote safe practices on Town buildings and grounds, and safety awareness, both on and off the jOb. It is directed to the prevention of all accidents, including motor vehicle, fire, hazardous materials, and environmental exposures. - - CONCEPTS AND PHILOSOPHY - A. Accident prevention is the responsibility of all Town employees. Leadership, direction, and support will be provided by the Town Board to accomplish employee training and safety while maintaining quality and efficiency with respect to manpower, planning, performance, cost, time, and employee morale. - - B. All employees will be reminded frequently of his/her safety responsibilities to themselves and his/her fellow workers as well as the Town of Wappinger and it's property. - C. Carelessness and indifference can result in serious injury or death as well as property damage or loss. Facilities, equipment,~operating techniques, and teaching methods will be studie~, evaluated, and improved constantly, so that goals are achieved with eco~~my, efficiency and elimination of hazards. Conservation of life and property is the most profitable combination of human relations and good sense, and sets a good example for employees. - - III OBJECTIVES AND GOALS .. The objective of this program is the prevention of all accidents and the reduction of occupational injuries and illnesses. .. III .,.\.-.... . . .' ...'~".....," .. .... '~." ;', .."i ':.:':<<< . ";'~j' ',': .'. .f~. - - page 1-2 - RESPONSIBILITY I. SUPERVISOR - 1. Shall be responsible for the enactment of a Town safety policy and provide a safety and health program conforming to the best practices of a Town government. - - 2. Shall require compliance to the Town Safety Policy and State Safety Regulations by the various department heads and personnel. I I. DEPARTMENT BEAD - - 1. Is directly responsible for maintaining safe working conditions, practices, and rules for the safety and health of all personnel under his/her supervision. The Department Head shall take action to correct unsafe conditions and shall follow up to assure that corrections are made. - - 2. Is responsible for the establishment of a department training program dealing with ~ specific department hazards and safety procedures and assuring each employee receives safety training. Is responsible to assure that each NEW employee receives safety training fully explaining the hazards associated with his job and general safety procedures prior to starting work. Is responsible to see that required personal protective equipment is provided and use9.in accordance with safety standards and practices - 3. - 4. .. .. 5. Will require employees to report hazardous conditions and will give the reports immediate attention. - 6. Will schedule safety meetings as often as necessary to effect safe practice and work methods but not less than once a year. 7. Will be responsible for maintaining department records. .. - .. .. .. .. PAGE 1-1 TOWN OF WAPPINGER SAFETY PROGRAM .. SAFETY POLICY 1. 2. 3. 4. 5. 6. .. Personnel at all levels shall be responsible for the prevention of accidents and unsafe conditions. .. Al-l personn~l are required to observe all safe practices, ~tate safety regulations, and Town safety policies and directives, and avoid unsafe acts which might endanger or injure them, his/her fellow workers or the public. - - Meaningful safety meetings will be held on a department level with the cooperation of all employees. Regular safety inspections shall be conducted to assist in successful loss prevention. .. . All accidents will be investigated by the injured employee's supervisor and when necessary, the Town Board. .. Adherence to the established rules of safety shall be taken into account during an employee's performance evaluation. - - .. .. ... - .. - liliiii - - page 1-3 - 8 . - 9 . - Will conduct and document periodic safety reviews of his/her facilities, equipment, ._.and vehicles and take the necessary corrective action to remove unsafe conditions. - Is responsible for assuring that all equipment assigned to his/her department is maintained in a safe operating condition in accordance with appropriate standards. 10. Will assure that employees under his/her department follow the Town Safety Policy, State occupational safety and health standards, and department safety rules and regulations. 11. Will see that all accidents are reported and that in case of injury will advise that the employee seek treatment. - - - 12. Will, in the event of an accident involving an employee under his/her immediate supervision prepare the required incident report form at the time of notification and forward it to the Comptroller and shall take corrective action to prevent similar type of accidents, if possible. - - - - .. .. . - . . .. - page 1-5 .. IV. THE EMPLOYEE 1. Is to read and abide by the Town Safety Policy and Department Safety Rules and Regulations. 2. Will exercise maximum care and judgment in the performance of his/her job to prevent accidents. 3. Shall not consider his job complete unless he has followed every precaution and safety rule to protect himself and fellow employees from injury. 4. Should immediately report all injuries to his/her immediate supervisor and seek treatment for all injuries, when necessary. - - - . 5. Shall report unsafe conditions, equipment, or practices as soon as possible on an unsafe condition report form. . 6. Shall use provided personal protective equipment. 7. Should consider safety meetings as a regular part of the job. . . . . . .. . . .. . . .. .. - page 2-0 FIRE PROTECTION, FLAMMABLES AND HAZARDOUS MATERIALS SECTION 1 .. Page Classification of Fires 2-1 2-1 2-1 2-2 2-2 - .. Extinguishers General Information Maintenance and Inspection Types Flammable Liquids - Use, Storage & Transportation 2-3 2-6 2-6 2-7 2-7 2-7 2-8 - .. Evacuation Procedures Health Hazards - Other Hazardous Materials Definition and Identification Control & Storage Container Labels & Specific Hazard Warnings - - SECTION 2 Emergency Evacuation Plan 2-12 - - .. .. . ... . . - .. - - - .. . . . . . .. . . JII . .. . - - page 2-1 FIRE PROTECTION AND FLAMMABLES CLASSIFICATION OF FIRES - ... Fire Class Description - "A" Ordinary combustible materials: - - "B" Flammable liquids: Greases oils, paints, gasoline, etc. .. "C" All Electric- al equipment ., Extinguishing Effect Needed Extinguishing A<Jents Cooling Quenching water soda-acid Solutions con- taining _-a- large % of water Smothering Blanketing Foam Carbon Dioxide Dry chemicals Sand A Non-conducting agent Carbon Dioxide* Dry Chemicals *Note: Carbon dioxide extinguishers with metal horns are A9t safe for use on fires in energized electrical equipment. EXTINGUISHERS Use the right extin9uisher for the type of fire for which it is intended. The wrong extinguisher may spread the fire and could be dangerous to the operator. A sticker should be attached to each extinguisher showing the type of fire for which it is intended. In addition, signs containing this information should be posted above the location of each extinguisher. - - General Information ... . . The number and placement of extinguishers depend on the size of the area, the type of building construction, and the combustibility/flammability factor of the contents. It is very important that extinguishers be installed in accessible location, easily seen, attached to a rigid stationary object, and that a clear "right-of-way" be maintained to the extinguisher. . . Extinguishers shall be installed so that the top of the extinguisher is not higher than 5 feet above the floor. . III . . "~.o. '-" ",' , .; -,' ',:'". ". '.', ;"~';'''.-': .. .. page 2-2 All department trucks, self-propelled equipment, and towed equipment such as tar kettles, thermoplastic stripers, etc. shall be equipped with a fire extinguisher of the appropriate class. All personnel should read the extinguisher label and become familiar with the operation of the equipment before the need arises. .. .. - Maintenance and Inspection .. Extinguishers should be checked every month for damage, clogging of nozzles, deterioration, an recharge by the Fire Inspector. An annual inspection tag must be attached to every extinguisher, and should be initialed and dated by the inspector after each inspection. A very fine wire acting as a seal may be attached between the extinguisher and wall or attached to the release valve. A broken seal indicates that the extinguisher has been used or tampered with. If a seal or wire is broken, the extinguisher shall be immediately inspected and recharged, if necessary. Extinguishers containing charge indicators will indicate the necessity for recharging. When the indicator falls below the "operating range" the extinguisher must be serviced immediately. '. . III . . TYPES ~, .. ~LASS A FIRES Ordinary ~ombustible materials (wood, cloth, paper) Water control (cooling effect) Pump Type Release lock latch Pump plunger rapidly Lasts one minute - 30-35 foot stream Stored pressure type Pull locking pin Squeeze handle Direct stream at fire base (not at smoke) Side to side motion Wet all burning surfaces Break apart and soak Don't use on flammable liquid (splash) Don't use on electrical fires (shock) . . . . . . j' '.'. J' :;,:' '" ~ ,.~. !.... 'i. - ... .. .. - - ... - - ... - ... .. .. .. . .. .. . page 2-3 CLASS B FIRES Flammable or combustible liquids (gas, oil, grease, solvents) Carbon dioxide (co2) and dry chemical (excluding oxygen) Carbon dioxide Remove horn Pull locking pin Squeeze handle Begin near edge Steady sweeping motion as you prog~~ss Continue discharge to prevent reflash Avoid splashing flammable liquids Don't touch horn - co2 frostbite Discharge time - 15 lbs. - 11 to 15 seconds Dry chemicals (stored pressure) Remove nozzle Pull locking pin Squeeze handle Gas Cartridge type Remove nozzle Pull locking pin Press lever Squeeze operating handle Discharge dry chemical across entire fire front Allow discharge stream to fan out Side to side motion as you progress Continue discharge to prevent reflash Avoid splashing flammable liquids CLASS C FIRES Energized electrical equipment Carbon dioxide Co2, dry chemical Shut off power as soon as possible Don't use water--severe shock hazard FLAMMABLE LIQUIDS All storage, handling, or use of flammable liquids should be under the supervision of persons instructed in.safe handling and use. Sources of ignition should be prohibited in areas where flammable liquids are stored and used. Warning and "NO SMOKING" signs must be posted. Rubbish, brush, long grass, or other combustible material should be removed from immediate areas where flammable liquids are stored or used. page 2-4 All spills of flammable liquids should be cleaned up -immediately. Electrical lighting is to be the only means used for illumination in areas where flammable liquids, vapors, fumes, dust, or gases are present. Globes or lamps are not to be removed or replaced nor should repairs be made on the electrical circuit until the circuit has been de-energized. All buildings, rooms, and compartments where flammable liquids are stored or used should be properly veptilated. Shipment of all flammable liquids should be in containers approved for shipment of such materials and tagged or labeled appropriately. Drums and other flammable liquid containers should be kept tightly capped. This regulation applies to empty and filled containers, at all times. Flammable-"liquids should be stored in a fireproof metal cabinet. Storage tanks of flammable liquids should be electrically bonded and grounded, equipped with proper relief vents. Tank vents should not be located close to open flames, stacks, heating apparatus, or any other source of ignition. Water draw off valves should be anti-freeze type or insulated to prevent freezing. Dispensing outlets from storage tanks above ground should be equipped with quick-closing valves. Smoking or the use of open flames within 50 feet of where flammables are being used or where equipment is being fueled is prohibited. Handling of all flammable liquids by hand containers should be in approved safety containers, not to exceed 5 gallon capacity. All tanks, hoses, and containers involved should be kept in metallic contact while flammable liquids are being transferred. Employees should guard against clothing becoming contaminated with flammable fluids. Do not continue work when clothing becomes contaminated. Remove contaminated clothing as soon as possible and wash the effected body area using a shower, hose, etc. - .. - .. - . . ,. . 4l1li .. 