Small Employer Safety Program Manual Appendix 3 Forms

Safety Program Manual Appendix 3 – Forms

Appendix 3 – Forms

 Block Site Hazard Assessment/Site Inspection/Pre-Work Meeting/Daily Pre-Shift Safety Meeting

 Contractor Management Pre-Qualification Checklist

 Contractor Safety Meeting Minutes

 Contractor Selection and Safety Checklist

 Corrective Action Log

 Danger Tree Risk Assessment Reference

 Emergency Response Drill Form

 Emergency Response Plan – Field Version

 Emergency Response Plan – Supervisor Version

 Employee Injury Communication Tracking Sheet – Return-to-Work Program

 Exposure Control Plan – Blood-Borne Pathogens

 First Aid Assessment Worksheet

 First Aid Assessment Worksheet for Harvesting Activities

 First Aid Kits: Recommended Minimum Contents

 Hazard, Close Call/Near Miss, Property Damage or Injury Report

 Incident Investigation Form

 Initial Safety Meeting Checklist

 Job Safety Analysis

 Meeting Log

 Monthly Meeting Minutes

 Orientation of Persons Other Than Employees Checklist

 Orientation of Young or New Workers Checklist

 Orientation of Young or New Workers Checklist with Follow Up Assessment

 Phase Congestion Guiding Document

 Phase Congestion Hazard Assessment

 Pre-Work Planning Log

0cb15583e2330252c41a1c188a0f4382.doc Page 1 of 2 Revised: November 17, 2016 Safety Program Manual Appendix 3 – Forms

 Prime Contractor Agreement – Form 23

 Prime Contractor Corrective Action Log

 Prime Contractor Orientation Form

 Prime Contractor Pre-Qualification Checklist

 Prime Contractor Pre-Work Checklist

 Prime Contractor Site Inspection Checklist

 Prime Contractor Worksite Checklist

 Refusal of Unsafe Work Tracking Form

 Risk Assessment Form

 Safety Alert

 Safety Meeting Log

 Site Inspection Checklist

 Site Log

 Site Safety Plan

 Steep Slope Logging Risk Assessment and Site Pre-Work

 Tailgate Safety Meeting / Crew Talk

 Training and Certification Log

 Travel Plan

 Vehicle Inspection Report

 Worker Assessment Checklist

 Worker Contractor Training List

 Working Alone or in Isolation Safe Work Procedure and Checklist

 Workplace Bullying or Harassment Complaint Form

 Workplace Safety Plan (two versions)

 WSBC Form 7 – Employer's Report of Injury or Occupational Disease

 WSBC Reference Guide Form 7 – Employer's Report of Injury or Occupational Disease

0cb15583e2330252c41a1c188a0f4382.doc Page 2 of 2 Revised: November 17, 2016