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CS-1 revised October 2001 Cal/OSHA Consultation Service
State of California-Department of Industrial Relations- Division of Occupational Safety & Health
 MODEL
INJURY AND ILLNESS
PREVENTION PROGRAM
FOR
NON-HIGH HAZARD
EMPLOYERS
 ABOUT THIS MODEL PROGRAM
Every California employer must establish, implement and maintain a written Injury
and Illness Prevention (IIP) Program and a copy must be maintained at each
worksite or at a central worksite if the employer has non-fixed worksites. The
requirements for establishing, implementing and maintaining an effective written
Injury and Illness Prevention Program are contained in Title 8 of the California
Code of Regulations, Section 3203 (T8 CCR 3203) and consist of the following eight
elements:

- Responsibility
- Compliance
- Communication
- Hazard Assessment
- Accident/Exposure Investigation
- Hazard Correction
- Training and Instruction
- Recordkeeping

This model program has been prepared for use by employers in industries which
have been determined by Cal/OSHA to be non-high hazard. You are not required
to use this program. However, any employer in an industry which has been
determined by Cal/OSHA as being non-high hazard who adopts, posts, and
implements this model program in good faith is not subject to assessment of a
civil penalty for a first violation of T8 CCR 3203.

Proper use of this model program requires the IIP Program administrator of your
establishment to carefully review the requirements for each of the eight IIP
Program elements found in this model program, fill in the appropriate blank
spaces and check those items that are applicable to your workplace. The
recordkeeping section requires that the IIP Program administrator select and
implement the category appropriate for your establishment. Sample forms for
hazard assessment and correction, accident/exposure investigation, and worker
training and instruction are provided with this model program.

This model program must be maintained by the employer in order to be effective.

RESPONSIBILITY
The Injury and Illness Prevention (IIP) Program administrator,
_______________________________________________________________________
Program Administrator
has the authority and the responsibility for implementing and maintaining this IIP Program for
_______________________________________________________________________
Establishment Name

Managers and supervisors are responsible for implementing and maintaining the IIP Program in
their work areas and for answering worker questions about the IIP Program. A copy of this IIP
Program is available from each manager and supervisor.

COMPLIANCE
All workers, including managers and supervisors, are responsible for complying with safe and
healthful work practices. Our system of ensuring that all workers comply with these practices
include one or more of the following checked practices:

_____ Informing workers of the provisions of our IIP Program.

_____ Evaluating the safety performance of all workers.
_____ Recognizing employees who perform safe and healthful work practices.
_____ Providing training to workers whose safety performance is deficient.
_____ Disciplining workers for failure to comply with safe and healthful work practices.

COMMUNICATION
All managers and supervisors are responsible for communicating with all workers about
occupational safety and health in a form readily understandable by all workers. Our
communication system encourages all workers to inform their managers and supervisors about
workplace hazards without fear of reprisal.

Our communication system includes one or more of the following checked items:

_____ New worker orientation including a discussion of safety and health policies and
procedures.
_____ Review of our IIP Program.
_____ Training programs.
_____ Regularly scheduled safety meetings.
_____ Posted or distributed safety information.
_____ A system for workers to anonymously inform management about workplace
hazards.
_____ Our establishment has less than ten employees and communicates with and
instructs employees orally about general safe work practices and hazards unique
to each employee's job assignment.

1
HAZARD ASSESSMENT
Periodic inspections to identify and evaluate workplace hazards shall be performed by a
competent observer in the following areas of our workplace:

Periodic inspections are performed according to the following schedule:

1. When we initially established our IIP Program;

2. When new substances, processes, procedures or equipment which present
potential new hazards are introduced into our workplace;
3. When new, previously unidentified hazards are recognized;
4. When occupational injuries and illnesses occur; and
5. Whenever workplace conditions warrant an inspection.

ACCIDENT/EXPOSURE INVESTIGATIONS
Procedures for investigating workplace accidents and hazardous substance exposures include:

1. Interviewing injured workers and witnesses;

2. Examining the workplace for factors associated with the accident/exposure;
3. Determining the cause of the accident/exposure;
4. Taking corrective action to prevent the accident/exposure from reoccurring; and
5. Recording the findings and actions taken.

HAZARD CORRECTION
Unsafe or unhealthy work conditions, practices or procedures shall be corrected in a timely
manner based on the severity of the hazards. Hazards shall be corrected according to the
following procedures:

1. When observed or discovered; and

2. When an imminent hazard exists which cannot be immediately abated without
endangering employee(s) and/or property, we will remove all exposed workers
from the area except those necessary to correct the existing condition. Workers
who are required to correct the hazardous condition shall be provided with the
necessary protection.

2
 TRAINING AND INSTRUCTION
All workers, including managers and supervisors, shall have training and instruction on general
and job-specific safety and health practices. Training and instruction is provided:

1. When the IIP Program is first established;

2. To all new workers, except for construction workers who are provided training
through a construction industry occupational safety and health training program
approved by Cal/OSHA;

3. To all workers given new job assignments for which training has not previously
provided;

4. Whenever new substances, processes, procedures or equipment are introduced

to the workplace and represent a new hazard;

5. Whenever the employer is made aware of a new or previously unrecognized

hazard;

6. To supervisors to familiarize them with the safety and health hazards to which
workers under their immediate direction and control may be exposed; and

7. To all workers with respect to hazards specific to each employee's job

assignment.

General workplace safety and health practices include, but are not limited to, the following:

1. Implementation and maintenance of the IIP Program.

2. Emergency action and fire prevention plan.

3. Provisions for medical services and first aid including emergency procedures.

4. Prevention of musculoskeletal disorders, including proper lifting techniques.

5. Proper housekeeping, such as keeping stairways and aisles clear, work areas neat and
orderly, and promptly cleaning up spills.

6. Prohibiting horseplay, scuffling, or other acts that tend to adversely influence safety.

7. Proper storage to prevent stacking goods in an unstable manner and storing goods
against doors, exits, fire extinguishing equipment and electrical panels.

8. Proper reporting of hazards and accidents to supervisors.

9. Hazard communication, including worker awareness of potential chemical hazards, and

proper labeling of containers.

10. Proper storage and handling of toxic and hazardous substances including prohibiting
eating or storing food and beverages in areas where they can become contaminated.

3
 RECORDKEEPING
We have checked one of the following categories as our recordkeeping policy.

_____ Category 1. Our establishment has twenty or more workers or has a workers'
compensation experience modification rate of greater than 1.1 and is not on a
designated low hazard industry list. We have taken the following steps to implement
and maintain our IIP Program:

1. Records of hazard assessment inspections, including the person(s)

conducting the inspection, the unsafe conditions and work practices that have
been identified and the action taken to correct the identified unsafe conditions
and work practices, are recorded on a hazard assessment and correction
form; and

2. Documentation of safety and health training for each worker, including the
worker's name or other identifier, training dates, type(s) of training, and
training providers. are recorded on a worker training and instruction form.

Inspection records and training documentation will be maintained according to the

following checked schedule:

_____ For one year, except for training records of employees who have worked for
less than one year which are provided to the employee upon termination of
employment; or

_____ Since we have less than ten workers, including managers and supervisors, we
only maintain inspection records until the hazard is corrected and only
maintain a log of instructions to workers with respect to worker job
assignments when they are first hired or assigned new duties.

_____ Category 2. Our establishment has fewer than twenty workers and is not on a
designated high hazard industry list. We are also on a designated low hazard industry
list or have a workers' compensation experience modification rate of 1.1 or less, and
have taken the following steps to implement and maintain our IIP Program:

1. Records of hazard assessment inspections; and

2. Documentation of safety and health training for each worker.

Inspection records and training documentation will be maintained according to the

following checked schedule:

_____ For one year, except for training records of employees who have worked
for less than one year which are provided to the employee upon
termination of employment; or

_____ Since we have less than ten workers, including managers and
supervisors, we maintain inspection records only until the hazard is
corrected and only maintain a log of instructions to workers with respect
to worker job assignments when they are first hired or assigned new
duties.

_____ Category 3. We are a local governmental entity (county, city, district, or and any public
or quasi-public corporation or public agency) and we are not required to keep written
records of the steps taken to implement and maintain our IIP Program.
4
 HAZARD ASSESSMENT AND CORRECTION RECORD
Date of Inspection: Person Conducting Inspection:

Unsafe Condition or Work Practice:

Corrective Action Taken:

Date of Inspection: Person Conducting Inspection:

Unsafe Condition or Work Practice:

Corrective Action Taken:

Date of Inspection: Person Conducting Inspection:

Unsafe Condition or Work Practice:

Corrective Action Taken:

 ACCIDENT/EXPOSURE INVESTIGATION REPORT

Date & Time of Accident:

Location:

Accident Description:

Employees Involved:

Preventive Action Recommendations:

corrective Actions Taken:

Manager Responsible: Date Completed:

 HAZARD ASSESSMENT AND CORRECTION RECORD
Date of Inspection: Person Conducting Inspection:

Unsafe Condition or Work Practice:

Corrective Action Taken:

Date of Inspection: Person Conducting Inspection:

Unsafe Condition or Work Practice:

Corrective Action Taken:

Date of Inspection: Person Conducting Inspection:

Unsafe Condition or Work Practice:

Corrective Action Taken:

 WORKER TRAINING AND INSTRUCTION RECORD

EMPLOYEE NAME TRAINING DATES TYPE OF TRAINING TRAINERS

 Cal/OSHA Consultation Programs
Toll-free number: 1-800-963-9424 • Internet: www.dir.ca.gov

On-site Assistance Program Area Offices

Northern California
2424 Arden Way, Suite 410
Sacramento, CA 95825
(916) 263-0704

Central Valley
1901 North Gateway Blvd., Suite 102
San Francisco Bay Area Fresno, CA 93727
1515 Clay Street, Suite 1103 (559) 454-1295
Oakland, CA 94612
(510) 622-2891
San Bernardino
464 West 4th Street, Suite 339
San Bernardino, CA 92401
(909) 383-4567
San Fernando Valley
6150 Van Nuys Blvd., Suite 307
Van Nuys, CA 91401
(818) 901-5754

Los Angeles/Orange
10350 Heritage Park Drive, Suite 201 San Diego
Santa Fe Springs, CA 90670 7575 Metropolitan Dr. suite 204
(562) 944-9366 San Diego, CA 92108
(619) 767-2060

Your call will in no way trigger an inspection by Cal/OSHA enforcement.

• Voluntary Protection Program • Research and Education Unit

San Francisco, CA 94142 Sacramento, CA 95825
(415) 703-5272 (916) 574-2528