SAFETY AND HEALTH PROGRAM
Campeon Roofing & Waterproofing, Inc.
3750 Roundbottom Road
Cincinnati, Ohio 45244
December 20, 2007
TABLE OF CONTENTS
DEDICATION 3
SAFETY AND HEALTH PROGRAM 4
GENERAL POLICY 6
PRE-JOB PLAN 9
RESPONSIBILITIES 9
MANAGEMENT 10
SUPERINTENDENT/FOREMAN 10
SUBCONTRACTOR 11
WORKER 12
ON-SITE PROCEDURES 13
GENERAL AND SPECIFIC PROGRAM 13
WORKSITE CONTROLS 13
TRAILER/OFFICE AREA SETUP 13
MULTI-EMPLOYER ISSUES 14
SUBCONTRACTOR ISSUES 15
ACCIDENT INVESTIGATIONS AND REPORTING 15
REPORTING PROCEDURES AND FORMS 16
A. DAILY/WEEKLY
INSPECTION CHECK LIST 18
B. ACKNOWLEDGMENT/AGREEMENT
FORM FOR OTHER CONTRACTORS 25
C. WEEKLY
"TOOL BOX" MEETING REPORT 26
D. PRE-JOB
PLANNING LIST 27
E. ACCIDENT INVESTIGATION REPORT 28
SAFETY & HEALTH PROGRAM
DEDICATION
This safety and health manual is dedicated
to you, our employees. It will assist you in performing your tasks
in a safe, productive manner, while at the
same time, helping all of us to have a safe healthful work environment.
This manual is also dedicated to your
family and loved ones. It will help build work habits which will help keep you
safe on the job.
YOU ARE THE FUTURE. We look forward to a safe and long-term
working relationship.
SAFETY & HEALTH PROGRAM FOR
CAMPEON ROOFING & WATERPROOFING,
INC.
CAMPEON ROOFING &
WATERPROOFING, INC. realizes that safety and health is a vital part of all
of our operations and is an integral part of every employees’ daily duties.
Your personal safety and health, as well as that of your co-workers, is of
primary importance to us here at CAMPEON
ROOFING & WATERPROOFING, INC. and will take precedence over production
whenever necessary. For our program to
be THE BEST IN THE INDUSTRY, you must view it as YOUR program.
Our objectives here at CAMPEON
ROOFING & WATERPROOFING, INC. will be to eliminate or minimize
exposures to conditions which may result in an injury and/or illness to you and
foster a cooperative effort to have the program grow. Your input to the program
will be vital to our combined efforts.
A good program must eliminate all ACCIDENTS. Keep in mind that "accidents" are defined as unplanned
occurrences. This means that, even if an injury/illness does not occur, we need
to know about it so that corrective action may take place. This will prevent
another "accident" which could result in an injury or illness.
Our program will, at a minimum, include:
> Providing mechanical and physical safeguards.
> Conducting pre-job audits to identify/eliminate conditions and
practices which could
cause injury or loss and
comply with all federal, state, and
local codes.
> Conducting follow-up audits.
> Providing training relative to your exposure(s).
> Developing, with your input, our own rules and policies.
> Providing personal as well as other protective equipment.
> Enforcing all safety policies as a condition of employment.
> Immediately investigating ALL ACCIDENTS.
> Providing work incentives for an EXCELLENT program.
> Expecting your input for better/safer ways to do the task.
> Planning our work to recognize/eliminate potential exposures.
> Providing for continuing updates.
We, here at CAMPEON ROOFING &
WATERPROOFING, INC., recognize that safety and health is EVERYBODY'S
business. Your safety and health is our future. You and your co-workers are our resources.
In the following pages you will find our overall program. Items which are specific to your worksite will be furnished to you both prior to commencing work and during changes.
GENERAL PROGRAM
1. ALL employees, including management, are expected to follow our
safety and health policies and make recommendations for their improvement.
2. ALL supervisors will insist on the ENFORCEMENT of all safety and
health rules.
3. Training will be provided at regular intervals to assure that all
procedures and policies are understood and followed.
4. As determined, personal protective equipment (PPE) shall be used.
5. Since alcohol, drugs, and fatigue impair judgment, they will not be
allowed or tolerated. Since your and your co-workers’ safety and health depend
on your being able to perform the tasks, persons with impaired judgment will be
dealt with accordingly.
6. All jobs will be pre-planned and have a continuing plan to monitor
for and eliminate safety and health hazards.
