Sample safety program forms

              These Safety and Health Program Guidelines were developed to provide a systematic approach to safety
and health management. These Guidelines are not law, but they are highly recommended to employers
as a road map for safety and health program planning. The following provides a summary of the
Guidelines' main parts.
The Safety and Health Program Guidelines can be divided into four main parts:
• Management, Leadership, and Employee Involvement
• Worksite Analysis
• Hazard Prevention and Control
• Safety and Health Training
The Guidelines outline the way the Oklahoma Department of Labor (ODOL) sees each element
functioning, and then provide recommendations for ways to put the particular part into action within an
organization.
10/98 1.1
Essential Elements of an Effective 
Safety & Health Program
(The Guidelines)
This publication, printed by Heritage Press, El Reno, Oklahoma, is issued by the Oklahoma Department of Labor as authorized by
Commissioner Brenda Reneau. Two thousand copies have been prepared and distributed at a cost of $50,228.46. Copies have been deposited
with the Publication Clearinghouse of the Oklahoma Department of Labor.
Management should provide leadership that
encourages workers within an organization to par-ticipate
in the programs that are offered by the
company, in this case the safety and health pro-gram.
According to the Guidelines, the elements
of a safety and health program can be broken into
the following components:
• Having a Safety and Health 
Policy
• Setting a Goal and Developing 
Objectives
• Getting Top Management to 
Provide Visible Leadership
• Getting Employees Involved
• Assigning Responsibilities
• Providing Adequate Authority
• Giving and Receiving 
Accountability
• Providing Program Evaluations
Having a Safety and Health Policy
State clearly a worksite policy on safe
and healthful work and working condi-
tions, so that all personnel with respon-
sibility at the site and personnel at
other locations with responsibility for
the site understand the priority of safe-
ty and health protection in relation to
other  organizational values.
To have an effective safety and health program,
there should be a written policy that is available to
all worksite personnel. The policy should be writ-ten
in a language that every worker can under-stand.
This policy provides direction for the com-pany
in the safety and well-being of the employ-ees,
and should be supported from top manage-ment
in the company.
Setting a Goal and Developing
Objectives
Establish and communicate a goal for
the safety and health program and
objectives for meeting that goal, so that
all members of the organization under-
stand the results desired and 
the measures planned for achieving
them.
Once a policy is developed, management should
set a goal for safety and health, then build objec-tives
that will allow employees to reach the goal.
The goal should be a realistic one, so as not to dis-courage
employees from striving for the goal.
Each employee should be able to see his or her
work activities moving toward the goal, thus
allowing him/her to meet the objectives.
Getting Top Management to Provide
Visible Leadership
Provide visible top management lead-
ership in implementing the program
and ensure that all employees at the
site are provided equally high quality
safety and health protection, so that all
will understand that management's
commitment is serious.
If it is perceived by employees that management
fully supports and abides by the safety and health
program, they are more likely to emphasize safety
and health in their own work habits. Employees
follow management's lead!
1.2 10/98
Management, Leadership 
and Employee Involvement
Getting Employees Involved
Provide for and encourage employee
involvement in the structure and opera-
tion of the program and in decisions
that affect their safety and health, so
that they will commit their insight and
energy to achieving the safety and
health program's goal and objectives.
This does not take the responsibility of the safety
and health of the worker from the employer. It
does say that an employer should try to get the
employees involved in the safety process.
Involving employees in developing their work-place
safety and health program is a good way to
obtain buy-in for the program.
Assigning of Responsibilities
Assign and communicate responsibility
for all aspects of the program, so that
managers, supervisors, and employees
in all parts of the organization know
what performance is expected of them.
Everyone should have some responsibility for
safety and health in the workplace. It should be
clearly understood by all employees what their
responsibilities are in the workplace, and what dis-cipline
will be forthcoming if failure to carry out
these responsibilities should occur. The employer
should try to base responsibility on the set objec-tives.
This way everyone knows what the goal is,
and will try to meet the objectives that were set.
Giving people responsibility and accountability for
their actions instills a good sense of pride, which
will carry over in terms of wanting to have a good
performance record. This leads to the next guide,
that of authority.
Providing Adequate Authority
Provide adequate authority and
resources to responsible parties, so that
assigned responsibilities can be met.
When an employee is given the responsibility to
do something, the resources and authority to per-form
that task should accompany it. The employer
should provide all the tools necessary for the
employee to be successful at his or her task. As
employees within the organization grow, they will
take on more responsibility if they feel manage-ment
is backing them.
Giving and Receiving Accountability
Hold managers, supervisors, and
employees accountable for meeting
their responsibilities, so that essential
tasks will be performed.
As was previously mentioned, accountability for
one's actions must accompany the responsibility
given and the authority and resources provided.
Holding employees accountable helps them see
how important they are to the overall process
within the company.
Providing Program Evaluations
Review program operations at least
annually to evaluate their success in
meeting the goal and objectives, so that
deficiencies can be identified and the
program and/or the objectives can be
revised when they do not meet the goal
of effective safety and health protec-
tion.
Once the safety and health program is in place, and
all components are functioning, management needs
to check on it from time to time to ensure its effec-tiveness.
If the program is not working, the
employer should determine why and try to resolve
it. A successful safety and health program will pro-vide
a sense of pride among employees, making
them feel like they are accomplishing something.
10/98 1.3
Worksite analysis is a combination of systematic
actions that provide the employer with the infor-mation
necessary to recognize and understand the
existing and potential hazards of the workplace.
While these actions may appear complicated, they
are really basic activities that are performed in
most workplaces. The Guidelines see these
actions as:
• Comprehensive Hazard 
Identification
• Regular Site Safety and Health 
Inspections
• Employee Reports of Hazards
• Accident/Incident Investigations
• Injury and Illness Trend Analysis
Comprehensive Hazard
Identification 
So that all hazards are identified:
Conduct comprehensive worksite sur-
veys to establish safety and health haz-
ard inventories and update the surveys
periodically as expert understanding of
hazards and the methods of control
change;
Analyze planned and new facilities,
processes, materials, and equipment;
and
Perform routine hazard analysis of
jobs, processes, and/or varied phases
of work as needed.
In order to design a program of prevention and
control, an employer must have a comprehensive
hazard survey, a change analysis, and a routine
hazard analysis. The comprehensive hazard sur-vey
is the most basic tool used to establish a pre-vention
and control program. This survey should
be performed on a periodic basis.
The second component used to build a prevention
control program is the change analysis. This
analysis is conducted prior to a change in facili-ties,
equipment, processes, or materials in the
workplace. In this way, potential hazards can be
identified before the change goes into effect. It
will also provide a source of savings for the
employer in that possible faulty designs can be
located and changed before going into place.
The last component of the comprehensive hazard
identification is the routine hazard analysis. The
most basic form of routine hazard analysis is the
job safety analysis. This analysis divides a job
into tasks and steps, then it allows for an analysis
of potential hazards. A method of prevention and
control can then be developed from the analysis
that can eliminate the potential hazards. When
dealing with complex hazardous chemical systems,
a process hazard analysis is used. This analysis
allows the complex system to be broken into its
smallest elements, then the potential hazards are
identified through each step of the process.
1.4 10/98
Worksite Analysis
Regular Site Safety and Health
Inspections
Provide for regular site safety and
health inspections, so that new, reoccur-
ring, or previously missed hazards and
failures in hazard controls are identi-
fied.
For each worksite a safety and health inspection
should be performed on a regular basis.
Employees at the worksite can be trained to per-form
these inspections. The goal of performing
this inspection will be to identify any controls
that might have slipped since the routine analysis
was performed.
Employee Reports of Hazards
So that employee insight and experi-
ence in safety and health protection
may be used and employee concerns
addressed, provide a reliable system
for employees, without fear of reprisal,
to notify management personnel about
conditions that appear hazardous and
to receive timely and appropriate
responses; and encourage the employ-
ees to use the system 
The goal of any safety and health program is to
identify and correct hazards before they become a
problem and employees are harmed. The
employer should use all employees as hazard
look-outs. The goal is accident and illness pre-vention,
and it should start with each person who
enters the job site.
Accident/Incident Investigations
Provide for investigation of accidents
and "near miss" incidents, so that their
causes and the means for their preven-
tion are identified.
Unfortunately accidents happen. Employers
should use accidents as learning tools by investi-gating
them to determine the causes and then
developing ways to avoid similar situations in the
future.
Injury and Illness Trend Analysis
Analyze injury and illness trends over
time, so that patterns with common
causes can be identified and prevented.
Tracking injuries and illnesses over periods of
time can provide useful information for devising a
prevention plan. The data may also point out
problem areas that are missed by simple inspec-tions.
10/98 1.5
Once a list of hazards and potential hazards for the
workplace has been produced, the prevention and
control program can be designed. The program
should consist of the following:
• Appropriate Controls
• Preventive Maintenance
• Emergency Preparation
• Medical Program
Appropriate Controls
So that all current and potential haz-
ards, however detected, are eliminated
or controlled in a timely manner, estab-
lish procedures for that purpose, using
the following measures:
Engineering techniques where feasible
and appropriate;
Procedures for safe work which are
understood and followed by all affect-
ed parties, as a result of training, posi-
tive reinforcement, correction of unsafe
performance, and, if necessary,
enforcement through a clearly commu-
nicated disciplinary system;
Provision of personal protective equip-
ment; and
Administrative controls, such as reduc-
ing the duration of exposure.
In designing the prevention and control program,
the ideal situation would be to eliminate hazards
or exposures that employees would encounter.
Since this is not always possible, employers
should use the best available methods for protect-ing
employees. Engineering controls combined
with good work practices can, for the most part,
provide maximum protection for employees. The
employer is responsible for providing whatever
training is necessary to ensure that their employees
know how to use the systems in place for protec-tion.
Preventive Maintenance
Provide for facility and equipment main-
tenance, so that hazardous breakdown
is prevented.
This simply says that the employer should provide
a good equipment maintenance program that will
keep the in-place engineering controls operating as
efficiently as possible. When equipment is not
maintained properly, it can become hazardous.
Emergency Preparation
Plan and prepare for emergencies, and
conduct training drills as needed, so
that the response of all parties to emer-
gencies will be "second nature."
No safety and health program is complete without
a plan for emergencies. Each employee should be
trained in the emergency procedures of the work-place.
For those who have special responsibilities
during emergencies, additional training should be
provided that will allow them to safely perform
their duties. Working training drills in the activi-ties
of the workplace will better prepare everyone
should an emergency arise.
Medical Program
Establish a medical program which uses
occupational health professionals in the
analysis of hazards, early recognition
and treatment of illness and injury, and
limitation of the severity of harm; and
which provides first aid and cardiopul-
monary resuscitation (CPR) onsite and
physician and emergency medical care
nearby, so that harm will be minimized
if an injury or illness does occur.
Providing basic health care services onsite does
not mean establishing a large department of doc-tors
and nurses. Instead, most facilities have
employees within their sites who can provide basic
health care should an emergency situation arise.
Employers should look for occupational health
providers when putting together the health and
safety program. For small agencies, the employer
should try to arrange for health care through local
clinics. The key to the medical program is to min-imize
the time an injured person will have to wait
before being properly treated. Training employees
onsite in first aid and CPR provides agencies with
a source of help during times of trouble.
1.6 10/98
Hazard Prevention and Control
For an effective safety and health program, it is
crucial that everyone at the workplace understands
his role in the program, actively works to prevent
and/or control hazards and potential hazards at the
worksite, and knows ways he should protect him-self
should a hazardous situation occur. A good
safety and health program is achievable if the fol-lowing
understand their roles and responsibilities
within their group:
• Employees
• Supervisors
• Managers
Employees
Ensure that all employees understand
the hazards to which they may be
exposed and how to prevent harm to
themselves and others from exposure
to these hazards, so that employees
accept and follow established safety
and health protection.
Each employee should understand how important
he is to the overall picture of safety and health, not
only for his well-being, but for every worker
involved. The employees need to know the gener-al
safety and health rules, specific site hazards,
safe work practices that are used to control expo-sure,
and the role he is to play in an emergency
situation.
Supervisors
So that supervisors will carry out their
safety and health responsibilities effec-
tively, ensure that they understand
those responsibilities and the reasons
for them, including:
Analyzing the work under their super-
vision to identify unrecognized poten-
tial hazards;
Maintaining physical protection in their
work areas; and
Reinforcing employee training on the
nature of potential hazards in their
work and on needed measures,
through continual performance feed-
back and, if necessary, through
enforcement of safe work practices.
Supervisors should be given special training in
both safety and health and in leadership.
Supervisors need to be attuned to the worksite and
the potential for hazardous situations occurring in
their areas. Supervisors need special training in
maintenance in their work areas, as well as how to
get their employees involved in controlling haz-ards.
Managers
Ensure the managers understand their
safety and health responsibilities as
described under  "Management
Leadership and Employee Involvement"
so that managers will effectively carry
out those responsibilities.
It is necessary for a manager to have a good sys-tem
of communication with the workers that are in
his department. A manager must also understand
his role in the safety and health program and set
the leadership example for others to follow. The
employer should use all available resources to help
raise the level of awareness of managers.
10/98 1.7
Safety & Health Training
Management Commitment and
Leadership
q Policy statement (goals established, issued,
and communicated)
q Program revised annually
q Participation in safety meetings, inspections
q Commitment of resources
q Safety rules and procedures incorporated into
site operations
q Management observes safety rules
Assignment of Responsibility
q Safety designee on site, knowledgeable and
accountable
q Supervisors understand safety and health
responsibilities
q Employees adhere to safety rules
Identification and Control of
Hazards
q Periodic site safety inspection program
involving supervisors
q Preventive controls in place (engineering
controls, maintenance, PPE)
q Action taken to address hazards
q Safety committee established, where
appropriate
q Technical references available
q Enforcement procedures by management
Training and Education
q Supervisors receive basic training
q Specialized training provided when needed
q Employee training program is in place and
monitored to ensure effectiveness
Recordkeeping and Hazard Analysis
q Employee illness/injury records maintained,
OK200 log summary posted in February
q Supervisors perform accident investigations,
determine causes and propose corrective
action
q Injuries, near misses, and illnesses are
evaluated for trends and corrective action
initiated
First Aid and Medical Care
q First aid supplies and medical service
available
q Employees informed of medical results
q Emergency procedures established and
training provided as necessary
1.8 10/98
Key Elements of a 
Safety & Health Program
Management Leadership and
Employee Involvement
4 Policy
4 Goal
4 Objectives
4 How visible and effective is management
leadership
4 How effective is employee involvement in
identifying safety and health problems and
finding solutions
4 How clearly is responsibility for safety and
health assigned
4 Are adequate authority and resources
allocated to the program
4 Are responsible people held accountable
Worksite Analysis
4 Have comprehensive surveys been done
4 Have pre-use analyses been done before
purchase and installation of new equipment
and materials and establishment of new
processes
4 Are routine hazard analyses being done and
used effectively
4 Are periodic site inspections being done as
scheduled, and are the inspection personnel
finding the hazards which exist
4 Is the system for employees to report hazards
effective
4 Are all near-misses, incidents and accidents
investigated effectively
4 Are the problems identified by the analyses
being tracked to resolution
Hazard Prevention and Control
4 Are engineering and work practice controls in
place and effective
4 Is the availability, use and maintenance of PPE
appropriate
4 Is the disciplinary system working well
4 Is the preventive maintenance system working
well
4 Have emergency drills been conducted and
critiqued
4 Is the medical program adequate and
effective
Training
4 Is appropriate training being conducted
4 Are employees learning what they should
4 Are training records easily accessible and
complete
10/98 1.9
Annual Evaluation of Safety & Health
Program Elements