41 . .. .. t iii . I . ~' '':''',''.''' ," , .. ,~ - .. - page 2-5 No flammable liquid with a flash point below 120 degrees should be used for cleaning purposes, nor should carbon tetrachloride be used. .. - Oxygen cylinders should be kept at least 50 feet from any flammable liquid storage area. This includes motor oil. Containers of paints varnishes, lacquers, thinners, or other volatile painting materials should be kept tightly closed when not in actual use, and stored in a cool, dry place, apart from other storage, and as far away as possible from employee exposure. They should be kept in a well-ventilated location, free from excessive heat, smoke, sparks, flame, or direct rays of the sun. - - Paint-soiled rags and drop cloth, when not in use, should be stored in cabinets. ... - Ventilations adequate to prevent the accumulations of flammable vapors to hazardous levels of concentration should be provided in areas where painting is done. - No smoking or open flame, exposed heating elements or other sources of ignition should be permitted in areas or rooms where spray painting is done. only explosion proof electrical devices are permitted in these areas. .. FUELING .. All motor vehicles and mechanized equipment should be shut down with ignition off during fueling operation. Smoking is prohibited near fueling stations. "No Smoking" and "Turn off Engine" signs must be posted at all fueling points. TRANSPORTATION OF FLAMMABLES . . Gasoline, diesel fuel, or other combustible or flammable liquids will not be transported in vehicles unless they are contained in 5 gallon approved safety cans, or in the original, unopened containers (55 gallon drum), and those drums are firmly secured to the vehicle. Combustible liquids will never be transported in passenger areas of a vehicle, nor will they be transported on the front of any vehicle. . . .. When transporting more than 55 gallons of a flammable in one container, the container should be properly vented, and contain an anti-siphon device to prevent leakage from the fill pipe in the event of an accident. .. . . ... page 2-6 - When transporting ~,OOO lbs. or more of a flammable material, it is necessary to placard all four sides of the vehicle with "flammable" warning placards. . EVACUATIONS PROCEDURES Evacuation procedures for personnel in case of fire will be provided. Evacuation routes will be posted in all facilities in which employees work. . . BURNING AREAS Compliance with appropriate local, state, and federal laws must be observed for all burning operations. . HEALTH HAZARDS . Fire isn't the only danger associated with flammable and combustible liquids: many of these liquids can be hazardous to health. . Avoid skin contact. Most flammable and combustible liquids will remove the oils from the skin and cause irritation, cracking, rashes, or infection. Wear protective gloves and aprons if there is a chance of skin contact. Always wash liquids from skin with non-abrasive soap or hand cleaner. Don't breath vapors. Avoid breathing vapors of any liquid: use flammable and combustible liquids only in a well-ventilated area. If ventilation is not possible, use an approved respirator. Be especially cautious when working in confined spaces. - . 411 . Eye protection. Always wear chemical goggles when pouring flammable or combustible liquids. If spraying these liquids, or if there is a chance of liquids splashing in the face, a full face shield should be used in addition to the goggles. If someone is splashed with harmful or burning liquid, he/she may not be able to help themselves. Chemical splashes.and burns can be very painful, and each worker must depend on his co-workers for help in an emergency. If someone is splashed, get him to running water immediately. Flush the splashed area with water for at least 15 minutes, and remove contaminated clothing while flushing with water. Get medical attention immediately. Eye wash and shower stations must be readily available when the possibility of splashing such chemicals exists. . . .. .. . - - page 2-7 - OTHER HAZARDOUS MATERI~LS Definition of Hazardou~ - - A material may be hazardous for more than one reason. The manufacturer's label may not identify all of the hazards or their true severity. Therefore, a reliable reference is advisable for any work place that handles a variety of chemicals, solvents, or other potentially hazardous materials. Questions should be directed to the Safety Coordinator or your supervisor. Chemical health hazards are grouped according to the effect they have on your body. .... - .. -Carcinogen -Corrosive -Toxic -Irritant -Sensitizer -Target organ effects Identification - - The first step in working safely with hazardous materials is to obtain a Material Safety Data- Sheet (MSDS). List their location by room or work area, their quantity, and use. All chemicals, solvents, cleaning fluids, or any other substance about which there are doubts should be included. List the complete chemical name if available, the manufacturer or supplier and telephone number, the trade name of the material, the quantity stored or used, and the purpose of the material. Include label warnings such as "extremely flammable." Do not assume that a material isyarmless just because there is ~~ warnin9 label. A list of hazardous chemicals and a copy of the MSDS for each is available at each facility where chemicals are used or stored. - - ... . . Control & Stora~e . Once hazardous materials have been identified, controls should be established for their purchase, storage, distribution, and use. Purchase intelligently. A five gallon drum may be bought even though only a small quantity is actually needed. Keep track of how much was used, and when. III' . . ... - page 2-8 - Safe storage facilities are a must. I~juries can occur thru container leakage and incompatibility of commonly stored materials. Strong oxidizers, flammable and explosive substances and highly corrosive materials should be assigned special storage areas. They should also be separated from each other. The amounts of a hazardous material, stored at a location in the work place should depend on the following: - .. . -Relative hazard of a material. -Type and size of storage container. -Distance of the storage area from other parts of the workplace. -Availability of ventilation and fire extinguishing systems. till . Also see manual section on fire protection & flammables. Container LabelR and Specifjc Hazards . Hazardous chemicals should be labeled clearly with precautions for safe use. If the contents of the container are hazardous, the container should display prominently one of the following words: .. II Caution (be aware of possible hazard) Warninq (protect yourself from possibly severe hazards) DanQer (follow all instructions precisely to avoid extreme and immediate hazards) . . poison (this word and/or the symbol of the skull and crossbones indicates that small quantities aLe hazardous, and that if swallowed, inhaled, or absorbed through the skin, the results may be fatal> . , .. If the label has one of the four key warnings listed above, it should state clearly the specific kinds of physical and/or health hazards in using the contents: ~;~::a~i~~ ~~~r~~~~y ;~am~ablel causes.irritation, may ;ki~; t~;ir_-- ---- r__~t1on, harmful 1f absorbed throuqh _____ ____Cl harmful dust, and vapor harmful.. .. , ". . .... - page 2-9 - Flammable means the contents are capable of being easily ignited and has a low flash point. The flash point of a liquid is the lowest temperature at which the material gives off enough vapors to form an ignitable mixture with air, near the surface of the liquid. Many hazardous liquids have flash points at or below room temperature. Vapors around these liquids will ignite immediately if a source of ignition is present. Extremely flammable means that the substance can catch fire or explode very easily, even if its temperature is below the flash point. Such materials evaporate rapidly at ordinary temperatures, forming a readily flammable mixture which can burn or explode if ignited. Keep flames or other sources of ignition away from any substance which ~be flammable. Even if a container is labeled non-flammable, read the label anyway. Some mixtures of solvents contain both flammable and non-flammable components. Manufacturers are not required to label such mixtures flammable, and may able them non- flammable. If in doubt, treat the material as flammable. - - - - - .. - "Causes irritation," "may cause allerc;]ic skin reaction,." "avoid contact with skin," "causes severe burns," and "causes severe irritation" mean exactly what they say. Keep the substance off clothing, where it might later contact skin. Anything which can damage the skin can more easily damage eyes. Always use any available protective equipment to protect eyes from contact. .. - - "Toxic" means POISON. Any toxic substance can cause harm if swallowed, but some also enter the body through the skin or by breathing dusts or vapors. "Harmful" dusts or fumes mean they can injure if inhaled. .. "Avoid prolon<;1ed breathin<;1 of vapors" means that brief exposure may not result in harm, but a longer exposure may. - - "Oxidant" or "oxidizinc;] a<;1ent" means that the contents readily give off oxygen. When oxygen combines with combustible materials, the mixture may burn or explode, even without a source of ignition. Keep the container closed to avoid rapid evaporation, and build up of high concentration of vapor. - - "Use with adequate ventilation" means that you should either use the substance with dependable, properly directed, forced ventilation (an open window or"door may not be enough), or use it outdoors. - .. . page 2-10 If any employee becomes ill during or after use of a hazardous substance, check the label for directions in handling the emergency. Get medical attention immediately. . . Route of Absorption There are three (3) possible routes of absorption of toxic substances into the body; swallowing, through the skin, and breathing into the lungs. .. .. Poisons can be absorbed when food or drink is left lying around exposed in air containing toxic fumes or dusts; thus exposure through swallowing. The effects of absorbing toxics through the skin vary greatly. Most hazards of this type can be countered by cleanliness and protective clothing. When handling toxic chemicals, full protective clothing should be worn. All containers or hazardous materials must be specially labeled to indicate the hazard of their contents. They must be covered when not in use to avoid unnecessary skin contact. . . .. - There are two types of dust in the work environment which can be absorbed into the lungs: ... Nuisance dusts which irritate, but are soluble in body fluids and are excreted. .. Dangerous dusts which are insoluble and get lodged in the lungs leading to long term ill-health effects. Also see Manual Section on Personal Hazards and Protective Gear - Respirators. .. Hazardous Materials Spills on the Highway .. It is the Town's policy nQt to have employees clean up hazardous materials spills of private shippers involved in accidents. Shippers of hazardous materials are responsible for the clean-up of their hazardous materials when spilled. rft .. - Vehicles which carry hazardous materials should have placards identifying the type of hazardous material being carried. These materials can be chemicals, explosives or radioactive materials. .. .. - ., ... page 2 - 11 - When employees encounter hazardous material spills, they should immediately notify police and fire departments. It is generally considered good practice to keep people 2,000 feet from a hazardous material accident until the material is identified and the safety precautions are understood. To effect this, Department forces should perform other necessary work, such as traffic control, until police and fire personnel arrive on the scene to take control. .. ... - - - - .. ... .. - ., - - .. .. - . 4Il .. . . .. . . . - .. 1M - - - .. - .. - page 2 - 12 - EMERGENCY EVACUATION PLAN - TOWN OF WAPPINGER FACILITIES ... CONTENTS - PURPOSE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PART I SAFETY ORGANIZATION & RESPONSIBILITIES......PART II FLOOR PLANS................................. PART "t I I SPECIAL INSTRUCTIONS........................PART IV - PURPOSE PART I - - To deal with emergencies such as fire, bomb threat, etc., this Emergency Evacuation Plan will be followed by every employee and visitor to insure an orderly evacuation of this facility. SAFETY ORGANIZATION & RESPONSIBILITIES PART II - TOWN SUPERVISOR--HIGHWAY SUPERINTENDENT .. DEPARTMENT'S-----WARDEN SEARCHER OCCUPANT - - - - - - - - .. .. page 2 -13 A. SUPERVISOR/HIGHWAY SUPERINTENDENT: .. 1. The Supervisor will be the Liaison Officer. 2. He/She will have Liaison with the Department Heads, Marshal (s), and others. (e.g. Fire, Police and Sheriff's Department representatives) 3. Recruits Marshal (s) for each floor. . . 