7. Any employee involved in horseplay, not following policy, or
otherwise endangering themselves or others, will be subject to disciplinary
action.
8. If you don't know how to perform a task or need help, ASK.
9. Report ALL accidents, no matter how minor. You could have been
injured.
10. Report all unsafe conditions created or controlled by others to
your supervisor. Your exposure cannot be allowed, even though you/we did not
create the unsafe condition.
11. The workplace is to be inspected each day prior to commencing work
for hazards.
12. ALL relevant OSHA 29CFR1926 and/or 1910 standards will be followed.
Specific items to be adhered to on ALL JOBS include:
a. Maintain this
program on site.
b. Display the
OSHA job protection POSTER.
c. Have all
contractual items in place (i.e.-drinking water, toilets, first aid, hazard
communication, etc.)
d. Post all
emergency telephone numbers. In remote areas, fire/rescue
departments should know your EXACT
location.
e. Hold weekly
tool box safety meetings with ALL in attendance.
f. Plan ahead and train for the remaining work.
g. Investigate and
report all accidents, regardless of whether or not there was an
an injury.
h. Train employees
in their specific tasks.
i. Maintain Hazard Communications program and
material safety data sheets
on site and train employees on their use.
j. Maintain first aid supplies and review our
medical emergency plan with
all employees on the site.
k. Maintain good housekeeping throughout the site.
l. Wear seat belts on ALL mobile equipment.
This includes dump trucks,
graders, dozers, earth movers, etc.
m. Wear hard hats
at all times when there is exposure on site.
n. Use personal protective
equipment such as gloves, safety glasses/goggles, ear
plugs, respirators, safety harnesses, etc.
worn where there is exposure.
o. Wear hard
soled, leather shoes on all jobs. No open toe shoes, sandals,
or other shoes not affording protection
are allowed.
p.
Have charged, fully
operable fire extinguishers of the appropriate type on the
job at all
times.
q. Use only approved containers for flammables.
r. Inspect all chains, wire rope, etc. prior to their use to determine
if defective. If so, they are to be removed
from service immediately.
s. Determine that
all hand or power operated tools are free from defects (no
mushrooms,
sprung jaws, cracked handles, etc. ) and have all guards in place
when in use. If
electrical, it must be properly grounded, be double insulated, and
used in a ground fault circuit ( GFCI ).
t.
Make sure all
temporary electrical services have GFCI's or the assured
grounding program is followed.
u. Do not use
electrical equipment in hazardous or damp locations unless
designed for that use.
v. Make sure all
ladders are of sufficient length and have no defects.
w. Protect all
floor and wall openings with standard guardrails ( top
and midrail ) or cover with materials of
adequate strength to support
intended loads.
x. Make sure all stairs will have standard
quardrails.
y. Make sure all
equipment to be worked on is locked out/tagged out or otherwise
put in a ZERO mechanical state.
z. Never enter a
confined space ( tanks, holes, etc. )
until it has been
determined to be gas free and with
sufficient oxygen. Special procedures
must be followed in these cases and
employees ARE NOT TO EXPOSE
THEMSELVES OR OTHERS until trained in
entry techniques.
PRE-JOB PLANNING
1. Have a site specific safety and health program at the job, including
the general program outlined herein.
2. Designate competent persons for safety, training, tool repair,
inspections and keeping records.
3. ALWAYS follow and use the plans and specifications for the job. Do
not assume, since you have "done this before" that the conditions are
the same. Special instructions from the engineer and/or architect are routinely
included in these documents.
4. Hold a pre-job conference with all employers, employees, and others
directly involved to plan for all phases of construction.
5. Have a clear understanding of the potential hazards and their
elimination. By following the multi-employer policy and having a cooperative
agreement, there should be no or minimal exposures.
> Know who
created the hazard
> Know who has
the responsibility and authority to correct it
> Make an
effort to have it corrected, preferably in writing
> Instruct own
employees to avoid hazard
6. Follow and support our safety and health policies.
RESPONSIBILITIES
The effectiveness of our program depends on the commitment and priority
given by not only owners and managers but ALL personnel. Our intent is to set
good personal examples for safety and health policies from the top down
throughout the organization, with the managers exercising close supervision of
all methods and working conditions.
We will insure that all employees under the supervisors’ direction
shall be trained in safe methods so they can conduct their responsibilities in
a safe and professional manner. Specific responsibility is as follows:
MANAGEMENT
_____________
a. Provide leadership,
commitment, and means to adhere to our policy.
b. Enforce our
policy and discharge anyone who willfully disregards it.
c. Require all
employers and self employed persons to abide by this policy,
or assure they have their own which is compatible.
d. Monitor all
safety activities, document violations, and take the necessary
actions to correct unsatisfactory
conditions.
e. Require a
pre-job planning review and hold a pre-job presentation at the
jobsite before work commences.
f. Investigate all
accidents and complete reports on findings, causal factors,
and corrective actions taken.
g. Require a
safety performance review and analyze results after completion
of work.
h. Include safety
as part of all performance appraisals.
i. Provide
training for workers.
j. Shut down
operation when weather or imminent hazards exist.
SUPERINTENDENT/FOREMAN
__________________________
a. Determine
customers and projects’ safety, health and loss control requirements
and evaluate them. These should be planned
into the jobs, including additional
or unusual control methods.
b. Provide all
other contractors with a copy of this book and assure they
understand the requirements.
c. Obtain signed
agreement regarding their understanding and adherence
to the program from contractors at the
same time the contract is signed.
d. Participate in
or conduct pre-job safety planning meeting for assigned work,
requiring all contractors to be in attendance.
e. Monitor
compliance with the program and provide leadership, authority,
and decisiveness in dealing with
non-complying contractors, up to and
including terminating their contract and
removing them from the project.
f. Provide on-going
input into the program for necessary changes in procedures
as determined by changes in working
conditions, violations noted, and unique
situations.
SUBCONTRACTORS
__________________
a. Be accountable and responsible for
program on assigned project site and stay
in compliance.
b. Attend and
provide input at the pre-job safety meeting.
c. Instruct all
project workers in safe practices through "weekly tool box"
meetings. All attendees are to sign off their
attendance, understanding of the
issues, and their agreement to adhere to
the issues and instructions covered.
d. Train employees
in all "job specific" tasks, whether it is a new employee or
new to the job function.
e. Post program
information on bulletin board as furnished and maintain close
contact with supervisors regarding changes
and/or their input.
f. Complete a job
checklist. Submit completed forms to the project manager
weekly/daily as required.
g. Take immediate
action to correct unsafe conditions created by other
contractors. Document the demand to the
contractor to correct the condition
furnishing them the request in writing
and keeping a copy for your report.
IMMEDIATELY STOP WORK in areas which are
hazardous/life threatening.
h. Insure that all
injuries/illnesses are promptly treated and reported.
i. Investigate ALL
accidents and submit completed report.
j. Be sensitive to
hazardous weather conditions ( wind, ice, lightning ) and
discontinue work when warranted.
k. Have all
necessary safety/health equipment available at site for use. Pre-plan
for the next days work so any additional
equipment can arrive prior to
commencing work.
WORKER
_________
a. Become familiar
with program and abide by policy.
b. Report to work
ready to perform tasks so as not to endanger yourself or others.
c. Use all PPE
necessary and/or required.
d. Report all
accidents, unsafe conditions, and observations to your supervisor.
e. Be mindful of your
co-worker since you too, are their co-worker.
f. Attend ALL
"weekly tool box" meetings and "specific task" training
which
relates to your work.
g. Maintain good
housekeeping in your work area.
h. DO NOT USE
unsafe, damaged, or defective equipment, including those which
you own.
i.
If a task to be
performed is not understood, ASK FOR INSTRUCTIONS.
ALL PERSONNEL
ON THE SITE ARE CO-WORKERS. IN ORDER FOR US TO MAINTAIN THE BEST WORKING
CONDITIONS, ALL MUST WORK TOGETHER ON SAFETY AND HEALTH ISSUES. THE SUPPLIERS
BRINGING MATERIALS TO THE SITE SHOULD ALSO ABIDE BY OUR POLICY TO MAINTAIN A
SAFE WORKPLACE.
ON SITE PROCEDURES
_____________________
GENERAL AND SPECIFIC PROGRAM
a. The program, which includes REQUIRED activities,
processes, and policies,
will be strictly adhered to as it is basic
and essential. While local conditions
may require certain variations, the
principles remain the same and are the
foundation of your program.
b. All contractors
are to agree to and follow the program.
WORKSITE CONTROLS
a. Audits of the
project operations and conditions existing will be on-going.
Any sources of accidents, injury, or
illness will be identified, corrected, and
reported as they occur.
b. Orderly and
clean housekeeping conditions are to be maintained at all times.
c. Audits for
compliance with federal, state, and local codes will be on-going
in order to minimize loss on site.
d. Weekly/daily
reports on findings will be prepared and corrective actions taken.