4. Coordinates all activities in the pre-designated assembly area. III B. MARSHAL: 1. Familiarizes himself/herself with the area and assists evacuees in the exit routes to the assembly area. .. .. 2. Designates an alternate to act in his/her absence. 3. Activates the Emergency Evacuation Plan for the _.9rea floor wh~n appropriate. 4. Ascertains the identification and work location of all handicapped employees or those who would require assistance to leave his/her area, floor or building in an emergency: a~sures the designation of certain individuals to assist when required. 5. Assures that all information concerning fires, bomb threats or other emergencies is always transmitted to the Supervisor/Highway Superintendent. . . II .. .. 6. When his area is cleared of occupants, he will report this information to the Supervisor and then leaves the building to the pre-designated assembly area for further instruction from the Supervisor/Highway Superintendent. C. DEPARTMENT WARDEN-SEARCHER: . ':0 h . . 1. There will be a Warden-Searcher appointed for the Town. (Highway--Town Hall) 2. Insures that an employee is assigned to each handicapped employee. .. . . - .. page 2 - 14 .. 3. Activates Emergency Evacuation Plan for his/her work area,where appropriate. .. .... 4. Assures that information concerning fires, bomb threats, or other emergencies such as occupants trapped in rooms, is always transmitted to the Supervisor/Highway Superintendent and the his/her Marshall is notified. .. 5. Familiarizes himself/herself with every conference room, library, Xerox room, rest room, storage room or remote location in his/her assigned area. - - 6. Will visit these locations and the appropriate rest rooms in the event of an ordered evacuation to ascertain that all have heard the alarm or instructions and have left the area. - 7. Will report to the Marshal that his/her area has been cleared of all occupants and then leaves the facility for the designated assembly area. 8. Reports" to his/her Marshal in the assembly area to receive further instructions. - .. D. OCCUPANTS - 1. In the event a fire is detected, SOUND THE ALARM, by using the automatic fire alarm device located in the building to alert occupants in the facility AND notify the local Fire Department. If you are unable to use the automatic fire alarm system, use the nearest phone - give your name, the room number and the floor where the emergency is located. Then notify your Marshal or area Warden- Searcher. .. - - 2. If the nature of th~ fire permits, you should close doors in attempt to contain it and then leave the building immediately. - 3. Cooperate with the Safety Organization, Police, and the Fire Departments. FOLLOW THEIR INSTRUCTIONS. - 4. At the sound of alarm or verbal warning: .. a. Terminate all phone conversations. b. Close all desk and file cabinet drawers ~ do not lock. - - - page 2 - 15 - c. Secure cash, valuables, etc., as per instruction from your Department's internal security plan. d. Take purse or outer clothing and leave the building. - . e. Close office door behind you - but do not lock. .. f. Take all visitors with you. g. USE THE NEAREST DOOR - h. Go .to your designated assembly area for head count, and stay there until further instructions are given. The Department Head or his representatives, will inform and control employees in the assembly area until instructions are given to re-enter the Facility. 5. Handicapped Occupants: With the assistance of a preassigned fellow employee, you will be assisted to the assembly area. E. SHERIFF, DUTCHESS COUNTY . .. - .. He will perform traffic control of evacuees at all exit doors, and then stand by these doors to PREVENT RE-ENTRY BY EMPLOYEES OR OTHERS during the emergency period. - .. FLOOR PLANS SPECIAL INSTRUCTION PART III PART IV .. A. The Safety Organization is only to move people NOT TO FIGHT FIRES OR SEARCH FOR BOMBS. :;iff - B. Qccupants of the building will evacuate the ""building when told to do so and assemble at the pre-designated location. OCCUPANTS OF THE . BUILDING WILL NOT REMAIN IN THE TOWN FACILITY NOR INTERFERE WITH POLICE AND FIRE DEPARTMENT OPERATIONS. An occupant will move to at least 300 feet from the facility. C. Occupants of the building and members of the Safety Organization will sound the alarm immediately when they are aware of an emergency. .. .. - - - - - D. - E. - - - - - - - .. . lilt . . ., . . page 2 - 16 Above all, don't panic! DON'T RUN - WALK! Keep conversation level down and listen for further instructions and follow them. Fire exit drills will be held a minimum of once a year to insure an orderly evacuation of all occupants and the corrections of any faults in this plan. - . - ... ... - . . . . . J . . .. . . . - - - page 2 - 18 - FIRE EVACUATION PROCEDURE - SPECIAL INSTRUCTION - TO: POLICE PERSONNEL - - In the event of a Fire Alarm sounding while you are on premises the following procedure will be followed: If you have person (s) restrained in your custody you may remain in the building, in the holding area, near the exit door from the Judges Chambers that leads to the exterior of the building, unless in your judgment, conditions become hazardous. - - If you are in the court room with a person in custody when the alarm sounds, please go to the holding area stated above until notified of all clear. - If you do not have anyone in custody, please evacuate the building with all other occupants and assist in preventing persons from re entering the Town Hall until the all clear is given or assist as requested. - - - .. - - - - - 41 41 III page 2 - 17 FIRE EVACUATION BY DEPARTMENT AREA . ASSESSORS OFFICE SR. CITIZENS ROOM . Occupants shall exit building via the east side and shall meet at the Gazebo for a head count. Citizens Room may also use direct exit from the the exterior of the building. main doors Sr. room to II TOWN CLERK RECREATION OFFICE TAX COLLECTORS OFFICE II shall exit the bu[ding via the main door and shall meet by the Flag Pole for a head count. . BUILDING DEPARTMENT ZONING OFFICE FIRE INSPECTORS OFFICE PLANNING OFFICE EMPLOYEE LOUNGE . . shall exit bulding from rear east exit (by lounge) and meet in rear parking area for head count. . SUPERVISORS OFFICE COMPTROLLERS OFFICE WATER DEPARTMENT JUSTICE COURT COURT CLERKS . . shall exit via the west side main doors and meet in west side parking lot for headcount. . FLOOR PLANS FOR ABOVE LOCATIONS WILL SHOW DESIGNATED EXIT FOR EACH AREA AND ALSO SECONDARY EXIT. .. .. .. .. .. .. - - page 2 - 20 - FIRE EVACUATION PROCEDURE - SPECIAL INSTRUCTION III . TO: Town Board Zoning Board Planning Board - When a public meeting is in session, the person chairing the meeting shall point out exits and fire alarm procedure prior to the start of the meeting. If the number of people preseflt is relatively small, the people should be instructed to leave by the exit at the front of the meeting hall directly to the outside of the building, with the designated board member securing the door to the corridor before leaving, if conditions and time permits. . - .. If the meeting consists of a large crowd, people should leave by the closest exit. The fire alarm system is a direct dial to the fire department at the time of activation. . .. . . . .. . . .. . . - page 2 - 19 . FIRE EVACUATION PROCEDURE - SPECIAL INSTRUCTION . TO: TOWN JUSTICE COURT DAYTIME SESSIONS: . Prior to calling the court, the Court Officer shall advise occupants that in event of fire alarm activation, all occupants shall leave the building quickly and in an orderly manner. The locations of the fire exits shall also be pointed out at this time. Court Clerks doing business at the window shall inform any persons waiting to sign in or pay fines to also leave the building as stated above. . I I NIGHT SESSIONS: , The above procedure will be initiated in addition to the Judge or Court Officer, at the time of fire alarm activation, notifying the occupants to exit the building via the main court door and turn to their left or right to evacuate building. . . Court Officers on duty in hallway shall direct people to either of the appropriate exits. . . . . . . - - page 3 - 1 - PROPER LIFTING TECHNIQUES - Of all unsafe acts, "Improper lifting of handling" is one of the most common. - 1. Before lifting, size up the load. Do not attempt to lift it alone if there is any doubt in your mind about your ability to do so. 2. If the container is wet or oily, place it inside a dry container so it will not slip while you are holding it. - - 3. Make sure hands are dry, not wet or greasy, grasp the load. - - 4. Make sure there is a clear path for you to carry the load without tripping if the load blocks your view, do not carry it -- roll it or use a shop cart or hand truck. - 5. Bend the knees outward and "straddle" the load somewhat, keeping the back as straight as possible. The best method consists of bending the knees, using the legs to lift. 6. Start pushing up with the legs, your strongest set of muscles. Keep the load close to your body as you come up, taking full advantage of the mechanical leverage your body now possesses. - - - 7. Keep your balance -- don't twist under strain or jerk the--load. - 8. Watch where you step, especially on stairways. 9. If you deposit the load on a bench or table, place it on the edge to make the table take part of the load and then push it forward with the arms or, if necessary, with part of the body in a forward motion. - - 10. In lowering the load from a waist-high carrying position, bend the knees and with a straight back and load close to the body, lower the load with the arm and leg muscles. 11. Finally, before leaving the object, be sure it is safely placed where it will not fall or have someone fall over it. - - - page 3 - 0 PERSONAL HAZARDS AND PROTECTIVE GEAR Proper Lifting Techniques Hard Hat and Vest Policy Eye Protection Foot Protection Hand Protection Hearing Protection Respiratory Protection . . . page . 3-1 3-2 3-3 3-5 3-6 3-7 . . . .. 3-9 .. . .. - - , .. III .. .. .. .. - - - page 3 - 3 EYE PROTECTION - Protective eye and face equipment is necessary where there is a danger of injury from flying objects and liquids, welding flash, or other sources of potential eye injury. Protective equipment must protect against the specific hazards it is designed for: be reasonably comfortable, fit snugly and not interfere with movement, be durable: and be kept clean and in good condition. - - - Protective eyewear for employees who wear corrective glasses must be one of the following: Eyeglasses with protective lenses that also provide optical correction, goggles to be worn over glasses, or a face shield to fit over eyeglasses. - - Types of Eye Protection - Welding & CuttinQ - Welding, cutting, and brazing require helmets or hand shields. Goggles also should be worn to protect employees working nearby against rays from adjacent work and from flying objects. Helmets and hand shields and other eye protection must be made of a material that insulates against heat and electricity, and which is flame resistant. Helmets must be provided with filter and cover plates designed for easy removal. All parts of welders' helmets must be constructed of a material that will not readily corrode or discolor the skin. Goggles must be ventilated to prevent fogging. All glass for the welding lenses must be tempered, substantially free from flaws. Lenses must have a permanent distinctive marking by which the source and shade is readily identified. - .. - - - Chemical Hoods and GOQQles - Goggles and face shields are available to protect the eyes and face against chemical splash hazards. Goggles used with chemicals may be ventilated with indirect or hooded vents only if no irritating vapors are involved. To prevent a splash from penetrating ventilation ports, special baffles in some goggles direct the chemical to the bottom of the goggles. - - .. .. page 3 -2 . HARD HAT AND VEST POLICY All employees must conform to the Town hard hat & vest policy. The basic provisions of the policy are: Employees exposed to an overhead hazard or hazard from flying objects are required to wear approved hard hats at all times in all locations, including indoors. Employees working or otherwise located within the highway right-of-way are required to wear approved hard hats, ~ approved vests, shirts, or jackets. The basic provisions of this policy apply to all employees, including visitors, supervisors, and managers. . II1II .. .. Without exception, employees flagging must wear approved safety vests. No alternative to a vest will be allowed for flaggihCJ. Hard hats and vests will not be required