TRAILER/OFFICE AREA SETUP
a. The site
trailer/office is the hub of all activity. Whether it be OSHA, state, or other
officials, or visitors, they first go there. Although OSHA normally inspects
larger worksites, ONE complaint may
bring them to YOUR door. The information and materials to be there are, at a
minimum:
1. First aid
supplies
2. Potable water
with individual disposable cups
3. Steps to area
with standard handrails
4. Emergency fire
and medical information
5. Bulletin board
with safety information ( crane signals, rigging, hazardous
chemical classifications, etc. )
6. Bulletin board
for all job notices ( OSHA poster, Fair Labor standards, Ohio
Utilities Protection, etc. )
7. Fire
extinguisher of correct type for hazards
8. Records of
maintenance, accidents, injuries/illnesses
9. Records of
safety audits/meetings
10. Name and
location of nearest emergency squad
11. Hazard warning
signs prominently posted ( HARD HAT AREA, NO
TRESPASSING, NO SMOKING, HIGH VOLTAGE,
ETC. )
12. Hazard
Communication program and material safety data sheets ( MSDS )
13. Copy of codes:
OSHA, State, etc.
14. Documentation
on smaller employers being checked out for safety programs
If you are
inspected by OSHA or the State of Ohio, call the main office and notify them.
Be cordial, courteous, polite, and take notes of the tour. If, by policy, you
are to request that they wait for the safety director, do so and continue with
the opening conference.
MULTI-EMPLOYER ISSUES
a. OSHA
enforcement policies now address multi-employer sites. OSHA will look closely at the CONTROLLING
employer in order to eliminate workplace hazards. Citations will be issued to:
> The employer who actually creates
the hazard
> The employer responsible ( by
contract or practice )
> The employer responsible to correct
it
It is very important that you work closely with other contractors in
order to remove the hazards on site, whether or not you have exposed employees.
If we are aware of hazards, we must take steps to eliminate them. Although one party may have created the
hazard and/or failed to correct it, OSHA will cite all other parties working
around or near the hazard.
SUBCONTRACTOR ISSUES
a. Each contractor
on the project should be contractually obligated to comply with our program and
with federal, state, and local codes. They may have their own program, but it
must, at a minimum, be at least as effective as this program.
b. Each contractor
shall designate a "contact" person or competent supervisor to
coordinate and implement the program.
c. Records of
audits, accidents, injuries, and illnesses shall be available for review and
ALL serious injuries or fatalities shall be reported IMMEDIATELY.
d. Each contractor
is to participate in audits of the job as it relates to their work area and
cooperate fully during any investigations which take place. They are to make
personnel available for interviews and records for review.
ACCIDENT INVESTIGATIONS AND REPORTING
All accidents are to be investigated and reported to us. By definition,
accidents are UNPLANNED OCCURRENCES which could result in personal injury or
property loss. Ten major human factors involved are:
> NEGLIGENCE
> ANGER/TEMPER
> HASTY
DECISION
> NOT CARING
> DISTRACTION
> CURIOSITY
> INADEQUATE
TRAINING
> WORK HABIT
> OVER
CONFIDENCE
> NO PRE-PLANNING
If an accident occurs, the following steps should be taken.
a. Determine the
severity of the accident and investigate it .
b. If necessary, account
for all personnel.
c. Immediately
determine if there is injury/illness and call the emergency
squad.
If in doubt, CALL.
d. Report the
accident to the main office.
e. Secure the area
and take photos since things can change.
f. Hold equipment/property
for inspection.
g. Obtain names of
all involved parties and witnesses.
h. Do not
speculate/discuss accident with persons not involved.
i. Complete an
accident investigation form and submit it to the main office.
j. If applicable,
immediately implement corrective action to assure that there
is no reoccurrence.
REPORTING PROCEDURES AND FORMS
_____________________
Documentation is a critical part of our organization. Reports must be completed
and files kept as outlined in this program. Forms have been included in this
book for your use in audits, meetings, investigations, agreement, etc. They
are:
a. Daily/weekly
inspection check list
b. Acknowledgment/
agreement form for other contractors
c. Weekly
"tool box" meeting record
d. Pre-job
planning list
e. Accident
investigation report
JOB SAFETY & HEALTH CHECKLIST FOR CONSTRUCTION
( NOTE THAT THIS IS NOT AN ALL INCLUSIVE
LIST BUT IS INTENDED TO IDENTIFY THE
COMMON HAZARDS IN THE INDUSTRY )
__________________________________ ______________________________
JOBSITE ( NUMBER/LOCATION ) DATE OF INSPECTION
__________________________________ ______________________________
PERSON COMPLETING INSPECTION TYPE INSPECTION ( ROUTINE,
ACCIDENT, PRE-JOB, ETC. )
CHECK ITEMS INSPECTED AND PLACE X IN THE BLANK IF ACTION IS NEEDED.
ITEMS
NOT APPLICABLE CAN BE CROSSED OFF THE LIST.
GENERAL
________
___ New employee
orientation performed
___ Weekly "tool
box" meeting Subject:__________
_____________________________________________
___ Emergency numbers
posted
___ Material Safety Data
Sheets available and current
___ Hazard Communication
program coordinated by designated employer and
program available
for your use
___ Safety program on site
___ All reports current including
injury/illness form, training, notification of
conditions to
other "Controlling employers", etc.
___ All safety/health
posters and accident prevention signs displayed
___ First aid/medical
provisions in place
___ Fire protection
available and operable
___ Housekeeping and clean
up of work area complete
___ Adequate lighting
provided
___ Toilets provided and
clean
___ All required Personal
Protective Equipment on site and used
___ Employees certified as
required ( i.e.-power activated tools, confined space,
lift operators,
etc. )
HEALTH AND ENVIRONMENTAL
____________________________
___ Excessive noise areas
requiring hearing protection
___ Exposure to dusts,
fumes, gases
___ Any asbestos,
tremolite, etc. exposure
___ All employees trained
in Hazard Communication
PERSONAL PROTECTIVE EQUIPMENT
_________________________________
___ Hard hats worn where
required
___ Safety glasses/face
protection wore
___ Respiratory equipment
cleaned, fit tested, and properly used
___ Safety harnesses,
lanyards, nets, etc. used
___ Safety
shoes/construction boots used
FIRE PROTECTION
_________________
___ All fire brigade
personnel properly trained
___ All equipment
inspected, maintained, and available for use
___ Flammable/combustible
liquids properly stored
___ Storage and usage
areas "Posted" and enforced
___ Approved storage
containers
___ All LP-Gas used,
stored and handled properly
___ All heating devices
ventilated, sized, and used correctly
SIGNS AND TRAFFIC CONTROL
____________________________
___ All required signs and
tags properly displayed
___ Flag persons trained
and wearing vests
___ All barricades, etc.
per ANSI D6.1.1971 specs
MATERIAL HANDLING EQUIPMENT
_______________________________
___ All items properly
stored with access clear
___ Items stored, stacked,
and located so as not to create hazards
___ Rigging equipment of
proper size for intended use
___ Rigging equipment
tested and inspected before use
___ All defective
equipment removed from service
HAND/POWER TOOLS
____________________
___ No defective tools in
use
___ All guards in place
___ All safety devices in
operating order (shutoffs, retainers, air pressure relief’s, etc.)
___ Scheduled maintenance
performed
WELDING AND CUTTING
______________________
___ All employees trained in
use of fuel gases, cylinders, arc welders, and equipment
___ All equipment
inspected for defects or damage
___ Proper separation and
valve caps on cylinders in storage
___ Fire watches used when
necessary
___ Arc welding equipment
properly located, cables in good repair, and welding
screens used
___ Items to be welded are
tested for hazardous coatings ( flammable/toxic )
___ Adequate ventilation
provided
___ Any unattended
equipment turned off
ELECTRICAL
___________
___ All employees trained
in installation, work practices, special equipment, and
environmental safe
guards
___ Ground fault circuits
in place for temporary electric
___ All electrical
equipment inspected per the grounded assured program
___ Electrical services
per code/standards
___ Temporary lighting
protected from damage or contact
___ Circuits identified
___ Circuits locked
out/tagged out as required
___ Circuits in damp, wet,
or hazardous locations proper
WORK AREAS
_____________
___ All equipment
installed per specs
___ Standard railings on
scaffolds, open sides of floors, floor openings, stairways
___ Safety harnesses used
where other means of fall protection not "feasible"
___ Scaffolds/ladders/hoists
properly secured
___ Safe means of access
provided to all levels
___ Employees trained as
required on falls, hazard recognition, etc.
CRANES, BACKHOES, ETC.