for operators inside a completely enclosed cab (truck or equipment) constructed of steel frame and glass, or inside an automobile. If the supervisor believes that an enclosure will not afford adequate head protection in the event of an accident, a hard hat will be required. Vests or belts will not be worn while working in trees, or operating a chain saw or bush clipper. Supervisory discretion will dictate the appropriate use of vests and belts while operating machinery with accessible moving parts. .. .. .. .. .. Hard Hats will be required while working in the bucket of a boom truck. . There may be isolated an specific situations of limited duration where the wearing of protective gear poses a hazard itself. When such a situation exists, supervision has the authority to accept this procedure as necessary, only for such limited duration. . . . . . . - - page 3 - 5 .. Foot Protection .. Protective footwear generally means ~hoes and boots specifically designed to: resist impact to toes and feet, penetration of the sole, slippery walkways, penetration by water, deterioration by chemicals and solvents, temperature extremes and hot materials, impact to the metatarsal area, cuts to the foot and ankle, and electrical hazards. .. .. .. Metal toe protectors must meet OSHA standards for impact protections and should be used where foot and toe injury could result. ~ypes of Protection .. Safety toe footwear is probably the most well known type of foot protection. Steel toe shoes and boots must meet minimum requirements for both compression and impact testing. Penetration of the sole of the foot is guarded against by means of soles reinforced with a flexible steel inner sole. However, they are not suitable for work where contact with energized electrical equipment is likely. .. .. .. .. Footwear designed for work in slippery areas usually have soles of neoprene, synthetic rubber, or a material impregnated with an abrasive surface. .. Other boots and shoes have soles resistant to oils, grease, creosote and metal fillings. They can be made of synthetic rubber also resists water and insulates against electricity. .. Shoes and boots of natural rubber resist some chemicals. Natural rubber also resists water and insulates against electricity. One way to protect feet from extreme cold is insulated boots and shoes. The insulating material should not absorb perspiration, moisture, oil, or odors. .. . .. When working with some material, such as logs and drums, workers need more protection. Logs and drums can roll, so the footbones (called metatarsal) also need protection. Shoes and boots are available with built-in metatarsal guards. .. .. . . page 3 - 4 . Rubber mask goggles designed with a corrosive- resistant molded frame fit snugly against the face and protect the eyes from chemicals, acids, caustics, and fine dusts. For best protection, goggles should be worn under face shields. . . Impact Protection Glasses and goggles with clear hardened glass, hard plastic, or wire mesh lenses offer protection against moderate impact hazards. Side shields should be a part of such eyewear. Polycarbonate lenses should be specified where special radiation protection is not necessary. I I Polycarbonate lenses must be worn when flying steel is a hazard. . Goggles designed especially for impact-resistance to flying chips, particles, and sparks, usually have ventilation ports to prevent fogging. Although they will prevent the entry of particles, they will not exclude fine dusts or liquids. Various types of face shields also are available to be worn alone or over prescription glasses. Other face shields are attached to safety hats, and can be readily removed or flipped-up out of the way. . . . . Contact Lenses Use of contact lenses as a means of protection is prohibited. Contact lenses do not provide protection in the industrial sense. Their use without additional eye/face protection should not be permitted. When a wearer of contact lenses suffers a chemical splash in the eyes, delay in removing the lenses and properly irritating the eyes complicates eye treatment. . . . Emer~ency Eye Wash An important part of eye protection is the availability of emergency eye wash stations and kits. Employees should be advised of the availability and locations of such emergency equipment, and know how to use it. Units should be replaced immediately after each use and at least once every 6 months. . . I . - - page 3 - 7 - Hearin9 Protection - The following shows the acceptable noise levels for various durations of time. This is a guideline for determining whether a potential noise hazard exists, and whether steps should be taken to either lower the level of noise, reduce the period of exposure, or require hearing protection. - - Permissible Noise- Exposures - Duration (hours) Sound Level dBA (decibels) - 8 6 4 3 2 90 92- 95 97 100 102 105 107 110 115 - 1 - 1/2 - 1 3/4 1/2 1/4 No exposure in excess of 115 dBA - The list below provides examples of various operations and the associated noise levels. It too is intended as a- guideline to prevent exposure 0 excessive noise levels, or take corrective action to bring noise levels within acceptable limits. - . Leroy air compressor - indoors Sandblasting Inside rear cab of striping machine Chipper Stump cutter Chain saw Mower running in shop 60 lb. jackhammer - 10' distance 90 lb. jackhammer - 10' distance Gradall excavating 125 dBA 112 94-98 105 105-107 115-120 90 98-102 105-109 92-94 - .. ,. - Certain operations, or operation of some equipment, produce noise beyond the acceptable level. In such cases, employees are required to wear hearing protection....disposable earplugs, earmuffs, sound bands. Supervisors are required to provide ear protection, and insure that employees wear it. - - .. . page 3 - 6 Some footwear is designed to protect against high voltage electricity. This footwear dissipates static- electricity and provides a stable conductive path. Exposed metal parts are made of nonferrous metal. . . Hand Protection Gloves can protect hands against solvents, acids, abrasions, and punctures. Once the degree of protection is established, then the type of glove becomes important. Glove manufacturers provide chemical resistance guides and sets of specifications for glove materials. This information includes general properties of glove materials. This information includes general properties of glove material, when they may be used, and what types of solvents and other materials they resist. Below is a simple guide to proper hand protection. . . . .. Hazard. Protection . Mild irritant Barrier creams, gloves: light duty .. Heat, flame Gloves: leather, asbestos, aluminized fabrics, aramid, wool .. .' , Heavy Materials Electricity Gloves: leather, canvas Gloves: rubber . Caustics, chemicals Gloves: Specially designed for exposure Moisture resistant gloves: rubber . . Liquids (nonchemical) Sharp objects Gloves: Cut-proof . . .. . .. . - page 3 - 9 - .RESPIRATORY PROTECTION - The selection of the proper type of respirator is based on the nature of the hazard: chemical properties, label warnings, effects on the body, concentration, established permissible levels of exposure, the period of time respiratory protection must be provided, and the activities of workers in the hazardous area. The type and physical characteristics of the respirator are . equally important. - - - One limitation of all respirators is the certain ~aseous contaminants can enter the body by means other than the respiratory tract. Therefore, a respirator alone may not provide complete protection. - Air Purifyin~ Respirators .. This type cleans the contaminated air before it reaches the user by mechanical filter, chemical cartridge, or combination of the two. .. .. Mechanical filters remove particulate matter and chemical cartridges remove gases and vapors. Neither is designed for atmospheres with i~~~fficient oxy~en or with contamination levels above the specified limit of the device. The useful life of all respirators is limited by th~ concentration of the contaminants, the breathing demand of the wearer, and the capacity of the filter or cartridge. - .. .. Mechanical filter respirators are designed to protect against airborne particles such as dust, mist, metal fumes, smoke, etc. The consist essentially of a facepiece and filter (s). Attached to the facepiece is one of the several types of filters, which trap harmful particles as air is inhaled through the filter. - - Chemical cartridge respirators use chemical filters to protect against certain gases and vapors. The contaminant is chemically neutralized, rather than trapped in a screenlike material. They protect against intermittent exposure to light concentrations of gases and vapors, Fut are not intended for use in immediately dangerous atmospheres. - - .... 1Il . page 3 - 8 OSHA standards require that hearing protection be made available when the time-weighted average noise level for an 8 hour period exceeds 85 decibels. Hearing protection is mandatory when noise exceeds levels and time periods specified in the chart. In circumstances where there is loud noise, but the decibel level is within an acceptable range for the period of exposure, employees may request hearing protection. In such cases, supervision will make protection available. The most common methods for reducing the hazard from noise are to: . . . . Isolate the workers or machines Insulate the machines Reduce exposure time Increase the distance between noise and employees Use hearing protection . . - - .. . - . .. .. .. .. ... - - page 3 - 10 - Chemical cartridges should not be used for the following: - -In areas where there is insufficient oxygen to support life; -Protection against material that is extremely toxic in very small concentrations; -Exposures to harmful gaseous matter that cannot be detected clearly by odor; -Exposure to gaseous material that is harmful to the eyes, unless adequate eye protection is provided; -Exposure to harmful material that the particular cartridge is not designed to stop. - - - - Cartridges are color-coded to the contaminant guarded against. - - - - - - - .. - - - - . III . . . .. . .. .. .. ... ... .. . . . .. . .. - - - page 4 - 1 DRIVING RULES AND REGULATIONS - All drivers of municipal vehicles, and those using his/her personal vehicles in pursuit of municipal business, will comply with all applicable laws of the state as well as any additional regulations of the municipality. PARKING - - 1. Town vehicles are not to park in "NO PARKING" zones except in emergency situations or in required performance of official duties. At those times a vehicle is parked in a "NO PARKING" zone, emergency blinkers will be turned on. - .. 2. No Town vehicle is to be left unattended with ignition key left in the ignition. 3. All Town vehicles should be locked when not in use. .. 4. Before initial use of any vehicle each day, the driver will walk around and inspect the vehicle for damage, inoperable lights, loose hardware, under inflated tires, or any other condition which may create an unsafe situation. .. .. 5. Any deficiency encountered in a vehicle maintained by the Town will be reported to the Supervisor in accordance with established policy. It will be the Supervisor's responsibility to insure that appropriate action is taken to correct the problem in accordance with departmental policy. - .. EQUIPMENT .. 1. Safety belts will be worn at all times by all drivers and other occupants in the vehicle. 2. Vehicles with movable windshields are to have these windshields in the "up" position while in operation. .. .. 3. Portable or detachable doors may not be removed from vehicles unless: a. It is a necessity in order to perform the job. b. Mirrors remain usable when the doors are off. - - .. III . page 4 - 2 4. Turn signals will be utilized by all drivers at all times not less than 200 feet from making a turn to warn oncoming or following vehicles of intent. 5. Drivers will insure that; a. The windows, headlights, taillights and windshield wipers are clean and operational at all times. b. Tires are properly inflated and have sufficient tread for safe operation. IIIIi .. .. . 6. Tailgates will be up and locked when vehicles so equipped are in motion. If a vehicle's function requires that the tailgate remain in the open position, red flags will be attached to the outward corners of the gate. If the vehicle does not have a tailgate, but is loaded, the driver of the vehicle will insure that the load is secure on the truck and that overhangs are properly marked in accordance with applicable state and local laws. 7. Employees are required to check the safety of the vehicle in accordance with Town policy before he/she operates the vehicle. . .. .. III SPECIAL EQUIPMENT .. I. No employee will use special equipment without appropriate training. Special equipment such as tractors, hi-lifts, high rangers, graders, plows, cranes, or any unit which has special devices added for specific types of work will require formal instruction in safe and proper operation prior to use by a driver. 2. Employees who operate special equipment will operate such equipment in accordance with state, local, and departmental regulations. .. .. .. .. III iii .. II .. .. - - - - 2. - 3 . .. 4. - - - 6. .. 7. - - .. .. - - .. page 4 - 3 GENERAL 1. , Backing up vehicles without a clear view of the area back of the rear end will be done only with the assistance of a guide. If a second person is in the vehicle, he will get out and guide the vehicle back using the appropriate hand signal and voice signal. If the driver is alone, he will get out of the vehicle and inspect the area behind before backing. Again, strict caution is to be observed. Each employee who operates a vehicle regularly or occasionally is required to report any suspension or revocation of his license to his supervisor. Drivers will direct his/her full attention to driving only. Inspection of streets, trees, signs, etc. will be made by a second person other than the driver. During periods of limited visibility or any time when windshield wipers are in use, the vehicle headlights will be turned on. 5. Consumption of alcoholic beverages or narcotics immediately prior to the operation of a vehicle is strictly prohibited. Trailers are to be fastened securely to hitches. Safety pins in pintel locks will be used. Safety chains will be crossed under the hitch and securely fastened before moving the truck. All items to be transported either in a truck_or trailer, which may move around during transport, will be secured. lIII III page 5 - 1 DEPARTMENTAL SAFETY MEETINGS .. 1. Safety meetings should be held at least quarterly, but may be held more frequently if desired or required. 2. All employees MUST attend these meetings. 3.0 Meetings should be restricted to matters of safety only with such items_as: . . A. Discussion of accidents and injuries which have occurred since the last meeting. B. Discussion of safety rules and safe practices. .. . . .. C. Sa~ety Suggestions - unsafe conditions .. D. Special bulletins and instructions E. Defensive Driving. F. Hazardous Communications Program 4. Make the meetings meaningful, get active participation from the whole group. 5. Records of meetings should be kept on file (see suggested form) .. .. .. .. - III .. .. .. Iii .. - - page 6 - 1 - SAFETY REVIEWS - 1. Make at least a quarterly safety review of your facility. Monthly is suggested in hazardous operations. 2. Keep your eyes open on a daily basis for obvious hazards. - - 3. Use the Safety Review Form in this section. 4. Records should be maintained. on an unsafe condition report. Supervisor. Report discrepancies Copy to Town - - 5. Records will be periodically checked by the Insurance Company Safety Coordinator during his regular visits. - - - - .. - - . - - - .. . page 6 - 2 WHY OFFICE SAFETY IS IMPORTANT . Office work is commonly considered a non-hazardous occupation. This is only true, however, for the office worker who understands the injury exposure it involves, \ knows the safe work practices he/she should follow, .aaQ Q.~ who works in an office where specific attention has been given to "e-liminating the physical conditions that may cause accidents. . .. Sources of Injuries Percentage of total disabling injuries . Falls Handling materials or equip. Striking against material, equip. Vehicles Flying Particles Hand tools (pencils,pens,rulers,etc) 53% 20% 8% 3% 2% 1% . . . ... ... .. .. .. ... . . . . - - - page 6 - 3 ELIMINATING OFFICE ACCIDENTS - The.majority of accidents are caused by a combination of an'un~afe act with an unsafe condition. Corrective action obviously lies in eliminating both the unsafe acts and the unsafe conditions. - Unsafe acts can be eliminated by making employees-aware of the importance of accident prevention in the office and of following safe work practices. This can be accomplished by safety indoctrination of new employees, and by educating all the office workers in the types of unsafe acts to avoid and the safe work practices to follow. Initial education along these lines needs to be supplemented by periodic reminders, such as: discussions with employees of unsafe acts versus safe practices; use of caution signs; safety posters and pamphlets; and prompt correction of unsafe acts when observed by supervisors. Unsafe conditions can be discovered through periodic inspections by the Supervisor or by Department Heads. Conditions to be corrected should be listed and the list retained until all items have been corrected or rejected. Supervisor/Department Heads should be continually on the watch for unsafe conditions, and corrective action should be taken promptly as soon as such conditions are found. The. following items indicate some of the physical conditions and employee actions often associated with the occurrence of accidents, and the actions to be taken for his/her correction. A check on such conditions should be made when' office- safety inspections are made. - - - - ., - - - - - - - - - III . page 6 - 4 OFFICE FURNITURE AND EQUIPMENT .. 1. Office furniture, equipment and electrical appliances should be arranged to obtain maximum safe utilization of installed facilities, such as overhead lighting, wall outlets, telephones, and others. 2. Desks, file cabinets, etc., should be arranged so that drawers will not open into aisles or walkways. Desk and file drawers should never be left open after use. 3. Distribute weight in file cabinets so top drawer con- tents are not disproportionately heavy. Avoid having more than one file drawer open at a time. Place heavy files in the bottom drawers. 4. Any splintered or defective condition of desks, chairs, or other office equipment should be promptly corrected. . . till . .. \WI 5. Desks, work places, walkways, stairways, and store areas should be well lighted. 6. Do-not place phone lines or electric cords across isles or around office furniture where they may cause a trip hazard or be damaged. 7. Unauthorized persons should not be permitted to operate office equipment. Only maintenance men should be permitted to repair or adjust it. . - - - - .. .. .. .. . - - page 6 - 5 - AISLES AND FLOORS - 1. Minimum clear aisles widths adequate for two-way traffic and unobstructed access to all parts of the office should be maintained. -- 2. Wastebaskets, briefcases, or other objects should never be left in aisles or other places where they can create a tripping hazard. 3. Floors should be kept clear of briefcases, pocket books,. pencils, bottles, and other loose objects. 4. Tripping hazards form electrical or phone outlets in the floor should be protected by arrangement of furniture, or by other means. 5. Floor holes, loose boards, splinters, or floor depressions should be promptly repaired. 6. Slip-resistant preparations should be used for polished floor surfaces. - - - - .. 7. Carpeting that is torn, badly worn, or has curled edges should be replaced or fastened down. .. STAIRS .. 1. Doors that open into one or more steps should be posted with prominent caution signs. 2. Stairways should be provided with suitable handrails, and severely worn stairs treads should be replaced.- - .. 3. Running on stairs, in corridors, or elsewhere in the office should be prohibited. ... - - .. - . . page 6 - 6 ELECTRICAL EQUIPMENT . 1. All electrical fans should be protected with guards of not over half inch mesh, to prevent fingers getting inside guard. Fans should not be handled until the power is turned off and the blades stop turning. 2. Worn electrical cords or plugs should be promptly replaced, and loose outlet plates or connections promptly repaired. 3. Exposed metal parts of electrical office machines or appliances should be electrically grounded. 4. Insecurely hung light fixtures or fixture parts should be rehung in a secure manner. . . . . .. 5. Extension cords should not be run over radiators, steampipes, or through doorways. 6. Electric switch pull chains should be of the insulating link type. . 7. Electric fans are not to be placed on the top of, or hung on partition walls. ... FIRE PROTECTION .. 1. Corridors, stairways, and exits should be kept clear of stored materials or other obstructions, and easy access maintained to fire extinguishers or hose. - 2. Ashtrays should be provided in all smoking and reception areas for disposal of burning tobacco or matches. - 3. Adequate fire exits should be provided for the number of people involved, and routes thereto properly marked and identified. - 4. Location of fire extinguishers and hoses should be plainly marked, and extinguishers tagged with date of annual inspection for operable condition. .tIlI iii 5. All employees should be taught the meaning of fire alarm signals, and the details of emergency evacuation procedures. 6. Employees who may use fire extinguishers or hoses should be familiarized with his/her location, operation, and use. .. . III - - - - 2. - 3. .- 4. - - - .. 7. ., 8. - - - - - - - - page 6 - 7 MISCELLANEOU S'. 1. Windows that are hard to open should have corrective adjustments made by the maintenance department. Good housekeeping should be maintained to minimize accident exposures. Sound ladders should be provided for reaching materials on stock shelves, and should be kept in safe serviceable condition. Employees should be instructed to avoid walking without looking where they are going - around corners, into open doors, or while reading correspondence and to approach closed doors with caution. 5. Office employees should not attempt to move furniture or lift objects. 6. Employees should be instructed in safe lifting procedures - to keep the back straight and lift with the legs and to get help if the objects are heavy or awkward to handle. Throwing paper clips, shooting rubber bands, throwing objects out of a window, and other horseplay is prohibited. Cleaning fluids should be used only in small quantity and in well-ventilated areas. They should be_stored in closed containers, and if flammable should not be used near a flame or while smoking. Only nontoxic cleaners should be used. III . page 6 - 8 THIRTY FIVE ITEMS TO CONSIDER FOR A SAFETY INSPECTION . (This list does not cover all conditions and is intended as a guide only) 1. Receiving and shipping: Equipment Job Planning Layout Methods - - 2. Piling and stacking: Projecting materials Safe heights Floor loads Methods Locations Distance from sprinklers . . . 3. Transportation: Handtrucks Power trucks Push trucks Gantrys 4. Mechanical material handling: Power cranes Bridge c.ranes Monorails Hoists Jilt ... -- 5. Building conditions: Floors Walls Ceilings Exits Stairs Walkways Ramps Platforms Driveways - .. - .. 6. Si tes : Location of buildings Flow of materials Equipment location Lighting Special fixtures Storage Aisles . - . . - - page 6 - 9 - 7. Housekeeping: Waste disposal Tools Objects Materials Leakage and spilling z"lethods General and immediate work area Windows Cleaning schedules Storage 8. Electricity: Equipment, selection, and installation Switches Breakers Fuses Switchboards Junctions Circuits Installation Modern, approved equipment Extensions Tools Motors Grounding Explos'ion-proof equipment High voltages .. - - - - - - ... 9. Lighting: . Modern, permanent installation Bright enough Well-diffused Approved installation Independently controlled Not in way No flicker Reflection Proper type Supplementary lighting Ground fault interrupters 10. Heating and ventilation: Warm enough Cool enough Dampness Good, natural, or artificial ventilation Humidity o.k. - .. - - - - - .. .. 11. Dusts/fumesl gasesl vapors Exhaust systems Sufficient capacity Right type Efficient page 6 - 10 ... 12. Color: . Painted walls Floors Ceilings Machines Objects Equipment Piping Aisles lines .. . 13. Hand power tools: Purchase Inspection Storage Repair Maintenance Carrying and handling Safe use Proper type Right size Special tools Grounding 14. Machine hazards: Point of operation Flywheels Gears Shafts Pulleys Keyways Belting Couplings Sprockets Chains Frame Securely attached Level Grounding General condition Operating controls Lighting The operator Incidental tools and equipment Brakes Exhausting Oiling and adjusting Maintenance methods Ample work sample Feeding .. . .. .. .. - - .. III - - .. .. - - page 6 - 11 - 15. The machine operator: Experienced and trained Cleans machine safely No oiling' adjusting when machine is in motion Safe clothes and shoes Uses pers~nal-protective equipment Uses feeding devices Checks machine before starting Neatly stores tools, etc., properly Lifts safely Work at safe pace Regulations Training programs ., - - - - 16. Repetitive motion and fatigue Muscular strain Pads and cushions Rest periods Chairs and stools Tired or improperly reacting muscles induce accidents .. 17. Lifting: Proper grip Safe footing Back straight Knees bent Object not too heavy, slippery, poorly shaped, bulky, etc. Steady motion Carry slowly 18. Protective clothing and equipment Shoes, gloves, goggles, hats, respirators, etc. Close-fitting clothes Easy-to-remove clothes Good Maintenance Psychological aspects Types Rules 19. Horseplay: Cause of accidents ... ., .. - - .. 20. Falls: ., Floors Steps Slopes Different levels Platforms Ladders Scaffolds Uneven surfaces .. - - .. 4Il page 6 - 12 25. Lockers, washrooms, eating areas, toilets, etc. Ample space Clean Well lighted Screens Ventilated Painted 21. Falling objects: Belts, pulleys, etc. Tools Materials Flying machine parts Wheels Objects 22. Maintenance: Regular schedule Effective Trained personnel-Electricians work etc. Good materials and parts Safe methods Machinery shut down and locked 23. Fire prevention and control: Extinguishers Alarms Sprinklers Smoking rules Exits Assigned Personnel Safe conditions Proper storage Dangerous operations separated Flammable materials Explosion-proof fixtures Waste disposals 24. Pressure vessels: Experienced personnel in charge Regular inspections Good maintenance and repair Safely located or protected Safety device equipped Safe operating practices III .. . .' for electric . . .. - .. - .. .. .. .. . - . . - - .. page 6 - 13 26. Conveyors, elevators, and other lifting devices: Shafts protected Machinery protected No unauthorized use Regular inspection Good maintenance Safety devices O.K. - - 27. Stairways: Condition good Steps uniform No obstructions Good lighting Clean Dry Wide enough Handrails Not too long - not too steep - .... .. 28. Ladders: .. Rungs and rails Rung spacing O.K. Cages (if fixed type) Safety feet Not painted Stored properly Marked for identification Inspection regularly .... - 29. Noise: - Machinery Building construction Operations 30. Chemicals, caustics, explosives, inflammable liquids, and other dangerous substances: Storage Handling Transportation Protective clothing and equipment Supervision Training Warning signs Amounts - - .. .. 31. Current safety activities: Meetings Quarterly Accidental reporting Accident investigation Responsibility assignment Job safety analyses Safe~ representatives . - - 32. Type management and supervision: Progressive Safety-minded Cooperative Efficient Fixed responsibilities . . page 6 - 14 .. .. 33. First aid: Emergency numbers posted Trained employees where required Safety supplies .. . . .. . . .. - - - .. . . . . - - ... page 7 - 1 ACCIDENT I INJURY AND INCIDENT REPORTIN<L. .. In .the event of accident or injury to a municipal employee I injury to a citizen by Town operationsl or damage to property related to municipal operations, the appropriate emergency services (policel fire, ambulance) will be notified immediately. As soon as possible following these notifications the department head will be notified. This includes fatalities occurring on Town property whether an employee or not. This rapid notification is vital to the proper management of the incident as well as to cause the necessary procedural steps to be taken. The department head is responsible for proper handling of the details of such cases, to make the necessary notifications to the Town Supervisor/Highway Superintendent Office. Assistance is obtained by calling 297-2744 for the Supervisor's Office and 297-9451 for the Highway Superintendent's Office. NIGHTS, WEEKENDS, AND HOLIDAYS CALL 462-1551 for the Supervisor and 897-5753 for the Highway Superintendent. THE APPROPRIATE NOTIFICATIONS WILL BE MADE. While work related injuries are infrequent and most are minor, the potential for serious injury cannnot be totally eliminated. For any serious injury, the first step is always to get medical attention and treatment as quickly as possible. Town rules require that every job related injury be reported to the department head in writing as soon as possible. As soon as any serious job related injury is reported or becomes known to the department head, the Supervisor's office will be notified by calling 297-2744. The Department Head will compYete the appropriate Town accident report and forward it to the Supervisor who will review the report and send it to the Insurance Company. .... - - - - - .. - ... - USE PROPER FORMS WHEN REPORTING INCIDENTS OR SAFETY PROBLEMS: 1. INJURY REPORT: Three part form used to report - employee injuries. 2. UNSAFE CONDITIONS REPORT: Four part form use to report unsafe conditions. This form should not be used to report ... conditions that are maintenance problems. 3. DPW f<lAINTENANCE REQUEST: Three part form used to - request repairs from DPW. - - . . . " . .. . .. . . .. .. ... - . - . . - - TOWN OF WAPPINGER SAFETY REV I EW CHECK LIST - Date: Depar tment: ------------------------- Inspected By: ______________________________________________ - This safety review check list is a guide and may be used as your check list or modified to meet your own department needs. This check list is not to be considered a complete inspection. - REPORT ALL 0 I SCREPANC I ES ON AN UNSAFE CONDITION REPORT - CONDITIONS CONDUCIVE TO TRIPPING, SLIPPING, AND FALLING 1,,0 Water, oil, soap, etc. ...................... --- H i (;i ~ 1 y pol i = h f?:; S'..J 1- fa c e s .................... - - - Rough or splintered surfaces ................ --- Torn or loose coverings .......... ..... ... ... --- Protruding nails, SCT"eWS, etc. .............. ___ Loose handra i 1 s ............................. --- Loose or missing treads ..................... --- Burned out or missing lights .... ............ --- Protruding outlets in work area .................. --- Extension cords across walkways.................. --- Lad d e r sin goo d co nd i t i 0 T1 ........................ Work Space: Adequate lighting........................... Are passageways and aisles adequately defined --- Personal Protective Equipment: Properly used by employees..................... --- Respirators maintained in a sanitary condition-.-- --- Protective equipment in good condition..... .... --- Are quick flush eyewash and shower facilities available where chemicals are used ............ - Floors and Stairways free of: - - - .. EQUIPMENT CONTAINING POSSIBLE HAZARDS - - Office Machines: Are all required guards in place ... ........ .... Are wiring, switches and cords in good condition Are machines proper ly grounded "................. Are fans properly guarded ............... ......... Are electric heaters away from combustibles....... Are metal edges of equipment or desks protruding.. Are electrically operated hand tools regularly inspected for a safe condition........ .......... Are other tools inspected for safe condition...... .. .. WORKING CONDITIONS - - - - - yES YES NO --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- YES NO '. Housekeeping: Are adequate waste receptacles provided. .... Are waste receptacles emptied daily......... Are flammable substances properly stored.. . Are chemicals properly stored...... ..... ... Are chemicals properly disposed of.......... Work, storage, lounge areas neat and orderly Sanitary Conditions: Wash areas clean and supplied. ... ..... ..... Are any plumbing fixtures loose or broken... FIRE PROTECTION Designated aT-eas posted for smokers............ . Disposal facilities for smokers available.. .. Fire exit plan posted in corridors.......... . . Emergency phone numbers posted on all telephones Fire safety plan for handicapped/ d i s ab I ed per so ns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fire Escapes and Exits: Are aisles leading to exits blocked....... Are emergency e:dts locked 0'- inoperative.. Exit signs posted and lighted.............. Emergency I ights operative................. Elevator signs - indicating "Do not use in case of fire"....................... Fire Protection Equipment: Fire extinguishers accessible.............. Fife extinguishers inspected monthly....... Do fire extinguishers have a current inspection tag............................. Are Fire Extinguishers of the proper type for your work area................. ........ !, YES NO --- --- --- --- --- --- --- --- --- --- --- --- . Fire Safety Organization designees: Mar sha 11 ................. Name: ------------------- Room Searchers .................Name:___________________ Liaison person..................Name:_______________---- Tr a i n i ng. . . . . . . . . . . . . . . . . . . . . . . . Name: ------------------- REMARKS: ---------------------------------------------------- ------------------------------------------------------------- ----------~-------------------------------------------------- ----------------------------~-------------------------------- ------------------------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------- . . . (~. , . . . . .. .. . . . - ... .. . . 'J ,,:i:"" .. . .. - rF:.OPERTY D,\:-!J\CE RE!'ORT - TOWN OF WAPPINGER - This report fOrl:1 ....ill be \\Sed to sho.... losses or damage incurred by CITY _ property other than vehicles and personnel. Give details as fully as p~s- sible but do not deiay this report. On completion this ,report ~ill be for- yarded to the Safi~v Coordinator. " ; . '". DESCRIPTION OF INCID~T (Check item) - VANDALISM FIRE - THEF': VEHICLE ACCIDENT OTHER (Give details) .' ..' - 3~ECIFIC DETAILS OF LOSS OR DAMAGZ (Where, ....hat, when and ho....): - - - - 57R.EET OR HILE l'I.ARKER ~ LOCATION OF INCIDENT ' , , . , . , . ' CITY /STATE' OTIiER POINTS OF REFERENCE ~ATE OF INCIDENT TIME .. ~IATERIALS ;'NO EOUIP~'~NT STOLEN. DISCRIPTION MODEL. SERIA~ NO., DESTROYED OR DAHAGED' COUNTY IDENTI- ETC. FICATIO~ NO. PURCH. YEAR PURCH. PRIC:': .. :iO . 0 F :7E!-IS NAl-lE OF ITEM .. ,- . - RE~L~R.KS - - - - ;;::l '{liT. I'OUC: :,~\j~J~ A 1':~:l'u::T (YI.::-;/r,;O):'- 'lJ11l01 ,\CE1:CY? .~::.:.~~'.:'.:~~2~ ~ . .., ,:. 'j!li: :::,'~F~ .\.:::. .\:):::.:'~:':~'~E: ::-:. .\\'..\TL;d1LE ~':!7::1~::i:i.:.: O~~ Tlii: r~/\c:: n;" .;.~t::. I: 1l r ::: (16) - .. ill :,~& . . tI!I . .. ~", .. ;ifj; . "',.,.'.; . - ... i/, . , .. . . . .. .. /-lnTm: \'1\111 <':Ll~ "CemENT REPOl\'T TOWN OF WAPPINGER - Immedi~cely afcer che acciden~ che operator will: 1. Leave vehic~e(s) in place. DO NOT MOVE ANY VEHICLES!! - ~ 2. SET WARNING markers, flashers, reflectors or fl~res. .. J.. GIVE .AID CO ~nj ured persons. 4. CONTACT .POLICE.....th~n your supervisor....:. - ~OR- - If you can not reach the:police notify your supervisor and TELL HIM TO CALL POLICE FOR YOU. 5. C~refully fi~ out chis form as accurately as possible and as completely as available information allows. : - JE? ARTHE..'1T OR DIVISION SUPERVISOR .. )RIVER I S MAl-IE IACO I HOHE ADDRESS - .. .~ ~ ~""- ~ODA1S DATE (00.1.) TII'lE LOCATION (Sc:i:'eec...or highway) TOi-l"l-l STAT::: -' W(Z OF VEHICLE YEAR. MODEL LICENSE NO. . I~'HAT \JAS TdE VE.IUCLE .BEING USED FOR? . - :;'.~ZNT OF DAl-ft.GE (Your vehicle) VEHICLE IDENT. tJ RS:?AIR ESTIl-lA., :r: --,_.--,~ .. .. .. 'X~~****************************** DAl-~GE TO PRIVATE VEHICLES ********************************** .',;m:p. AJ.'1~ H:IS ADDRESS I PHONE NO,. .. - RIVER AND HIS ADDRESS (Ii different: from a.bove)~ PHONE :W. i,j:E OF VEHICLE YEAR HODEL LICENSE NO. EST. REi' AIR cas T INSURANCE COl-lPANY Esc~rEE DAHAGE .. - NV.GE TO PRIVATE PROPERTY OTlIER TIL\N VEHICLES \JtLL BE LISTED ON nlE ENCLOSED PROPERTY DA~~\GE ::?Oi\1" FOP.1-l. .. t~'!:: *~***" PE?SO::S INJt;REL> u**....* NAl'lE .., :;~~::..:: s ---. ---..-............- . ..... ".- .---.o.- Am') 1'.:- ~:- ------_.____...___._._...._._..__ ... "CO r~.~.': OJ:.::::-,, ( 1 S ~ - .. . . . II :tif . . '*'f . *II ffAi .. . - .. . j~ .. . ~k . .. .. - TOWN OF WAPPINGER - No. Date - PERSONAL ACCIDENT REPORT - NAME DEPT - MALE FEMALE OCCUPATION - DATE OF INJURY DATE OF FIRST TREATMENT - TIME - NATURE OF INJURY - - - EMPLOYEE'S DESCRIPTION OF ACCIDENT - - - Employee's Signature - - - .. - .. .. . . till ~'t'~f' . . .. .. . .. .. .. . 'H "~ .. . . . . UNSAFE CONDITION REPORT - - Name (employee): Title: .. Department: Worksite address: Phone number: - Condition (include date and time of discovery with nature of condition): - - - - Date Signature - - Department head name: Comments: - - - - Date Signature - .. Original TmJ~~ SUPERVISOR Copy #1 DEPARTMENT HEAD Copy #2 COt~PTPOLLEn Copy #3 :.EMPLOYEE - CE.11 . . - - . .. . . . . . . . .. - .. - . .. . . . . - STATE OF NEW YOfIK WORKERS' COMPENSATION BOARD EMPLOYER'S REPORT OF INJURY/ILLNESS - Send this notice directly to Chairman, Wor1cers' Compensation Board III address shown on reverse side within ten (10) days after accident occurs. Answer all questions fully, Copy also should be sent to your Insurance carner. This fann replaces all previous versions of Forms C-2 and c-2.5. - wCB CASE NO.(1l Known) CARRIER CASE NO. CODE NO. WC POLICY NUMBER DATE OF ACCIDENT EMPLOYEE'S S S NO. 1,('1 EM~~YER~_~~E .. (bl EMP1.0YER'S MAILING ADDRESS (C) OSHA CASE/FILE.NO. _. .. .. .. (d) LOCA TlQN .(11 ~Iff_nt from ma.. add_). ... (el NATURE OF BUSINESS (Prineaplll products. aeMCeS, lItc.) (f) NYS U.I. Employer Reg. NO. . -- 2.('1 INSURANCE CARRIER (b) CARRIER'S ADDRESS GALLAGH!;R BASSETT 01 New Yor~. Inc., SELF INSURED RUM~n CorpUrllC PlIItk. 100 Sch4W\U~.~ Ad. S\MtC' ".I~ .' Sr"n~ V"Iey. New Ymk lll9n 3.('1 INJURED PERSON (FIRST. 104.1.. LAST) (b) ADDRESS (Include NO. & Slrlllll, City. SlAle, ZiP & ApI. No.) .l .. ADDRESS WHERE ACCIDENT OCCURRED : COUNTY ' WAS Aee'O'NT ON ,""mER.' I g , PREMISES? 0 D , , YES NO I ~ 5. TIME OF ACCIDENT 6. DEFT WHERE REGULARIL Y EMPLOYED 1.(1' DATE STOPPED WORK BECAUSE I (b) WAS INJURED PAID IN fULL N OF THIS INJURY/ILl.NESS , FOR DAY? D D T AM PM YES NO I 8. SEX I a.AGE 10. OCCUPATION (Specific lOb bile II wIllcn employed) ! I N P J E 11.(1) AVERAGE EARNINGS (b) TDTAL EARNINGS PAID DURING 52 WEEKS U R PER WEEK? PRIOR TO DATE OF ACCIDENT (Include R S bonU3eS. overllme. vllue of lOdging. lite ) ; 0 - E N 12.(1' PART OR FULL (bl INJURED WORKER'S WORK : D TIME WORKER? WEEK (IndiCAte dlYs ot _k i usually wor1<ed). .,.~ -. 13. NATURE OF INJURY AND PART(S) OF BODY AFFECTED 14 010 . JU PROVIDE MEDICAL CARE? : IF YES. WHEN? N DYES ONO , A , ~...--..J T I 15.(1) NAME AND ADDRESS OF DOCTOR (bl NAME AND ADDRESS OF HOSPITAL I N ; U J R I E U I R I Y ,----J 0 16. HAS EMP1.0YEE RETURNED TO WORK? : IF YES. DATE , AT WHA T WEEKL'( WAGE? I F DYES ONO , : .....-J I NOTE: FORM C-11 MUST BE FILED EACH TIME THERE IS A CHANGE IN EMPLOYMENT STATUS I : 17. WHAT WAS EMPLOYEE DOING WHEN INJURED? (PIea5e be specifiC. Identify looIs. equIpment or mllenallne employee WIS usIng.) I I c I A U -.- S I E I 18 HOW 010 THE ACCIDENT OR EXPOSURE OCCUR? (Please desCrobe fully the events Ina' resulted In ,njury or occupatlona' d'sease Tell whal happened and hOw I 0 i F II nappened. Please use separate sheell' necessary.) I A i C ~ C I , 0 19 OBJECT OR SUBSTANCE THAT DIRECTLY INJURED EMPLOYEE. e.g. lhe maenu18 employee Slruck agllnsl or whlcn slruck him/her: the vapor or polson 'nnlled E H or swallowed, the chemallnlllmlAled his/her akin. In c.ases of .tralns. lhe InlOg(sl he WIS lilting, pulling, etc. T , PLfASE PRINT OR TYPE-INCLUDE ZIP CODE IN All ADDRESSEs-EMPLOYEE'S 5.S. NO. MUST BE ENlCREO BELOW .... - - - - - - - - ... - - ... - ~AT"LI20. DATE OF DEATH CASES; I , NAME/ADDRESS OF NEAREST RELATIVE , RELATIONSHIP DATE OF THIS REPORT SIGNED BY - DATE YOU OR SUPERVISOR FIRST KNEW OF INJURY DFFICIAL TITLE ... CHECK BOX IF PREVIOUSLY REPORTED ON FORM Co2.1. TEL. NO. & EXT THE WORKERS' COMPENSATION BOARD EMP1.0YS AND SERVES THE HANDICAPPED WITHOUT DISCRIMINATION C-2 (6-86) C-2 C-2 C-2 C-2 C-2 - .. .. \'i; . . . . . "''It, . . . - - .. . . . . .. . - (-lle8-85) STATE OF NEW YORK WORKERS' COMPENSATION BOARD EMPLOYER'S REPORT OF INJURED EMPLOYEE'S CHANGE IN EMPLOYMENT STATUS RESULTING FROM INJURY - - This report is to be filed directly with the Chairman, Worleers' Compensation Board at address shown on reverse side as soon as the employment status or an injured employee. as reported on Form C-2.S, Form C-2, or on a previous Form C-Il, is changed. Change in employment status includes return to worle, discontinuance or work, increase or decrease or regular hours or worle and increase or reduction or wages. - Copy also should be sent to your insurance carrier. - A 4. - Add.... 10 which nollces should be Mnl (Glv. Number and SIr.." City. Sial.. end Zip Codel N.".. Apt No. - 6. InluNCI Penon 7. E""Moyer - S. Carrier SELF INSURED GALLI<GHEH BASSETT 01 New York. Inc. RUSleR Corporal. Park. 100 SchoolnOUH Rd. SUI'. ....12 SPf'nQ Valley. N_ York 10977 - 9 Date of most recent Employer':; o C-2.5u.............. ... ............. 10 Date Disability Began :.00....00 ..... " Nature of Injury:.. Repurt filed: (Check "x" form and gi\'e datc filcd.) o C-2.. .....00..._ 0 C-I L.. ...........Hllur of Day: ........ ....A.1-1.......................... . . P.:.!. ............................-......-......... ... ......... - 12 Date of FIRST return to work following injury: 13 (a) Change of employment status rc:;ultill~ from ahove lO]ury: EmplOYllleDt Hours per Days per [.aMlinr. OccupatioD SlAtu. Day Week Prior to ....--. Inju..,. Cha.,red to tb) Datc of this chan!:c 111 employmellt ~tatu~ :... (c) Rell1ark~ :..... - - - 14 Loss of time rcsulting from aIJo\'c injury :;nH"l' tirst rcturn to work: - From (Mo., D.,., Y_r) fo (Mo., Da".. Year) Rea.on ---< If so, givc name of physician: . - - 15 b injured slill under lhe care of a physician? - 16 Has in]ured died? - If so, slate dale of dealh: Namc and addrcss of nearcst relalivc known: Date ..r thi... I{('!l"rt I' irlll '\;II11C - 1'1::1.. NO. "1:,:llf"~ I" Ofth-i.1 Till.. C-ll C-ll G-l1 C-ll C~11 . - . . . . . . . ~:4 - . - - - - - . . . i . ... .. WORKERS' COMPENSATION BOAI EMPLOYER'S STATEMENT OF WAGE EARNINGS (Preceding the Date of Accident) BOARD EMPLOVS AND SERVES THE HANDICAPPEO WITHOUT DISCRIMINATION. .. - l. W.C.B. Case No. 2. Carrier's Case No. 3. Date of Accident 4. Employee's Soc. Sec. No. Name Address Apt. No. Injured . I 5. Employee 6. Carrier (Print N.me .nd Addreu of C.rrler on thll IInel . - . . .. - . .' :;;;;;:".'.: .:-. . . ~.. .-. ~:.Employer .._. - 7. .... - .. . .. - . - . - ... .... 0 8. Employee was employed at a .............................................................. wage for a....................... ..................day week. {hau,ly. daily. we.,le/y 0' man,h/.,J 15.6 a' 71 - - 9. Was injured employee in military service during the 52 week period immediately preceding the date of accident? - - ................................ if so, Date of Discharge.. ............................................ INSTR UCTIONS: 1. Give gross weekly eamin!!S for each of the 5~ week periods immediately preceding the date of accident. 2. If injured employee has not worked at the same wak for a year or a substantia! part thereof (234 days for a 5 day week, 270 days for a 6 day week) give the weekly gross earnings of another employee of the same cu who has waked for a year or a substantial part thcred immediately preading the date of accident. - 10. The following is.a schedule of gross wage earnings for the 52 weeks immediately preceding the date of accident of: (Check "X" one) o The injured employee named in item 5 above. - o ......................................iN~;;;,;.~i' .;;;.~i;;~~~. .~.,....i.~.;-;.;;.~. ~'i~~~'j""""""""''''''''''''''''''''''''''i Add~~ ~'s I - r - --._~ wrlK .&IK r.~l"C 0""" 'lass ....ou., ~&ID will. .Ir.. r.ol"G 0".' '101' ....0"..' ...0 we 1'-. weco 'NOI'" DAYI c.a... ....ou.,. '''t.1 D ... DATI ....ID '.cLues.... 0.....'..... ..0. DA'I woaKIO ZWC.LUOI." 09Ia,.... 1t0. O..f. woaltlD 'NCLUD1.e ClytlE", iN<< ..~ 1 19 37 'cc,~~ 2 20 38 3 21 39 4 22 40 ""~ 5 23 41 6 24 ~2 ---"- 7 25 43 B 26 44 9 27 45 ~-- 10 2B 46 11 29 _.- 47 --""- 12 30 48 '3 31 49 .,- 14 32 50 '5 33 51 .. -- '6 34 52 17 35 TOTAL 18 36 .. .. - ... - - 11. Was this employee given free rent, lodging, board, tips, bonus or other allowance in addition to the above earnings? .............................. I r yes, stat e wee k Iy value thereof S.... ..... .............. .................... ................ .............................. .................................. Describe: ........................................ ............. ....................... ...................... ................................... ................................. .................... .......... 12. Was there any wage adjustment made affecting the 52 week period scheduled above?........................................................................... I f yes, ex plain: ........ .......................... .......................... ............... ............................................................................ .... ........ ....................... I CERTIFY THAT THE ABOVE IS TRUE AND CORRECT: - Date ..... .................. ...... .................... ..................... ...................... .................................................................................................................. (N.m. of Employt!!t') - Tel. No. & Ext. ........................................................................... By.......................................................................................................... Official Tit Ie ............................................. .... ........ .................................. C-240 (11-87) order fro. HANKATTAM STATIONER! CO..I"C..H.I.C. (212) 977-0100 - . . )j~3 . . . . . . . . . . . . <r . . f'''- . . . - - - EMPLOYER'S REQUEST FOR REIMBURSEMENT - .SEEINSTRUCTI.ONS ON BACK : . _... .~. "";"'- --'.~ .&-:- . ., - " . ..._......:. MO - WORKMEN'S COMPENSATION BOAR.D CASE NO. CLAIM NO. - RECEIPT FOR WAGES ADVANCED - Received from employer, dollars and cents. ($ - as wages during my absence from work on account of disability, which allege resulted from accidental injury or occupational disease sustained by me on 19_. These wages cover period from - to Incl.) ~ (Date) (Employee's Signature) - CLAIM FOR REIMBURSEMENT To The Workmen's Compensation Board: - The undersigned employer, for moneys advanced during a period of absence on account of disability, hereby requests full reimbursement in accordance with Section 25 of the Workmen's Compensation Law. - Date: (Employer) - (Signature and Title) - NOTE TO EMPLOYER: - Please note that under current interpretations of Section 25 of the Workmen's Compensation Law, in cases involving temporary disability, an employer may not recover more than the compensation benefit rate for the period during which compensation or wages were advanced. nor may there be any reimbursement for the first week if the disability does not exceed two (2) weeks. - - - .. .. .. .. .. .. .. . - .,. .. .. .. .. .. .. "Z; .. . .. - - page 8 - 1 - GUIDELINES - The distinction between treatment and first aid depends not only on the treatment provided, but also the severity of the injury being treated. First aid is: (1) Limited to one-time treatment and subsequent observation; and (2) involves treatment of only minor injuries, not emergency treatment of serious injuries. Injuries are not minor if: - - a. They must be treated only be a physician of licensed medical personnel; b. They impair bodily function (i.e., normal use of senses, limbs, etc.); c. They result in damage to the physical structure of a nonsuperficia1 nature (e.g., fractures); or d. They involve complications requiring fOllow-up medical treatment. - - - Physicians of registered medical professionals, working under the standing orders of a physician, routinely treat minor injuries. Such treatment may constitute first aid. Also, some visits to a doctor do not involve treatment at all. For example, a visit to a doctor for an examination or other diagnostic procedure to determine whether the employee has an injury does "not constitute medical treatment. Conversely, medical treatment can be provided to employees by lay person;i.e., someone other than a physician or registered medical personnel. The following classifications list certain procedures as either medical treatment or first aid treatment. . - - - MEDICAL TREATMENT - The following are generally considered medical treatment. Work related injuries for which this type of treatment was provided or should have been provided are almost always recordable: - Treatment of INFECTION - Application of ANTISEPTICS during second or subsequent visit to medical personnel - Treatment of SECOND OR THIRD DEGREE BURN(S) - Application of SUTURES (stitches) - Application of BUTTERFLY ADHESIVE DRESSING (S) or STERI STRIP (S) in lieu of sutures - Removal of FOREIGN BODIES EMBEDDED IN EYE - Removal of FOREIGN BODIES FROM WOUND; if procedure is COMPLICATED because of depth of embedment, size or location - . - - . .. page 8 - 2 - Use of PRESCRIPTION MEDICATIONS (except a single dose administered on first visit for minor injury or discomfort) - Use of hot or cold SOAKING THERAPY during second or subsequent visit to medical personnel - Application of hot or cold COMPRESS (ES) during second or subsequent visit to medical personnel - CUTTING AWAY DEAD SKIN (surgical debridement) - Application of HEAT THERAPY during second or subsequent visit to medical personnel - Use of WHIRLPOOL BATH THERAPY during second or subsequent visit to medical personnel - POSITIVE X-RAY DIAGNOSIS (fractures, broken bones, etc. ) - ADMISSION TO A. HOSPITAL or equivalent medical facility FOR TREATMENT. . .. \I . .. . FIRST AID TREATMENT .. The following are generally considered first aid treatment (e.g., one-time treatment and subsequent observation of minor injuries) and should not be recorded if the work-related injury does not involve loss of consciousness, restriction of work or motion, or transfer to another jOb: - Application of ANTISEPTICS during first visit to medical personnel - Treatment of FIRST DEGREE BURN (S) - Application of BANDAGE (S) during any visit to medical personnel - Use of ELASTIC BANDAGE (S) during first visit to medical personnel - Removal of FOREIGN BODIES NOT EMBEDDED IN EYE if only irritation is required - Removal of FOREIGN BODIES FROM WOUND; if procedure is UNCOMPLICATED, and is, for example, by tweezers or other simple technique. - Use of NONPRESCRIPTION MEDICATIONS AND administration of single dose of PRESCRIPTION MEDICATION on first visit for minor injury or discomfort - SOAKING THERAPY on initial visit to medical personnel or removal of bandages by SOAKING - Application of hot or cold COMPRESS (ES) durinq first visit to medical personnel - Application of OINTMENTS to abrasions to prevent drying or cracking - Application of HEAT THERAPY during fi~st visit to medical personnel - Use of WHIRLPOOL BATH THERAPY during first visit to medical personnel .. .. .. .. .. . .. II I .. .. - - page 8 - 3 - - NEGATIVE X-RAY DIAGNOSIS _ OBSERVATION of injury during visit to medical personnel. - The following procedure, by itself, is not considered medical treatment: - 1. Administration of TETANUS SHOT (S) or BOOSTER (S). However, these shots are given in conjunction with more serious injuries; consequently, injuries requiring these shots may be recordable for other reasons. - - 2. LOSS OF CONSCIOUSNESS. If an employee loses consciousness as the result of a work-related injury, the case must be recorded no matter what type of treatment was provided. The rationale behind this recording requirement is that loss of consciousness is generally associated with more serious injuries. - - 3. RESTRICTION OF WORK OR MOTION. Restricted work activity occurs when an employee, because of the impact of a job related injury, is physically or mentally unable to perform all or any part of his or her normal assignment during all or any part of the workday or shift. The emphasis is on the employee's ability to perform normal job duties. Restriction of work or motion may result in either a lost worktime injury or a nonlost-worktime injury' depending upon whether the restriction extended beyond the day of injury. 4. TRANSFER TO ANOTHER JOB. Injuries requ~r~ng transfer of the employee to another job are also considered serious enough to be recordable regardless to the type of treatment provided. Transfers are seldom the sole criterion for recordability because injury cases are almost always recordable on other grounds, primarily medical treatment of restriction of work or motion. -- .. .. - - - .. - - - . page 9 - 1 RESPONSIBILITIES & PROCEDURES ..f.QR BOMB THREATS . . A. PURPOSE . To establish responsibilities and procedures for respond~ng to bombings and bomb threats within the Town of Wappinger Building in order to minimize loss of life and property. This plan outlines Evacuation, Search and Reporting Procedures, only. Under no circumstances should an employee search for, inspect or touch a suspected bomb. This will be left for the experts. .. . B. RESPONSIBILITY . Supervisor/Highway Superintendent is responsible to execute this plan and each phase therein to include periodic drills. The Dutchess County Sheriff is the chief advisor and is responsible for this plan and coordination with the Town Supervisor/Highway Superintendent, support agencies and department heads. The Department heads are responsible to his/her personnel and to insure they are intimately familiar with evacuation and reporting procedures and the policy NOT to search for, inspect or touch a suspected bomb. . ., ., - C. PROCEDURES ., Telephone . 1. All personnel answering telephones MUST be intimately familiar with these procedures, remembering THE MORE PRECISE THE CALL THE MORE REAL THE THREAT. 2. Keep the caller on the line as long as possible. Ask the caller to repeat the message and RECORD EVERY WORD SPOKEN BY THE CALLER. 3. If the caller dose not indicate the time of detonation or the location of the bomb, the person receiving the call should try to get this information to include the following: -a- Time and type of detonation -b- Location of the bomb -c- Why the caller has taken this drastic action -d- It may be advisable to inform the caller that the building is occupied and the detonation of the bomb could result in death or serious injury to many innocent people. - - - . .. .. . - - .. -e- .. - -f- - .. -g- -h- - .. .. .. .. page 9 -2 -i- Pay particular attention for any strange or peculiar background noises, such as motors running, background music and the type music, and other noises which might give even a remote clue as to the place from which the call is being made. Listen closely to the voice (male-fe~~~e) ~~~~; Quality, accents or speech impediments. di~tely after the caller hangs up, report thi~ information to the Sheriff's department 452-0400, then notify Department Head. The Department Head will immediately notify the Town Supervisor or Highway Superintendent. The Sheriff will in turn notify: Local Police County Fire Dispatcher 471-1414 The Sheriff may also alert the 146th Ordinance Detachment, 564-7000 Ext. 3232 (24hr.) The 146th will "stand-by" at their location Stewart Field in the event of a bomb threat but is not authorized to assist in a search. Current Army Regulations permit them to assist in disposal of a bomb or military explosive item; they are not authorized to assist with YSEHNYal materials or bulk explosives such as DBIOHNTE. . The County Fire Dispatcher will alert the local fire company in whose area a bomb threat is received. 4. After normal working hours, the receiver of a bomb threat call will immediately notify the Sheriff's Department and record the name of the receiver. WRITTEN MESSAGES Should the threat be written, it will be protected from handling to preserve investigative possibilities. Reporting procedure will be the same as telephone threats. The written message will be given the appropriate police agency, by the Town Supervisor or Highway Superintendent or his/her designated representative. Notifying Other Building Occupants: Department Heads located in the facility will notify all others in the building if a bomb threat is received. .. - - .. ... .. .. II III page 9 - 3 D. COMMAND AND CONTROL . 1. The Dutchess County Sheriff will provide the Town Supervisor/ Highway Superintendent with all pertinent information concerning a bomb threat and a recommendation on whether or not to order evacuation. The Town Supervisor/ Highway Superintendent is the individual responsible to order an evacuation. .. .. 2. Department Heads are responsible for keeping- his/her employees informed and to clear the area of all personnel when so ordered. 3. Notify only those designated and do not alarm -.employees unnecessarily. Because of the potential adverse effect on morale of employees, particular care must be taken to limit the dissemination of information until such time as directed by the person exercising command. .. . . - 4. The Dutchess County Sheriff's Department will control search and reporting procedures in all areas. .. 5. The Dutchess County Sheriff is to be responsible for permitting employees to re-enter the building and the resumption of the normal business. .. E. EVACUATION .. The evacuation plan prepared for fires will be used with modifications, determined by type and location of bomb. In addition, when evacuation is ordered for a bomb threat, if time permits, doors and windows will be left open and personnel on floors above the danger area will be evacuated first. Control of entry into the building during search will be accomplished by the Sheriff. .. .. F. SEARCH .. The search phase is the responsibility of the Sheriff's Department. .. a. Departments--Bombs may take any form i.e., packages, lunch bags or box, thermos bottles, books, letters: therefore, all personnel must be familiar with these items and storage areas, etc. Maintain good housekeeping and proper disposal or protection of combustible material. .. .. .. - - - page 9 - 4 b. " $heriff--To accomplish his requirements, the Sheriff will coordinate with Department Heads, Local Police, EOD Personnel and others as required. The Sheriff will: 1. Insure the Town Supervisor/Highway Superintendent or his/her representative is completely aware of the situation. 2. Maintain procedures for control of personnel permitted to enter a building ~uring search. 3. Be responsible for conducting a search of the buildings threatened. 4. Alert Fire personnel of standby. S. Identify if possible the danger area and block off a clear zone of 300 feet to include, areas above and below the suspected bomb. 6. Advise Town Supervisor/Highway Superintendent and Responsible Person when re-entry to building is safe. - - - - - c. Highway Department will maintain a stock of sandbags for emergency use. - G. TESTING/TRAINING - TestinCJ: An effective pre-emergency program of informing personnel what is expected of them in an emergency. Coupled with the' example of strong, competent leadership will not only minimize loss of life and property but will also control panic. Testing of drills will provide assurance, eliminates unrest and demonstrates decisiveness. Each department head should insure his personnel are at all times aware of the procedures of this plan. The Town Supervisor/Highway Superintendent, thru the Sheriff, will insure spot-checks at least quarterly and a full-test to include all departments, at least once annually. - - - - Trainin<j1: The Sheriff is responsible for the training of personnel within his department who will conduct searches for bombs and for the disposal of such objects. The Supervisor/Highway Superintendent will formulate Evacuation Plans and be responsible for their coordination. - - H. MISCELLANEOUS - All involved personnel will maintain log of events to insure accurate reports are submitted. As previously indicated in "Procedures", Paragraphs "3-g", the initial report will be made to the Town Supervisor or his/her . - - . . page 9 -5 representative and the Highway Superintendent or his/her representative. If after duty hours, immediately notify the Sheriff. This initial report should include any information the receiver has been able to collect, to include time was received. III . The After Incident Report - will be prepared by the Sheriff and submitted to the Town Supervisor at the earliest possible time but no later than twenty-four hours after the incident. To assist the Sheriff with this report, all involved personnel will immediately forward his/her event log. The final report will include: a- The initial report to include how and when the threat was received or incident took place. b- Complete description of all actions taken and resources used. c- Names and nature of injuries to personnel; to include prognosis, if available. d- Damage assessment. e- Assistance received from Police, Fire, EOD and other agencies. f- Security measure implemented. g- Recommendations to preclude such incidents from reoccurring. . h- The initial report will be made to the Sheriff. . . . . . . . I. PREVENTATIVE CONSIDERATIONS .. a- Visitors must be restricted to visitor's areas, check I.D.Cards to insure unauthorized persons are denied access to critical areas. Develop package and material control procedures (all packages and material going in or out of critical areas should be checked). b- Insure that doors and access ways to boiler rooms, mail rooms, computer areas, switchboards, elevator machine rooms and utility closets are securely locked when not in use. c- Check key control to insure all keys to all locks are accounted for. If keys cannot be accounted for--locks should be changed. d- All personnel in all departments should be alert for foreign objects, items or parcels which do not appear to belong in the area. This coupled with daily checks for good housekeeping, is the single best method of preventing sudden surprises. . . .. .. . ; ;. .. ..