________________________
___ Swing radius guarded
___ Overhead/underground
hazards ( electric, trees, gas, etc. )
___ Equipment maintained
and records available
___ Defective equipment
taken out of service
___ Proof tests performed
on all lifting equipment
___ Personnel platforms
designed by qualified personnel
___ Personnel platforms
meet all specs and proof tested to 125% of rated capacity
prior to each lift
___ Wire rope, slings,
lifting equipment inspected for
overloading or defects
___ Daily inspections of
equipment performed
___ All hoists enclosed
___ All exposed gears,
pulleys, etc. guarded
___ Operators and signal
persons trained to communicate instructions
MOTOR VEHICLES/MECHANIZED EQUIPMENT
________________________________________
___ Seat belts worn where
rollover protection is installed
___ Rollover protection
provided
___ All equipment
maintained with records available
___ Brakes, backup alarms,
lights, etc. operating
___ Operating surfaces
well maintained
___ Maintenance performed
only by qualified personnel
___ Safe access to
equipment provided
COMMENTS ON ITEMS TO BE CORRECTED____________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
ACKNOWLEDGMENT/AGREEMENT FOR CONTRACTORS
I have read and understand the Safety and Health requirements of
Campeon Roofing and agree to abide by them during the course of our work on
this jobsite. I understand that strict adherence to these rules and policies is
a condition of the contract and that Campeon Roofing may remove us from the site for infractions of
it. I further understand that, with the complex issues involved on coordinating
work on a MULTI-EMPLOYER site, all safety and health issues must be closely
supervised. I will be responsible for
maintaining safety and eliminating hazards in my own work area and other areas
under my control where any contractor may be exposed to hazardous conditions.
COMPANY____________________________________
REPRESENTATIVE_____________________________
DATE_________________________________________
JOBSITE______________________________________
SIGNATURE___________________________________
WEEKLY "TOOL
BOX" MEETING REPORT
COMPANY____________________________________________________________________
DATE________________________________________________________________________
SUBJECT________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
SIGNATURE OF THOSE ATTENDING:
________________________________
________________________________
________________________________
________________________________
(continue list on back of sheet)
COMMENTS AND SUGGESTIONS:_____________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
SIGNATURE OF SUPERVISOR/TRAINER___________________________________
PRE-JOB PLANNING LIST
1. Have a site-specific program, including:
* Medical/first aid plans
* Hazard Communications Program & MSDSs
* Records and Posting requirements
* Contractual agreements
* Identifying designated representatives ( competent person, safety, training, etc.)
* Conformance to this program, plans, and specifications at all times
* Planning for special issues ( i.e., confined spaces ) and training
* Emergency response plan
2. Hold pre-job conference with all affected contractors.
3. Follow the multi-employer worksite policy for hazard elimination.
* Who created the hazard
* Who has the responsibility/authority to correct it
* Make an effort, in writing, to have controlling employer correct the condition
* Instruct your employees to avoid the hazard or provide alternative means of
protection.
4. Follow the on-site procedures for set-up.
PLEASE SIGN AND RETURN THIS FORM TO YOUR SUPERVISOR AFTER YOU READ AND
UNDERSTAND ALL OF THESE RULES.
I have read CAMPEON ROOFING & WATERPROOFING, INC. safety manual and agree to follow
the safe working rules it contains. I understand that adherence to these rules is not to be
considered by any individual as a contract or guarantee of continued employment. I further
understand and agree that violation of safety practices including failure to use personal protective
equipment will result in disciplinary action up to and including dismissal.
________________________
Employee’s Name
________________________ ______________________
Employee’s Signature Month Day Year
________________________ ______________________
Company’s Representative Month Day Year
Safety Policy
Campeon Roofing & Waterproofing, Inc.
3750 Roundbottom Rd.
Cincinnati, Ohio 45244
REPORT ALL ACCIDENTS TO THE OFFICE
IMMEDIATELY
JOBSITE_______________________________
DATE OF INVESTIGATION_______________
DATE OF ACCIDENT______________________ WEATHER___________________________
TIME_____________________________
PHOTOS TAKEN AND NUMBERED?
YES NO
NAME OF
EMPLOYER__________________________________________________________
NAME OF
EMPLOYEE__________________________________________________________
DESCRIPTION OF ACCIDENT__________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
INJURY/ILLNESS____________________________________________________________________________________________________________________
UNSAFE CONDITION/ACT CAUSING THE
OCCURENCE_____________________________________________________________________________________
___________________________________________________________________________________________________________________________________
WHAT WAS EMPLOYEE DOING?_______________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
CORRECTIVE ACTION TAKEN________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
NAME/ADDRESSES OF WITNESSES:___________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
IN SPACE BELOW, DRAW A SKETCH OF THE SCENE: