HomeMy Public PortalAboutADM-125.1_Safety Policy and Addendums_Effective 08-29-2022City of Lebanon
New Hampshire
ADMINISTRATIVE POLICIES & PROCEDURES
SAFETY POLICY
Policy Number Effective Date Last Revision Page No.
ADM-125.1 08/29/2022 Page 1 of 1
Approved by: Shaun Mulholland, City Manager
See attached Safety Policy, as well as the following Addendums:
•Bloodborne Pathogens Policy and Infectious Materials Control (08/31/2005)
•Hazardous and Toxic Substances (Worker’s Right to Know Act)(08/18/2005)
•Respiratory Protection Policy (08/31/2005)
•Confined Space Entry Policy (04/16/2008)
•Noise Exposure Policy (08/18/2005)
•Lockout-Tagout Program (08/18/2005)
•Personal Protective Equipment Policy (08/31/2005)
JOINT LOSS MANAGEMENT
COMMITTEE
SAFETY POLICY
Approved,
\F
Shaun Mulholland, City Manager
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
6/17/2022
City of Lebanon - Safety Policy
Policy Statement ............2
)Goals
Responsibilities .
.4
3
5
5
5
6
6
Joint Loss Management Committee
Safety Audits and Conective Actions
Communication of Identified Hazards .....5
Tracking Losses
Safety Rules and Regulations
Disciplinary Policy
9
Communication of Safety Policy Issues .............
Resources Dedicated to Safety
Record Keeping and Posting........
Hazardous Materials ........
Personal Protective Equipment (PPE)
Sub-Contractors/Outside Service Prov iders
Alternative Duty and Return to Work Programs
6
1
9
9
l0
l0
Responsibility for Enforcement.... l0
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon - Safety Po].icy
Title XXll Labor Worker's Compensation Section 281-A:64 ll
Chapter Lab 600 Safety Programs and Joint Loss Management Committees 12
Hazardous and l'oxic Substances (Worker's Right to Know Act)..L2
Respiratory Protection Program .A3
Noise Exposure Policy .45
Lockout-Tagout Program .A.6
Personal Protective Equipment Policy .47
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
Safety PoJ.icy
Policv Statement
The safety and health ofall City ofLebanon employees is a priority.
All employees will be required to make their safety, and the safety of their co-workers, a
priority.
As a condition of employment, each individual within the City of Lebanon will be expected
to conduct their daily tasks in a manner that is consistent with the philosophy and objectives
of this policy as well as any safety rules or procedures the City of Lebanon practices.
With these goals in mind, the City of Lebanon's Safety and Health Program will include the
following:
To provide adequate safeguards to the maximum extent that is possible.
To conduct a program of health and safety inspections to identify and eliminate unsafe
working conditions or practices, to control health hazards, and to comply fully with all Safety
and Health Standards.
To train all employees in health and safety practices.
To provide necessary personal protective equipment and instruction for its use and care,
when and where applicable.
To develop, update, and enforce health and safety rules and require all employees to
cooperate with these regulations.
To investigate, promptly and thoroughly, every accident or incident to determine the cause
and to take action (s) to prevent any recurrence ofthe problem.
It is imperative that every employee, no matter what level in the organization, do his or her part
in supporting safety. No job or task is so important that we cannot take the necessary time to
perform it safely. Adherence to this policy and our safety program will provide safer working
conditions for everybody, including sub-contractors.
Workers' Compensation - Coverage Statement
The City of Lebanon and its employees shall comply with the New Hampshire Workers'
Compensation Law as outlined on the "Notice of Compliance" which is posted on each
departmental bulletin board.
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'fhe management of the City of Lebanon recognizes the importance of safety and health and is
committed to providing a workplace for its employees in which recognized hazards are
controlled or eliminated. The philosophies and objectives behind this commitment are as
follows:
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of lebanon
Safety PoJ-icy
Goals
The City oflebanon's safety goals are to:
l. Provide a safe and healthy environment for all City of Lebanon employees and sub-
contractors.
2. To have no lost work time due to accidents
Respons ib ilities
'l hc Ci M will:
Have overall responsibility for the coordination and implementation ofthe Safety Program.
Ensure adequate resources are budgeted for the Safety Program.
Ensure compliance with State and Federal reporting requirements, including the review and
update, if required, ofthe written safety policy every two years.
Ensure emergency backup systems are properly maintained and in good working order.
DeDartment Heads will:
Develop and implement Department specific safety policies and procedures.
Ensure that each level of supervision and all employees are made aware of the elements of
the safety program, and that those elements are implemented.
Make certain personal protective equipment is available to those employees whose job
functions require its use.
Provide the support necessary to ensure a safe and healthy work environment.
Make certain supervision enforces safety through training and monitoring. Enforce
established disciplinary procedures to employees who do not adhere to safety rules and
regulations.
Take immediate action(s) to correct any hazardous conditions or unsafe employee acts.
Ensure all appropriate protective guarding on equipment is in place and being used properly.
Ensure employees have received the necessary training to perform theirjob safely'
Take prompt action in accident investigations and reporting.
Employees will
Report all accidents or incidents and hazardous conditions to their supervisor.
Adhere to and follow all safety rules and regulations.
Attend all required training sessions and safety meetings.
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
Safety Policy
Joint Loss Manaqem ent Commiftee (JLMC) will:
Assist and advise management in establishing and maintaining the safety program.
Review and update rules and programs as needed.
Plan and coordinate inspections, committee meetings, and training.
Review accident and incident records, reports and data.
Conduct a program of health and safety inspections to identifu and eliminate unsafe working
conditions, to control health hazards, and to comply fully with all Safety and Health
Standards.
Joint Loss Management Committee (JLMC)
The Joint Loss Management Committee consists of an equal number of employee and
management representatives, and represent the major work activities/facilities of the City as
follows:
City Hall - Human Resource Director (management or employee)
Public Works - I employee rep/l management rep
Fire - I employee rep/l management rep
Police - I employee rep/l management rep
Airport - I
Library - 1
Recreation - I
Assessing/Planning/Building Inspection - I
(The 4 people representing Airport, Library, Recreation, Assessing/Planning/lnspections must
consist of2 employees and 2 management)
Each collective bargaining until shall be represented and the employee representative shall be
determined by the bargaining members. A representative for all other full and part time
employees shall be appointed by the City Manager after receiving nominations from Department
Heads.
The JLMC will meet at least quarterly to develop and carry out workplace safety programs,
alternative work programs that allow and encourage injured employees to retum to work, and
programs for continuing education ofemployees on the subject ofworkplace safety.
ln addition to the JLMC, each Department is encouraged to organize a Department Safety
committee. The Department Safety committee should assist the Department Head with
compliance with this policy, to identify training needs, and to review accidents within the
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
Safety Policy
Department
Health and Safety Inspections
The Joint Loss Management Committee will oversee the annual safety inspection of all City of
I-ebanon facilities. Annual safety inspections are to begin September I't each year and
completed by December 3lst each year. The purpose ofthe annual safety inspection is to identifu
any potential hazards. A list of items to consider, but should not be limited to the following:
General housekeeping
Means of egress and exit
Fire hazards/extinguishers
Hazardous equipment/materials
Ergonomic and workstation design, and industrial hygiene (i.e., noise/air quality) shall be
evaluated on an as-needed basis.
Safety Audits and Corrective Actions
After an annual safety inspection audit, to be completed by April lst ofthe following year, the
Joint Loss Management Committee will prepare a report of its findings. The report will address
provisions to correct or improve safety hazards or concems found during the inspection.
Communication of Identifi ed Hazards
The Joint Loss Management Commiftee will share the report findings with the City Manager,
Department Heads, and all employees. The JLMC will submit their findings and
recommendations in writing to the City Manager. After the report is reviewed, and approved, by
the City Manager it will be posted on departmental bulletin boards and communicated to
employees by department heads or their designees.
Tracking Losses
The Human Resources Director or designee will review any loss records, first reports of injury,
investigation reports, etc., in an effort to identify problem areas or concems and to take
corrective actions to prevent the problems from recurring. Where available, the JLMC will
request an annual trending/cost analysis reports from both the Human Resources Department and
the third-party service provider, to be analyzed by the JLMC and Human Resources Director or
designee.
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of l,ebanon
safety Policy
Safety Rulcs and Regulations
Employees shall perform their jobs in accordance to accepted sale work place practices
specific to their occupation.
Each employee shall report all unsafe conditions and practices immediately to his/her
supervisor.
Each employee shall cooperate with members of the City of Lebanon's JLMC.
Each employee shall immediately report any accidents, incidents, or injuries to their
supervisor. (See Reporting an Incident section)
Each employee shall use protective equipment as required.
I)isciplinarr Policl
As a condition of employment, all employees are required to familiarize themselves with,
comply with and support both City and department safety programs, policies and initiatives, and
follow safety regulations in the interest of on-the-job accident prevention.
Willful disregard of safety practices, rules, instruction, or the positive welfare of fellow
employees has no place in the City of Lebanon. This kind of behavior may lead to injuries,
damage to products or equipment, and production delays.
Disciplinary action shall be conducted in accordance with the appropriate collective bargaining
agreement or the Personnel Policies and Procedure ofthe City ofLebanon.
Training
All employees must be aware of the training requirements for their jobs, as well as the reasons
for such training. No-one should be allowed to work with any hazardous equipment, or with any
hazardous materials until they have been properly trained
The JLMC will plan and schedule periodic training on safety and health subjects. Each
Department Head should plan and schedule periodic training on safety and health subjects that
meet specific Department objectives. Scheduled training will be based on incident trends.
Documentation of completed employee training will be kept in the employee's personnel file.
Communication of Safelv Policy Issues
This written safety policy, and any subsequent amendments will be made available electronically
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
Safety Policy
Resources Dedicated to Safety
The City of Lebanon will provide the resources necessary to comply with the goals and polices
of the safety program.
Emergency Response Procedures
Each department and individual building should have their own emergency procedures clearly
posted in the building. The emergency procedure plan should provide who to notiry in
management, process for contacting emergency services (911) and instructions on exiting the
building and where to go upon exiting to ensure everyone is out ofthe building.
Reporting an Incident
Employees should report all incidents (illness and/or injuries or occupational exposure) and
property damage immediately to a supervisor. The supervisor shall ensure that the area and/or
equipment and environment, where the incident occurred, is properly secured until the incident
investigation has been completed.
A "Nolice of Incident or Occupational Exposure" ond "Supervisors Investigation Report"
form should be filled out and sent to the Benefits Coordinator in the Human Resources
Department, through the Department Head or designee by the end ofthe next business day of the
incident. The Benefits Coordinator must complete and forward the First Report oflnjury to the
N.H. Depa(ment of Labor within 5 days of injury or of receiving the first report of injury. The
format will include but is not limited to the following:
inj ured employee information
date and time of injury
date and time of treatment
parts of body injured
treatment given
location of accident
how the accident occurred
why the accident occurred
any witnesses
date and time reported to supervisor
to all employees, as well as posted on the City's employee portal. Approved minutes of the Joint
Loss Management Committee will also be given to each Department Head to be shared with
employees.
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
Safety Po].icy
Accidcnt Investigation
Most accidents are caused by human or equipment error or caused by environmental conditions.
Accident investigations will be conducted to determine how and why these failures occurred. By
using information found during an investigation, a similar or perhaps more serious accident may
be prevented. Accident investigations are targeted towards accident prevention and are not
conducted to place blame.
For minor accidents, it is the responsibility of the immediate supervisor to investigate the
accident and review the injured employee's report. The supervisor will fill out the "Supervisors
Investigation Report" which is sent to the Loss Prevention Commi$ee for review with the
individuals "Notice of Incident or Occupational" rcporl.
For accidents involving property damage, in excess of $5000, or injuries with apparent loss ol
work time, it is the responsibility of the Department Head or his/her representatives to
investigate the accident. A report on the accident is to be submitted to the Loss Prevention
Committee. This report should include actions taken to prevent future accident(s). The
D€partment Head or supervisor will use the following guidelines when conducting investigations
and making their report:
Accident investigations have one primary goal - to prevent future accidents.
All accidents resulting in an injury or any accident with the potential to have caused
injury should be investigated.
The primary objective is to find out exactly and completely how and why the accident
happened.
The secondary objective is, based on the facts, to establish what could have been done to
prevent the accident, and what can be done to prevent a recurrence.
A good accident investigation includes an investigation to get the facts; identification of the
hazards or exposures involved; identification of the causes involved without placing blame;
developing a plan ofaction which consists ofphysical and administrative controls; presenting the
plan to management; and follow through.
The accident investigation :
should be conducted as soon as possible and no more than 24 hours after the accident has
occurred at the site where the accident took place;
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Resnonsibilitv of Investisation :
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
city of Lebanon
Safety Policy
photograph and/or sketch the accident scene;
identify the people involved in the accident;
interview witnesses separately and as soon as possible after the accident
witnesses who:. saw the event(s) leading up to the accident. saw the accident occur. arrived at the scene immediately after it occurred
Intcrvicrv all
When conducting the interview:
interview for facts, not fault
ask non-leading questions
test the information
beware of "smoke screens"
interview privately
Cet complete information about the injured person and accident, including thejob the
employee was performing
Describe where the accident took place, including all environmental conditions at the time of
the accident
Department Head should review and take any corrective actions to prevent a recurrence
The JLMC will review the investigations for thoroughness and accuracy. It would be the Loss
Prevention Committee's responsibility to advise the City Manager if the action was appropriate
or additional action is needed to prevent further accidents ofthat type.
Record Keeping and Posting
The City of Lebanon shall keep on file in the Human Resources Department: first reports of
injury; safety inspection and audit findings; accident reports; insurance loss recourse; training
records; first aid treatment records; fire and emergency drill records; minutes of joint loss
management committee; written responses from management regarding committee
recommendations and investigation reports.
Hazardous Materials
Each department will train employees who handle, use or are otherwise exposed to hazardous
and toxic substances in accordance with NH RSA 277-4 "Worker's Right to Know Act." (Refer
to Hazardous and Toxic Substances addendum attached).
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
Safety PoJ.icy
The Fire Department will assist departments in complying with this section.
Personal Protective Equipment (PPE)
All employees will wear personal protective equipment provided by the City. Department Heads
will supplement this policy to identily Department specific personal protective equipment issued
to employees. (Refer to Personal Protective Equipment Policy addendum attached).
Sub-Contractors/Outside Service Providers
All Sub-Contractors / Outside Service Providers are govemed by the City of Lebanon's Safety
Policy.
Alternative Duty and Rcturn to Work Programs
The Joint Loss Management Committee when requested will assist in the identification and
definition oftemporary and alternate tasks.
Responsibility for Enforcement
It is the responsibility for each Department Head to enforce the Joint Loss Management
Committee Safety Policy. The Department Head or their designee will distribute to and review
the JLMC Safety Policy with all of their employees.
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
TITLE XXIII
LABOR
CHAPTER 281.A
YYORKERS' C OM PEN SATI O N
Sectlon 281-A:64
281-A:6,{ Sefety Provblons; Admlnlstrrtlve Pemlty. -
I. Evcry cmprloycr shall providr employccs with safc employmcot. Safe cmployment includes but is not
limitcd to fifoishing pc6on8l protective equipmcnt, ssfcry applianccs and safcguards; cnsuring that such
equipmcnt, applianccs, and s3feglsds are uscd regularly; aod adopring work methods and proccdures which
will protcct thc lifc, hcalth, and safety ofthe employccs. Fo. rhc purposcs of this scction, ,,cmploycr"shall
includc railroads. cvcn if the employecs olsuch railroads receive compensation for work injuries under fcdcral
law rathcr than RSA 2E l -A.
n. All qmploycrs with l5 or morE employces shall prepsrc, with thc assislance ofthe commissiooer. a current
wrincn safcty program and file this program with thc commissioncr. Aftcr a written safety prcgram h&s bcen
frld thc program shall bc rsviewed and updated by the employer at least every 2 years. Employer programs
shall, ir additioo to thc specific rulcs and rrgul8tions regarding worket safcty, include the proccss ofwarnings,
job suspansion, and job termination for violations ofthe safety rulcs and rcgulations ser forth in the progrem.
lU. Evcry cmploycr of l5 or more employccs shall cstablish snd administcr ajoint loss managcmcnt
commitlcc compGcd ofcqud numbcrs ofcmploycr and cmploycc rcprcssriativcs. Employoe r€prrscntstivcs
shsll bc srlcctcd by thc employecs. Ifworkcrs are rrprcscctcd by a union, thc unioo shsll selcct thc employca
rEprrs€olativcs. Thcjoint loss uranagcmcnt commiltcc shall mcct rcgularly lo dcvelop and csrry out wgrtplacc
saEty programs, altcmative work programs that allow and encouragc injurcd cmployees lo rctum lo $ork, and
prograrns lior cootinuing education ofemployers and employees on the subje,ct of workplace safety. The
coorBiuee shsll pcrform all duties required in mlcs adoptcd pursuant to this sectior.
IV. Employcrs subjcct to the requiremcnb of paragraph III, other than employcrs panicipating in the ssfay
incantivc program undcr RSA 281-A:64-a. shall b€ placcd on a list for carly and pcriodic workplacc inspcctions
by die dcprrthcnt's s8fety inspectors in accordancc with rules adopted by the commissioner. Such cmployers
shall comply with thc dircctivcs ofthc dcparmcnt rcsulting from such inspcctions.
V. Notwithstanding paragraphs lll and Iv, an cmployer of l5 or morc cmployccs may satisry thc
rsquitrmcnts ofthosc paragraphs ifsuch cmploycr implcments an cquivalenl loss managcment and safcty
program approvcd by tbc commissioner,
Vl. The comrnissioncr, in conjunction witb thc Natiooal Council ofCompcnsation lnsurancc (NCCI), shrll
devclop 8 list ofthe bcst and worst p€rfomeG bascd on lbc cxpcriencc modification factors promulSrtcd by
NCCI. Thc list shall includc thc top l0 lowcst cxpcricnc€ modification employcrs. The commissioncr sh.ll
publicly rccognizr thcsc low experience modification cmploycrs by presentiog thcm with an award sl th€
deparaacnt's aonual workcrs' compersation conference. The list of the top l0 highest and low€st cxperience
modificrtion employcrs shall be providcd to thc advisory courcil. Thc dcpartmcnt shall review any specific
claim agaiost any cmployer listsd in th€ top l0 highest experience rnodification list ir conjunction with thc
safcty program on filc with thc commissioncr.
vtl. ln ord6 to assist sclf-iNurcrs ill dcvclopiag experiencc modification factors, sclf-insucrs tDay submit
thc tgpropriste statisric8l information to thc National Couocil ofCompcnsation lnsurance for calculatiag
cxpcricncc modifi cstions.
VIII. The commissioncr may assess an administrativc p€nalty ofup to S250 a day on any employcr not in
compli8ncc with thc writren safety program rcquircd uoder pangraph Il ofthis scction' thcjoint loss
managcflEnl comminec rcquired under paragraph lll of this section. or the di.ectives ofthe dcpanment under
paragraph IV of this scclion. Each violalioo shall be subjccl to a scparatc adminislrative penalty. All pcnaltics
collectcd undcr this paragraph shall be dePosited in the general fund
fX. [Rep€aled.l
sotrsi, 1990,254:36. 1994,3:19. 199?,343:9, 10, eff. Jao. l, 199E. 2010' 134:1. eff. July l4' 2010, 2012.
l,l4: l, 2, 4, l, clY. Jan. l, 2013.
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
CHAPTER Lrb 600SAFETY PROGRAMS AND JOINT LOSS MANAGEMENT COMMITTEES
BEYNKIN.N T.E:
Documcrt #5909, effective l&13-94, made extcnsive changes to the wording, format, structurt, and
numbcring of rulcs in Cbrptcr Lab 600. Documcrt #5909 supers.dcs all prior filings for the scctions ia this
clxpcr. Thc prior filings for formcr Chaptcr Lab 60o inchdc thc following docommts;
burce. #5372, cff 4-14-92
PART LBb 601 DEFINITIONS
lrb 601.0t "Eoploy6 rc?rcsenradvc" as uscd io RSA 281-A: 64, IU mcaos any individual who servcs
as thc marlagemcrt incmbcr of rhe joioi lqss managcmcnt committee and who h8s the authority dclagalcd by tbc
ctrlploycr to usc hiJh€rjudgmcnt h the intcrest ofthe employer to takc thc followirg actions:
(a) Hirc;
(b) Tra$fcr;
(c) Suspcnd;
(d) lly ofn
(e) Rccslh
(f) Promotc:
(g) Discharge;
(h) Assigu
(i) Rcward;
(l) DisciPtinc;
(k) Dircct them; or
(l) Adjust Sri€varccs or cffectivcly to rccommend such actions.
So[st (S€o Rsvision Notc at chspter heading for Lab 6OO)
#5909, cfr 10-13-94, EXPIRED: IG1340
New. #8592, eff3-24-06; ss by #10379, eff7-18-13
PART l.ab 602 SAFETY PROGRAMS
Lab 602.01 frogo.SflIilrogtL Ass€t forth in RSA 281-A: 64, tt' the writacn safcty program shall
incltdc thc following:
(a) Thc comporcnts rcquired by Lab 603.03G)i
(b) The Focess of warnings, job slspcnsion, and job termination for violrtions of thc safety rules and
rcgularioos sd fonh irl thc ptogrsrll;
(c) Provisioo(s) for tbc commitm€ol ofadequate resources solcly lbr safcty;
(d) Provision(s) for mcdical scrvices' emerSetcy rcspons!' first aid, and accidenr rePorting snd
invcstigationl
(c) Provision(s) for rcview ofthe currrnt writicn $fcty program by all cmployccs;
(0 Provision(s) fioI review and updatc ofthe written ssfety program by an cmploycr repfBtentativ€ at
le8st cv€ry 2 ycars: and
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
G) Provisioo(s) for a signature ofthe above cmploycr rcprcscntativc which shall includc thc date thc
pmgraB was rcviewed and updatcd.
!ql[$, (Sec Revision Nore at chaprer heading for Lab 600)
f5909, eff l0-13-94, EXPIRED: l0-134O
!3s. #8592, cff 3-2rH,6; ss by # t 0379, cff 7- t 8-13
Lab 602.02 Filing Procedurcs. Undcr rhc aurhoriiy of RSA 2E l-A: 64, tt, an cmploycr with l5 or morc
employees sh&ll file a singlc submission ofthe summory ofthe above written safety program with the
commissioocr oflabor by complctiog aod submining a Safcty Summary Form WCSSF lO/07/t5. Sec Appeodix
u.
Sqlqg (Sre Rcvisiol Notr rt chrptcr b€sding for Lab 60O)
#5909, cff l0-13-94; ss by fl ,16735, clT4-23-9E; ss by #E592,
clI 3-2406; ss by #10379, cffT-18-13 ss by: ,ll05l, efi3-
t0-r6
PART Lab 603 JOINT LOSS MANAGEMENT COMMITTEES
kb603.01 lgpqgg To carry out the puryosc ofRSA 2El-A: 64, ajoint loss managemcot committee is
to bring workcrs 8nd managemcot togcthcr in s non-advcrsarial, coopcmtivc effon to promotc safcty aod hcalth
in cach workplace. A joint loss managemcnt committee assists thc cmploycr and makes recommendations for
chargc.
Sq11lqi (See Revision Note at chapter headin3 for Lab 600)
#5909, cff l0-t3-94, EXPIRED: l0-13-00
Nq. #8592, cff3-24O6; ss by #10379, cff7-18-13
Lrb6o3.o2@ix!e,
(s) Pursu.nt to RSA2E I -A: 64, lll, all cmploycrs of 15 or morc cmployces shall cstablish a working
joint loss management committcc composcd ofequal numbcrs ofcmploy€r and employee represeotBtivls or
morr employcc rcprcscntativcs as follows:
(l) The sizc ofthejoint loss msnagement commiltee shall bc dctermined as follows:
a. Employers with l5 to 20 employees shall have a minimum of 2 members; and
b. Employers with more than 20 employecs shall have s minimum of4 members;
(2) Employc. r"prcsentativcs shell bc selcctcd by thc cmployees;
(3) Whcrc thc cmployccs are rcprcscntcd by a single, cxclusive bargaining represcntative. the
bargaining rcprcscntativc shall designate the members:
(4) Wherc the employces arc tcprese[led by more than one labor orS,anizetion or where somc but
not all of tbc employe€s arc rcprescnted by a labor oryanizatiod, cach barSainin8 unit of represcoted
employecs and ally rcsidual group ofcmployc€s oot rcprcscnted shall hav€ a proponion.tc numbcr
of committee memben bascd on the numbcr of€mployccs in cach bargaining unit or group; arld
(5) Committee membcrs shall bc rcprcscntative ofthe major work activities ofthe cmploycr.
(b) An employ€/s auxiliary, mobilc or satellite localion, maybc combincd into a single, cenralizedjoint
loss maragcm.nt committee whcn an employer ownedleased facility is physically and/or geographically
scpsntcd from the employer's primary facility such as would be found in construction opcralions, trucking,
branch or ficld oflices, sales operations or highly mobilc activities, which shall rcprcsenr thc safety and heahh
canc€rns of all locations.
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DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
- (c) A joint loss management committee shall bc located ar each of th€ cmploycr's primary places of
cmploymcnt at I major economic unir at a single g"ographic Isation compdsed ofa builditg ;r goup of
buildings and all surrounding facilities. Thc location shall have both employer and cmployce reprcsenrativcs
pr8s€al, gontlol of8 ponion ofa budget, and thc ability !o ta&c actiou on the majority ofthe recommcndations
madc by thcjoint loss managcmcnt comlnince.
(d) Committcc members shall be trsincd in workplace hazard identiffcation and accidenVincidcnt
investigation adcquate to carry ou( the committee's res;nnsibilities.
$qqgg. (Scc Revision Notc at chaptcr hcading for Lab 60O)
#5909, eff l0-13-94, EXPIRED: l0-13-00
Ncru #8592, eff 3-24-06; ss by # t0379, eff 7- | 8- t l
Lab 603.03 Duties and Resnonsihilities ofJoint Loss Manacement Committee- To carry out the intent
ofRSA 2tl-A; 64, thc joint loss management committee shall:
(a) Mcet at lcast quancrly to carry out their dutics and rcsponsibilitics.
(b) Kccp minutcs ofmectings which shall be madc availablc for rcvicw ofall cmployccs;
(c) Elect a chai.p€rson, altemating b€tween employee and employer representativesi
(d) Develop and disseminate to .ll cmployees a commince policy ststcnent;
(c) M.itrtain curctrt 8nd disseminalc to all employecs the clearly established goals and objectives ofthe
commiucc;
(f) Rcvicw *orkplace accident and injury &ta to hclp cstsblish the committee's goals and objectivcs;
(g) Eshblish specific safery programs which include, bur are nor be limit€d to, th€ following:
(l) Designatioo, by name and title, ofa person who shall be knowledgeable of site specific safcty
requircments 8nd b€ accoul able for their implcmc ation aad rdhcrcnce;
(2) Provisions for hcslth and ssfcty inspections at least annually for hazard identificalion purposes;
(3) Performance of audits at least antuatly rcgsrding the inspection findings; aod
(4) Communicatioo ofidentified hazards, with rccommended control measurcs. to thc pcrson(s)
most able to implement conlrols:
(h) Assist with the identifica(ion ofnecessary safery and health training for employees; and
(i) Assist with thc idcntification aod definitioo oftemporary, altemat! tasks.
Sousr. (See Revision Note at chapter heading for Lab 600)
#5909, eff l0-13-94, EXPIRED: l0-1340
Nss. #8592, cff 3-2446; ss by #10379, cff 7- l8-13
Lab 603.04 Dulies and Resnonsibilitics ofthe Frnnloyer. To carry out the intent of RSA 281-A: 64, thc
cmployer rhall:
(8) Respond in writing to recommendatio.s madc by thc committce, or mak€ a verbal r€spo.lc that is
recordcd in lhe comminee's official minutes;
(b) Pay any amploycc who pfiticipates in commincc aeivirics in his/her role as a conrmine€ m€mber,
including, but Ilot limitcd to, attending meetings, traioing activities, and irspections, at hiy]er rcgula, rat€ of
pay for all timc spcnt on such activitics: and
(c) Providc for the required and oecessary safety and health training for employccs, at no cost and
without any loss ofpay so they can perform their work in a saf'e and healthy manner and cnvironmetrt.
- t4-
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City Manager:
CITY OF'LEBANON
SAFETYPOLICY
BLOOD BORM PATEOGENS POLICY
ANI)II,Tr\CONTROL
rblr
-j_.t-
Updated: _
The potential for exposurE to blood and/or aitbome pathogcns is a real and present
darger to all employees. The City of Lebanon prcvides its enployees with the
educatior, immunization, prophylactic care and tools neccssary to minimize the risk of
exposure and iis aftermath.
To eosure compliance with New Hampshire Department of t abor Standard 1403,09,
B]ood Borne Pathogens.
coNTA(r
Al unprotectcd erposnre detemined by the Medical Referral Consultett that does not
prcseot a, exposue risk.
EXAMPLE: A glove fails and a employec,s skin cornes ln contact ryith a patients
blood. It is determlned by the Medical Referral Consultant that the sldn ryas intrct
agd inmediate corrective actlon \ras taken. The incident is classifled as contact
vithout exposur€.
EXPOSTJRE
A employee who susteios or suspects hdshe has sustained an unprotected exposure.
INTECTION COI.ITROL OFfiCER (RSA 1rt1-Gr3)
A desigrated physiciaa or registere{ nurse at APD, DIJMC or the VA, knowledgpable of
the hospital's infection control policies and procedurcs.
MEDICAL REI'ERRAL CONSULTANT (RSA14r-G:2)
A health care professional desigrated by the City Departments to acropt referals,
cvaiuate, and follow up on exposures.
SOITRCE INDIYIDUAL
Any person whose btood, body fluids, cxhalatiot ald such were specifically identified as
the source of an exposure.
Pagc 1 of 6
Addendum Al
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
IINPROTECTED EX POSI,IRE
Instances where a source individual's blood, body fluids, or exhalation has had direct
contact rrith a employee without barriers and contact with unprotected pe$onnel and raw
sewage.
In the practice of proper infection control procedures, persooal hygiene and compliance
with the intent of this procedure are keys to minimizing risk.
An incident involving the exposure of a employee is co:rfidential. The involvement of
the City of kbanon is limited to initiating the process and receiving a fit for duty/not fit
for duty notification ftom t}le Medical Referral Consultant. Discussion, supposition, or
release of information regarding an exposure constitutes grounds for termination of
employment.
In City Departments where irnmunization is provided, a employee who does not want to
be immunized does so at his/her ow:t risk. Should an immunization protected disease be
contracted, the non-immunized employee will assume firll responsibility and liability.
An employee who rsfuses to participate in the prophylactic phase of an exposure does so
at his/her own risk and expense. The City of Lebanon will assume no responsibitty for
the outcome of an untreatgd exposwe.
The disinfecting solution for the City of kbanon consists of one (1) part bleach to one
hundred (100) pads water.
Employer shall:
Identify job classifications where employees have occupational exposure to
blood or other potentially infectious materials.
Identiff job classifications where some employees have exposure based on
certain tasks.
Train the above-identified employees in proper response procedures for
situations involving blood and other poteatially infectious materials.
Train employees to treat all infectious materials, blood and other body fluids
with universal precautions (as if known to be infected with IIfV, HBV or' other
bloodbome pathogens).
1
2
4
Pagez of 6
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
5. Supply first aide and potentially infectious material clean-up kits that contain:
b.
d.
One time use disposable gloves such as surgical or examination gloves.
Bye/face protection to protect the face against splashing of body fluids.
Motedal to absolb blood or other potentially infectious material.
Device(s) to scoop up the absorbent and body fluid (two pieces of stiff
cardboard will suffr ce).
Disinfectant to clean surfaces which blood or other potentialiy infectious
material has contacted, For some surfaces a 1: L0 bleach/water mixtue is
appfopdate.
Biohazard containers/bags or specific cottainers for the disposal of
needles, sharps, used bandages, and all other emergency items that come
in cotrtact with blood or other potentially infectious materiais. These
containers must be marked so that they are not confused with other
similar containers in the workplace used for other purposes.
Waterless disinfectant hand cleanerc.
f
c
1
6. The City of kbanon wili have in place a Medical Referral Consultant.
Employee shall:
Respond to all situations involving infectious materials, blood, or other human
body fluids with universal precautions (treat all blood and body fluids as if llown
to be infectious for HfV, HBV or other bloodbome pathogens).
Follow the procedure listed in Section 3 of this Policy when responding to aly
situation iavolving blood or other potentially infectious materials.
2.
1
2
PREVENTION CONCEPTS
All patients and victims are tleated without prejudice by treating all, including
employees as potential source individuals.
Body Substance Isolation @SI) is utilizid as the level of protection for situations
with potential for infectious materials exposure for all patient care. Bmployees
will utilize equipment consistetrt with the potential for exposure. If in doubt, the
higher level is always utilized.
The risks of patient care and contact is minimized by;
B arrier protection
Minimizing the number of employees involved in pdmary patient care of
victim.
Hantlling on scene.
3
Page 3 of 6
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
5
4.The risks of hfectious materials exposure when working near or with sewage is
minimizsd !y
Barrier protection; use of personal protective equipment
Proper personal hygiene.
The ability of employees to fend off infectioD./disease is dependent upon:
The virility of the infection, which we cannot control.
The strength of the exposure, which we can minimize.
The health of the employee, which can be maximized.
Basic personal hygiene and Station cleanliness have a direct impact on the control
of in-house infection problems and the potential spread of acquired diseases.
knmunizations and tests, consistent with OSIIA and CDC guidelines, are offered
to all employees upon emplo)rment.
EXPOSIJRE CONTROL I'I,AN
1. Personal Hygiene - The impodance of each employee's attention to their owrl and
collective hygiene cannot be over emphasized. Intact skin is the best protection
against disease and infection. Cover open wounds whiie on duty, change any
dressing or bandage that becomes wet or soiled. Protect hands and face if any open
cuts or wounds are present.
2. Haad washing and./or exposed skin - Ilands should be washed before any contact with
food or drhk, after rcmoving exam, structual or work gloves, or immediately after
any possible exposure.
3. Facility Considerations - When contaminated gear is present, a Bio-Hazard sign will
be displayed. When this sign is displayed, inside the red line is a Bio-haz ard hot
zone. Those inside the hot zone should be propedy protected with an apron, gloves
and safety glasses. Contaminated equipment is rough cleaned in the field when
possible, bagged and brought to this area for complete cleaning and disinfecting.
Equipment and supplies are maintained within the area along with drying racks for
cleaned equipment to dry on. Once cleaned and dried, equipment is removed ftom
thc a.rea and placed back into service.
4. With sewage facilities, consider all surfaces as potential sources: keep food areas
clean aad free of exposure.
5. Warm, cold and hot zones for patient carc - Any City equipment coming in contact
with a patient or victim is considered contaminated until properly cleaaed. Wherever
possible, disposable equipment should be used. The number of employees having
dircct patient contact should be minimized. One employee, working on or with the
patient (hot zone), is supplied by another employee (warm zone)
Page 4 of 6
6.
7.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
EQUIPMENT SELECTION AND PROCEDURES
A. SELECTION
Infectioue disesse control concems ffr tokon into consideration whcr purcliasiitg ncw
equipment and inspectiag existing equipment. Equipment should be non-porous, easily
cleanable, and of a color that contributes to easy identification of contamination.
B. USE OFPROTECTIVE EQI.]IPMENT
l. Utilize work gloves over exam gloves in all but firefighting and direct patient carc
situations. Contaminated work or structural gloves cannot be de-conned and must be
disposed of properly.
3. Masks are wom when the potential for akborne exposure is present. If a patient
presents a productive cough, or conditions warrant, masks are to be wom by both
patient and employee.
4. Safety glasses should be wom during patient care where the threat of infectious
material eDcounters exists.
5. Full gowns should be utilized when gross exposure potential exists
6. Sharps Containers are aboard each Firc Department Unit and at each Station where
fV equipment is maintained, aad/or used.
7. Barrier Devices such as BVM's, pocket masks and such should be used whenever
possible. Mouth to mouth resuscitation shall be performed only as a last resod with
no other equipment available.
C. CONTAMINATED EQTIIPMEM
The Fire Deparment at 12 South Park Street, (Station 1) has a designated area for
decontamination of clothing and equipment which can be used by all City Departuents.
Page 5 of 6
2. Exam gloves are donned prior to any patient or infectious material contact. With
multiple patients, change gloves between patients. Allthing touched or handled
while wearing exam gloves is suspect of contamination and must be
handled/cleaned/disposed of propedy. A complete hald washing should follow glove
removal.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
POST E)'POSURE PRO CEDURES
Any on-duty employee having an exposure will:
TAKE IMMEDIATE ON.SCENE ACTION TO MIMMIZE TIIE EXPOSURE
a. Declare the employee contaminated; replace, remove from operations.
b. Wash the area with gerrnicidal soap. If atr eye contamination, flush with water.
c. Proceed to the hospital wi0l the patient in such manner as consistent with the
patient's condition.
B, NOTIF"T TIM HOSPITAL
Notify the receiving doctor, in person, at the hospital that an exposure took place.
C. DOTIIEPAPERWORK
a. Document the exposure completely.
b. Notice of Accidental Injury or Occupational Disease.
c. Uniler the space "Nature" write in "Exposule to blood aad body fluids, standard
procedure followed."
D. TREATMENT
The exposure will be evaluated by the Medical Consultant for the determination of
whether an exposure or contact took place.
1. If a contact took place, no further action may be taken and the employee so
advised. Should the employee disagree with the determhation, the employee can
request a second review through the Medical Consultaat to the Deparrment of
Public Health. Should the Deparunent of public Health concur with the initial
furdings, the City's responsibility ends.
2. Should it be determined that an exposure did occur, the Medical Consultant with
I the Infectious Disease Control Officer will prescribe a rcgime of treatment
consistent with the nature of the exposure, the contaoinant exposed to, and the
curent procedures applicable.
LONG TERM TREATMENT
Irng tefitr tleatuent or testing, if required, will be coordinated between the emlloyee
ard the Medical ConsultaDt.
Page 6 of 6
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
Ciry M
CITY OF LEBANON
SAFETYPOLICY
Hszatdous and Toxlc Substances
Wolkcrts Rigltt to l(rloa Act
,^r,tr/r/n Llpdared
,l
6
1 To protect City oflebanon employees from hazards associated f ith the stomge and handling
ofhazardous and toxic substances.
To ensure compliance with New llampshire Department oflabor Standards 1403.36
Eazardous *h Toxl" Srbst"oces, and NE RSA 277-A 'ry'lorker's Rlght to Know Act'"
z
Employer shall:
1. Eaoh Departrnent will train erployees who hmdle, use, or are otherwise exposed to hazardous and
toxic substances in accordance with NII RSA 277-A "Worker's fught to K-uow Act "
2. Keep a running inventory of all hazardous and toxic substances in the workPlace'
3. Detemine the level of chemical hazards wi0in the workplace'
4. Replace chemicals with less harnrful altematives when applicable'
5. Obtain and make Material Safety Data Sheets for all hazardous and toxic substances in the
workplace available to emplo)€es, upon request, for examination and reproduotion'
6. Ensure proper labeling olall hazardous and toxic substances, including those that are farsfcrred
oul oftheir original containers.
7. Posr appropriate signs an<l notices as required by NH RSA 277-A "Worker's Right to Kno]tr Act."
8. Provide rnd rcquire the use ofappropriate personal prolective equiPment at no cost to emPloyecs.
Employee shall:
l. Hardle, store and dispose ofhazardous and toxic substances according to manufacturer's
guidetines.
P&ge I of 3
Addendum A2
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
2. Never mix chemicals tmless authorized by employe.r.
3. Never rernove labels ftom containers ofhazardous or toxic substances
4. Use appropriate personal protcctive squipnent when the employer and/or the Material Safety Data
Sheet indicate that it is necessary.
Material Safety Data Sheets-
2. The Material Safety Data Sheets shall be kept on file ir: a convenient office location <note
location(s)> and made available, upon request, for examination and reproduction.
3. Each Material Safety Data Sheet must contain the following fuformation about the substance for
which it is supplied:
a. Identily ofthe substance as it is listed on the label
b. The chemical's common name.
c. If the chemical is a mixture, the identity ofthe ingredients.
d. Phlsical and chemical characteristics.
e. Physical and health hazards, including the primary routes of entry into the body.
f. Safe handling, use, and disposal procedures.
g. Spill and leak precautions and procedures.
h. Emergency and first aid procedwes.
L Name, address and phone number ofthe chemical manufachrrer.
Lab eling Requirements-
1. Al1 hazardous and toxic substances must have a labe1 containing the following infonnation:
a. Identity of the substance
b. Name and address of the chemical manufachrrer, impoder, etc.
c. Hazard warnings including acute and cbronic health hazards as well as physical hazards.
3. Labels must not be removed under any circumstances
4. Containers without labels must be removed from use even ifthe contents are supposedly known.
Page2 of 3
i. Material Safety Data Sheets shall be supplied for each hazmdous and toxic substance in fhe
worktrrlace.
2. Labels must be substantial.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
5. Signs, placards, process sheets, batch tickets, operating procedures or other written materials may
be used in place ofindividual container labels as long as the above labeling requirements are met.
Training Requirements-
1. Frnployees will receive training on hazardous and toxic substances in their work area upon initial
assignment and whenever a new hazard becomes present.
2. Employees will receive the following infonnation:
a) Any operations in their work area where hazardous chemicals are ptesent.
b) Location and availability of Material Safety Data Sheets and lists ofchemicals.
3. Employees will be trained in the following areas:
a) Methods and observations that may be used 1o detect the presence or release of a hazardous
chemical in the work area.
b) Physical and health hazards ofthe chernicals in their work area.
c) Methods employees ca:r use to protect tlemselves from hazards in their work area.
d) Iabeling systems.
e) How to use Material Safety Data Sheets.
P'ersonal Protective Equipment required for handiing haz ardous atrd toxic substances will be listed
on each Materiai Safety Data Sheet. Equipment most commonly required includes:
Goggles
Face shields
Rubber gloves
Aprons
Page 3 of 3
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
Addendum A3
CITY OF LEBANON
SAFETY POLICY
Y C'f ION PROGRAM
{/tr/o'-City Datci
To astablish a Respiratory Protection Program for all work areas of the City of trbanon
16"1 641tqins or potentially cofltains hazardous atmospheres to which employees could be
exposed.
To fully comply with all appticable codes rcguladons and standards pertinent to
respirator use at City of Lebanon work locations including but not limited to the
New l{ampshire D€partment of Iabor Standard 1403.61, Resplratory Protection.
Employer shall:
1. Test any work arca or work process to determine the necessity of respiretory
protection for empl-oyees in those areas.
2. Ensure that omployees wear respiratory proteclion when requiEd to do so.
3. Assure tbat aI1 respirators used meet the NIOSH 42CFR Part 84 requirements.
4. Assue that all respirator users hrve a prcper fitting respirator that lhcy are
courfonable wearing and that protects them ftom the anticipated hzzards they will be
exposed or potentially exposed to in theirjob tasks.
5. Assure that employec complaints on rcspirator use arE promptly forwarded to the
Deparsnent llead, and that hdshe sees that such complaiats arc investigated and
evaluated as sooD as possible. Ihis is ofhe utrnosl irtrportancel Ail employees
reporting signs or symptons to inhalarion hazards are to be promptly interviewed to
delermine the followilg:
A. When do they ocour? (what season, timo, da1s, froquency).
B. Wbere do they occur? (wlat work location, which supervisor in charge of
arca).
C. How long do the symptoms last? @o thoy clear up after leaving work, if so,
how soon; do they last ovefiight, etc,).
D. Have the symploms bc€n triggered by any specific event, work task or in a
specifrc work area'l
Page 1 of 6
Uodeted:
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
E. What is the sourre of the sym.ptoms? (any medical diagnosis or care
rendered):
F. Any first repod of injury?
G. What characteristics of the worker may be a factor? @oes he/she smoke,
allergies, pre-existing illncss ur disabili(y, is merlication being used, etc.).
6. Assure that corrective actions are taken to promptly resolve all employee complaints
in using respirators and for signs and symptoms.
7. Assure that all employees me first medically evaluated as to thet ability to use the
respirator required for their work; then have them go through a fit testing potocol to
detelrdne which face-piece or face-pieces provide them with a proper fit.
8. AII employees, who are to wear a respirator for their job, must pass the medical
evaluatior and be successfirlly fit tested with the proper respirator for their work. No
individual shall be assigned to a task that requires the use of respimtory protection
unless found physically able to do the work while wearing a rcspirator. A physician
will make the deterrninatiol of an employee's fitness. This medical evaluation will
be conducted prior to any respirator fit testing or usage. Employees refusing to
undergo a medical exam cannot be assigned to work areas where they are required to
wear a respimtor.
9. A11 employees must complete the City ofl*banon Respirator Training Program
before working in any haz ardous ahosphere.
10. The Department Head will implement procedures to obtain feedback ftom
employees, users and supervisors on the effectivsness of the program. He./she will
implement audit procedures and prograrn reviews to firrther evaluate the program
effectiveness. A1l employee complaints or probiems will be corrected or resolved
promptly for all affected parties.
11: The Administrator shall seek ways and means to improve the program and to assure
that it meets all appiicabie regulatory obligations.
Employee shall:
1 . Fo1low practices set by the City of Irbanon for proper selection, use and
maintenance of respiratory protection.
2 Use rsspfuatory protection when deemed necessary by the Depadment Head.
Page2 of 6
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
FEASIBLE ENGINEERING CONTROI.S
It is the City of Irbanon poiicy to use feasible engineering controls where they will be
effective in removing or controlling the hazard or will be effective in reducing the level
of haEord to IBssBn the oevarity of oxpoouro to omployccs. Whcrc cnginccring controls
do not completely remove the hazard, rcspkatory Protection will be used to provide
employees with proper protection from the atmospheric hazards.
WORK SITE HAZARD EVALUATION PROCEDI]RES AND SELECTIONFOR
RESPIRATORY IIAZARDS
1. The Depafirnent Head will coordinate a hazard assessment for those wodr areas
where personal protective equipment will be needed. The assessment procedurx and
results will be documented for each work location or task. All new work areas will
be evaluated using similar procedures before employees begin work in these areas.
Properly condrcted instrument readhgs of air contaminants for those work areas
where hhalation hazards exist or potentially exist sha1l be taken in the breathing zone
and other locations deemed appropriate. The monitodng results will be retained. The
contaminant's chemicai and physical proPerties and states will be documented.
2. A:ry signs or symptoms reported ftom employees that may affect the hazard
assessment for a work area will be reevaluated to see if any changes are necessary'
The reevaluation is to be done promptly after the Safety Comrnittee or Administrator
is made aware of tie problem.
3. The City of Lebanon will use the more conservative values of the current TLV's by
ACGIH or the OSIIA PEL's including those issued in 1989 as criteria for determining
the ievel of hazard for respiratol selection.
4. The City of kbanon will select only respirators certified by MOSH and used in
accordance with the MOSH approval label as stated in 42CFR Part84. Any
applicable regulations will be used to make the appropriate respirator selections for
each employee and for the hazards that are anticipated in their work areas.
Medical Examination Procedures
FACTAL IIAIR
Once it has been determined by the Department Head that all individual will need to wear
respiratory protection, a medical examination will be scheduled. Al1 medical
examination arrangements will be scheduled through the Departrtrent.
AII employees must be clean-shaven to remove facial hair that could interfere with the
face to face-piece seal aea or fuaction of the face-piece whenever they wear a rcspirator.
Employees with long facial hair such as beards are not pffrnitted to wear respiratory
protection.
Page 3 of 6
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
EYE GLASSES
The use of regular eyeglasses with any fu11 face-piece is not allowed. Contact leflses are
permitted and must be worn when fit tested. Employees who wear glasses and must wsar
a full face-piece will be provided with an approved spectacle kit which shall be wom
during thc fit tcst, and with thcir assigncd respirator,
TRAINING PROGRAM AND OBJECTIVES
1 . AII employees who wi-11 use a respirator in the coming year will be required to
complete a taining program and must demonstrate the use of respiratory protection,
selection of respiratory protection and the proper donni:rg and doffing of their
rcspirator including the seal check procedure after completing the traidng program.
Al1 new employees will successfully complete the training program before using their
respirator on the job.
2. Training prc$am objectives will include City of Irbanon Departuent Staldard
Operati::g Procedures for using respirators in routine as well as emergency situations,
including where the equipment fails:
a for donning and doffing respirators using the seal check procedures.
b. for cleanilg, disinfecting and sanitary maintenance of respirators.
c. for storage and inspection of them.
d. the appropriate application and capabilities of and the limitations of those to
be used includilg the hazards of poor fitting face-pieces .
e. recognition of medical signs and symptoms that may limit or prevent proper
use of assigned equipment.
3. Retraining will be required of an employee before the annual refresher. If there are
changes in their work area that impact respirator use and renders the previous training
obsolete, the employee no longer has the skill and understanding to follow and use
the Organization/Company's Standard Operating Procedures that were part of the
training completed earlier. This may also apply if a Administrator of Supe isor
recommends that the employee be retrahed.
AIR QUALITY FOR ATMOSPIIERE, SUPPI,YING RIiSPIRATORS
1. The air quality for atmosphere supplying respirators is to be at least Gmde D air that
meets the Compressed Gas Association's Standard ANSyCGA G-7.11989 or better.
All work locations that puchase their breathing air directly ftom a supplier are to
obtair a Certificate of Analysis from the supplier that states the breathing air meets
the company requirements. This Certificate shall be retained until the air is used up
and then the Certificate is forwarded to ths Administrator.
2. All breathing air cyliaders brought on City of I*banon work sites are to meet the
DOT requirements- Those that do not are to be retumed and replaced with those that
do.
Page 4 of 6
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
FIT TESTING PROCEDURES
1. All employees, who use or will use a respirator in the coming year, will be fit tested.
This will be done each year at the time of their arurual refresher taining date. The
Administrator wili be responsible to schedule employee's fit testing and annual
refresher training so that it does not go beyond a l2-month cycle.
2. AII City Departments will use a quantitative fit testing protocol to fit test all
employees who wiII use rcspiraton. The quantitative fit testing protocol will be
operated in a manner that follows the manufacturer's instructions/recommendations
and will meet all 1egal obligations. These will also be used in detemining the overall
fit factor for each face-piece for each employee, The fit testing records using the
attached form are to be retaiaed for each employee by the Administrator.
3. All employees will be instructed on how to properly don their face-piece(s) and check
the face ssal following the Standard Operating Procedure for seal checks' This
insauction will occur before the employee begins the actual quantitative fit testing
protocol.
4. A retest before the amual fit test may be necessary if the employee reports changes in
his/her physical condition and the designated face-piece is causing a problem for the
employee, the employee's supervisot or the Department Head recommends it, or the
employee notifles his/her supervisor or the Administrator that the respirator fit is not
acceptable before the next annual fit test.
Respiratory Protection Cleaning, Inspection and Maintenance
Inspect rcsphatory protection before use to check for contamination, deterioration or
other conditions that would make equipment unfit for use.
A11 respfuatorc shall be inspected routinely before and after each use and during cleaning.
Equipment designated for emergency use shall be inspected aftsr each use, dwing
cleaning, and at least weekly.
Disinfect and clean respiratory pmtection after use and check for damage.
STORAGE
Respiratory equipment shall be stored so as to protect it from dust, sunlight, heat,
extreme coid, excessive moisture, and damaging chemicals.
Respirators shall be stored in a conveEient, clean and sanitary location where they are
protected against damage or distortiol by overcrowding or by contact with tools, such as
in a tool box.
Routinely used respirato$ may be placed in clean plastic bags.
Page 5 of 6
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Respirators shall be stored separately from the cartidges andin a single iayer with the
facepiece and exhalation valve in a near normal position to prevent the rubber or plastic
parts from taking a permanent distorted set.
}.IRE DI1PARTMENT
Thc Ffu'u Depa.rtmcnt will mai-utain dreir own Standard Opcrating Froccdutcs on sclf
contained breathing apparatus respfuators (SCBA) because of the special nature of their
emergency use.
Before Fire Departrnent members can use SCBA they must achieve Firefighter One
Certification through the New Hampshire Fire Standards and Training Commission.
Page 6 of 6
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Addendum A4
CO\T'INED SPACIi
City Managc4
CITY OF LEBANON SAFETY POLICY
I(]Y
Date:?Updated:
'l'o protect workers from hazards associated with Contined Space Entry.
To ensure compliance rvith New Hampshire Department of Labor Standard 1403.15,
Conlined Spacc Entry.
l. Purpose
2. Definition
PERMI'I' RIIQUIRUD CONFINED SPACI]
At the City of trbanon, a permit-requircd confined space is dciincd as a space which is largc
cnough and so configured that an employee can bodily enter and pcrform assigned rvork, has
limited or restdcted means for entry or exit, is not designed for continuous employee occupancy,
and has one ormolc of the follorving characteristics. It contains, or has a knorvn potential to
contain, a hazardous atmosphcre, contains a mHterial with thc potcntial for cngulfing an entranl,
has an internal oonliguration such that an enrrunt could be trapped or asphyxiated by inwardly
converging walls, or a floor which slopcs dorvnward and tapers to a smaller cross-section, or
contains any other recognized serious safety or health hazard.
A confined spacc includes, but is not limited to, any of the following if the criteria set fonh ill
th€ above definition are met:
Storagc tanks, tank cam, process vessels, bins, tank trailErs, and other tanklike
compartments usually with one or morc manholes for cntry;
Open-topped spaces of more than 4 feet in depth, such as bins, silos, pits, vlts, tubs,
vaults, vcsscls, floating roof storage tanks, or trenches;
Ventilation or exhaust ducts, manholes, se$,ers, tunnels, pipelines, and similar structures;
Ovens, furaaces, kilns, boilers 'dnd similBr structurcs.
NON-PERMIT CONIIIN'ED SPACI'
A non-permit conflned space means a confincd space that docs not contain or, with respect to
atmospheric hazards, have the potential to contain any hazard capable of causing death or serious
physieal harm.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
3
3. Responsibilities
EMPLOYERSHALL:
1. Appoint a competent pe$on ftom each Depadment to evaluate the wor$lace to
determine if any areas fall under the deflnition of confined space as defined by the New
Hampshire Departnent of Labor Standard 1402.02. Then they will assess the physical
and chemical hazards of the confined spaces and any other hazards to which the worker
may be exposed. Must specify the necessary test$ to determine whether employeas are
likely to be exposed to the hazards.
Post danger signs at the location of confined spaces or inforrn exposed employees through
equally effective means.
Each Department will establish an entry-pemrit system
Specify and provids the necessary safety and emergency equipment, as determined by the
hazard assessment.
SI]PERYISOR SHALL:
In assigning tasls requiring entry into a pemrit required confined space, the supervisor shall:
Obtain a confined-space enhy permit detailing the work to be performed and the
perceived hazard.
2. Documentation
The permit will be filed by the department conducting the work and will be kept
for seven (7) yean,
The supervisor shall fax a copy of the confined space permit to:
I-ebanon Fire Department - 448-8811
Lebanon Public Safety Dispatch Center - /148-3315.
3. Ensure that all participants are briefed on every safety procedwe to be followed.
Appoint an Entry Supervisor/Attendant for each crew; know the actual or potential
hazards of entry futo any confined spaces within his or hel alea. When a gas test consists
of a series of readings, such as stratification readirgs, the results of each reading must be
recorded on the document signed by the Entry Supervisor/Attendant certifying the
confined space.
4
5
1
a.
b.
c
4.
1
Each Deparhent will train all involved employees in safe confined space entry
operations.
The permit will be on site, in the vehicle during al1 work.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
5. Be competent and trained in the following aspects of confined-space entry:
a. Proper procedures and safety equipment required'
b. Proper procedures for emergency rescue work.
In addition, Supervisors who must certify the confined space but rely on another person to test
that space (such as a Entry Supervisor/Attendant) must:
. Know the correct procedues for testing tle confined space
. Ensure the person carrying out the tests follows the correct lnocedures.
. Be able to interpret the results of the gas test for valid certification.
I-evels must be:. O2>19.59o atd123.54o. Co < 35 ppm. I{2S < 10 ppm. comb. Gas < 10% TFr.
. Other toxics below established TLV's or P
6. Continually evaluate the entry and remove entrants should conditions warrant.
ENTRY STII'ERVISOR
The Entry Supervisor has the following responsibilities:
a. Ensure that all work can be, and is, conducted both safely and in the prescribed
manner.
Review the safety and job procedurcs with employees involved in each
assignment.
Ensrlre that the Co nfineil-Space Entry Permit is completed.
Ensure that the requred safety equipment is on site and in proper working
condition.
f. Bnsure that the air content is monitored at all times and documented
Ensue that a person properly trained in artificial respiration is conveniently
available when work is done ir:. a confined space that contains, or may contain,
hazardous gas, vapor, dust or that has an oxygen content of either less than 1870 or
morc than 23Vo, and that cannot be purged and ventilated safely throughout the
work.
c
d.
e.
c
The Entry Supervisor will act as the Attendant when only two people are
working on a confined sPace entrY.
h.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
NOTE: The entry supervisor may serve as an attendant or as atr entrant as long as there is an
attendant that has completed the appropriate training and is properly equipped for that role. Also,
the duties of entry supervisor may be passed ftom one individual to another appropriately trained
person during the course of an entry operafion as documented on the permit.
ATTENDANT
The person selected to act as Attendant must stand at the confined spaces' access point. This
person must lnow the possible hazards, what action to take in an emergency, and how to
organize additional heip without delay in the event of an emergency. In small enkies with no
hazards that require only two people the Attendant can perform these duties. Large hazardous
entries will require more than two people and the Attendant wili be a separate person besides the
Entry Supervisor.
When a Attendant has been appointed, it becomes his or her duty to oversee all safety
requirements in and around the confined space. Specifically, the Attendant has the foliowing
rcsponsibilities:
Ensure that the protective equipment and devices required for the entry are available to be
used by or are being worn by those entering the space, as the case may be.
b. Ensure that the Confined-space Efiry Pemtit is complete before the enty
Monitor atmospheric test rcsults and record them on the entry permit. If the fimits are
exceeded, evacuate employee(s) ftom the area iomediately.
a,
c
0
d. Maintain continuous contact with the worker(s) in the confined space.
Continuously maintain ar accurate count of entrants in the permit space and ensure that
the method used to identify each entrant is accurate. It is essential that entrants are
monitored as they enter and leave the permit space.
f Deliver f:rom outside the confined space equipment or materiai to the wodrcr(s) inside
without entering the space. Perform no additional duties that might interfere with
primary duty to monitor and pmtect entrants.
g. Ensure all workers have knowledge of emergency plan.
h. Guard the access point at all times.
NOTE: If the Attendant has to leave, even for just a few minutes, either the worker(s) must leave
the confined space for the duration of the absence, or another competent person must be
appointed to act as temporary Attendatrt by the Entry Supervisor or Superintendent.
7 Help assist emergency removal from the confined space, if needed.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
EMPLOYEE (ENTRANT)
Employees entering the confined space have the following responsibilities:
a. Participate in kaining and ensure they fully understand thejob's requirements, iflcluding
the scope of the work and the applicable safety procedures. Review pemrit, ensure they
are narned on permit as ettrants and note entry atrd exit times are recorded.
b. Ensure their personal safety and that theh actions do not endanger of harm co-workers.
c. Report unsafe conditions to the Entry Supervisor/Attendant'
d. Wear apptoved protective clothing and devices'
e. Ensure all accidents/incidetts are repoded.
f. Comply with specific practices and procedures while working and immediately comply
with all instructions from the Entry Supervisor/Attendant.
MINIMI]M NIJMBER OF EMPLOYEES
A minimum of two (2) employees will be immediately available during all permit required
confined space entries. A minimum of one (1) trained Entry superviso/Attendant will be
outside within line of sight and verbal communication distance of the employee Entrant inside
workfurg. A typical conlined space team consists of a minimum of an Entry Supervisor/
Attendant and entry personnel. More personnel may be required for high hazard or large
confined space areas.
IMTIAL AIR MONITORING
I
2
3
Keep manhole covers and access doors to confined spaces closed until air testing
instrumgDts are ready for testing. Perform initial test around manhole cover, hatch or
access door prior to opening.
Remove manhole cover ot access door and immediately begin testing the atr:rosphere of
the space. Use additional monitoring instruments as necessary for specific contaminants.
For vaults and manholes, refrain from leaning over the area to be tssted; lower the unit
slowly, taking readings to evaluate work space. The sarnpling interval for each gas
moniior may be a specific to that piece of equipment. For example, if the gas monitor has
an electonic pumping attachment to retrieve a sample, it may take a specific period of
time prior to viewing results of each sample. "consult manufacturers specifications"as to
this time period. Test all levels for Estratification of gases, top, middle, and bottom (to
4. Procedural Overview
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
within six (6) inches of the bottom or standing water surface) of a confined space as well
as any pocket areas. Do not allow the sensor head to get wet! Record values on the
permit form and note any stratification.
*Skatification: The density of gases or vapors causes them to either be heavier than air
and settle to the bottom of a space, or lighter than air which causes them to concenhate at
the top of the space.
For horizontal spaces (e.g. boilers), move the sensor head into the space with a pole or
other means. If all vedical layers cannot be sampled in the space remotely, have the
Entrant carry the sensor head into the space after thorough remote testing. A tag line and
harness are required on the Entrant. Recofd the worst-case values on the permit form and
note any stratification. Have the Entrant evacuate the space if there is any indication of a
dangerous atmosphere.
A written record of air testing results shall be made on the permit fomi and kept at the
work site for the duration of work. Affected employees and./or their representative shall
be afforded an oppofiunity to review and record the testing results.
Testing should be performed without disturbing the space, if possible.
After long breaks (> half hour) such as lunch, complete testing for required permit shall
be performed again to detemine if any atmospheric chatrges have taken place inside the
confined space.
Testing of the oxygen content and for flammability (UBL, I FT ) shall be documented with
sufficient frequency to ensure conformance with this section.
10.Continual documentation wili be:
a. Every 15 minutes.
b. Hazardous environment may require testing more often.
c. At minimum there will be a documentation before entry and at the time of exit.
\.IINTILATION
Adequate ventilation will be provided to protect employees from dangerous working conditions
resulting from accumulations of hazardous concentrations of flammable vapors, toxic gases, or
an oxygen deficient or enriched environment in al1buildiags, pits, rooms, vaults, or other
enclosed areas.
TAI(E NOTE: Positive pressure ventilation applied to single entry/exit point may cause
potentially contaminated air to come out of the space. Precautions should be taken to
prevent workers from being exposed (e.g. run air lines away from area or clear workers
from entry point).
5
7
8
9
4.
6.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
1
2
3
PRII-ENTRY PROCEDI,tsES
Lines which may convey flammable, injurious, or incapacitating substances into the space shall
be disconnected blinded, or blocked off by other positive means to prevetrt the development of
dangerous air contamination and/or oxygen deficieucy within the space (Consult Lockout/
Tagout Policy & Procedures for specific infonnation). The method used shall prevent
inadvertent rc-connection or disabling of the 1ine.
Exception: This does not apply to public utility gas distribution systems'
NOTE: This section does not require blocking of all laterals to sewers or storm tlrains.
Where experience or knowledge of industrial use inilicates materials resulting ln dangerous
air contamination may be tlumpetl into an occupied sewer, all such laterals shall be
blocked.
Confined space shall be emptied, flushed, or otherwise purged of flammable, injurious or
incapacitating substances to the extent feasible.
ff air contamination exists, spaces shall be ventilated prior to entry until the meters
stabilize to the proper ranges. (e.g. blowing air into or drawing air ftom the space).
Where interconnected spaces are blinded off as a unit, each space shall be tested, the
results recorded and the most hazardous condition found shall govem procedures to be
followed.
A confined space entry permit wili be completed, signed and dated by a Entry Supervisor/
Attendant designated by the Supervisor. A copy of the confined space entry permit wiJl
be forwarded to the Department Head and will be kept on file. The original entry pemit
shatl be kept on flle by the deparment using the permit.
An Attendant shall be continually present while workers are inside an enclosed or
confined space. The Attendant may operate the air monitoring equipment.
A11 tanks, vessels, ot other confiled spaces will be entered from the side whenever
possible.
7. To the extent feasible, all exits and entries shall be readily accessible
SPECIAL PRECAUTIONS
Work involving the use of flame, mc, spark, or other source of ig$tion is prohibited
within a confined space (or any adjacent space having cornmon wa1ls, floor, or ceiling
with the confined space) which contains, or is likely to develop, dangerous air
contamination due to flammable and/or explosive substances.
5
1
4.
6.
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5
2
1
3
Whenever gases such as nitrogen are used to provide an inert atmosphere for preventing
the ignition of flammable gases or vapots, no flame, arc, spark, or other source of ignition
shal1 be pennitted unless the oxygen concentration is maintained at less than 20 percent
of the concentration which will support combustion.
If the existence of dangerous air contamination and/or an oxygen deficiency is detemined
by the tests performed, existing ventilation shall be supplemented by the appropriate
means.
Whenever oxygen consuming equipment is used, arangements will be made to ensure
sufficient venting for al1 combustion air and exhaust gases.
Where live electrical work will be performed, the tripod unit will be propedy grounded
(e.g. welding cable and clamp).
( )I'IJRA.TING I'Ro CEDU RIrl,S
Non-Permit Required Confined Space
A minimum of two (2) employees will be available during al1 confined space entries; an Entrant
and Attendant. The Attendant shail be continually present while workers are inside a confiaed
space. The Attendant will operate ttre air monitoring equipment recording pre-enty and exit
readings.
Employees working in non-perrDit confined spaces sha1l wear personal protective
equipment appropriate for the hazards expected in the space.
Air testing shall be conducted periodicaliy to monitor the preexisting atrnospheric
environment and to detect any aknospheric changes that might occur. Al1 testing data
obuined shall be recorded.
ff air sampling instruments indicate a developing adverse atmospheric change (e.g.
steadily rising hydrogen sulfide or carbon monoxide levels, or steadily increasing or
decreasing oxygen concentration), the Attendant wili immediately direct Entrants from
the confined space and reassess the area for its new hazard.
Permit-Required Confined Space
Ail procedures described in Non-Perrnit Required Confined Space shall apply
An approved safety hamess v/ith an attached Iine shall be used. The free end of the IiDe
will be secured outside the entry opening to approved fall protectior/rekieval equipment.
Only intrinsically safe lightilg and elecaical equipment, in accordance with low voltage
eleckical safety order, shall be used in confined spaces where dangerous air
contamination due to flammable and/or explosive substances exists.
3.
4.
6.
2.
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All equipment and lines shall have appropriate rating class for confined space retrieval.
Exception: Where a Person in Charge determines that a safety line would further
endanger the life of the employee. Under these clrcumstances' the harness will be woru to
facilitate rescue in the event of an emergency.
Where air contaminants persist or begin to appear after ventilating a confined space,
continuous air monitoring will be perforrned. Data will be entered on the confined space
entry pernit every 15 minutes by the Entry Supervisor/Attendant.
TOP OPENING
When entry must be made through a top opening, the following requirements also apply:
A safety belt of the harness type that suspends a person in an upright position will be
wom by any person entedng the space.
A hoisting device (tripod) or other effective means shall be provided for lifting empioyees
out of the space.
RESCI]E PROCIIDURE
In the event that entrants become injured while perfoming their duties, notify rescue
personnel by dialing 911, explain the location of the incident, the nature of the injuries
and give a telephone or ce1l phone number that you can be reached at along with any
other information requested by the emergency operator.
NOTE:DO NOT ATTEMPT A RESCIJE OR ENTRY INTO'I'HE SPACE.
After notifying resc;,:Le personrrel, a non-entrv rescu.e r:Tay be attempted using tripod and
hamess if attached, if it can be done safelv from the outside.
The Entry Supervisor/Attendant should meet the emergency workers and give them all
pertinent infonnation:
a. Location of entrance that inside persomel used to gain entry.
b. Number of personnel inside the confined space.
c. A11 documentation on meter readings.
d. kngth of time since last corrnunication from inside confined space.
e, Any other inforrnation requested.
I
2.
-)
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
CONFINED SPACE ENTRY PERIITIT
Department
Telephone-=--
1) Address of Entry
2) Permit Space to be entered
3) Purpose of Entry
4) Date of Entry----- ---
-Authorized
Duration of Entry
5) Authorized Entrants: (Please PrlD0
6) Attendant(s):
7) Name of Current Entry Superyisor(s):
Start Time: _ End:
(l'rinl)(Sig aturc)
End;
(Print)
8) Supervisor who Originally Authorized Entry:
(Slsnatur€)
Pernit Supefl,isor (Signalurc)
Fax to: City of Lebanon Firc Department - Fax (603) 448-881lPhone (603) 448-8810
Lebanon Public Safety Dispatch Center - Fax (603-448-33l5Phor,e (603) M8-1212
Page_of
9) Potential Hazards
of the permit space
Check or list measures used to isolate the permit space
and to eliminate or control permit space hazards before
entry.Hazarrl,YES NO N/A
Lack of Oxygen Purge - Flush and Vent
Comhustible Gases
Combustrble Vapors Ventilation
Combustible Dusts
Toxic Gases Lock out/Tag out
Toxic Vapors
Chemical Contact Inerting
Mechanical Exposure B1anking, BIocking, Bleeding
Temperature
Engulfment Extemal Barricades
Entrapment
Other:Confined Space Identification/Si gns
RevilionDalc: JuDc 11, 2007
Start Time:
l0) Acceptable Entry Conditions:
Electrical Hazards
t-rr
_-rffiT.l
trffi
=
I
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
Test 4
Record
Test 5
Record
Test 6
Record
Test 2
Record
Test 3
RecordParameter
Permissible
Entry Levels
19,5 Vo to 23,5 Vo(7o) - Percent Oxygen
<10 VoLEL - Combustibles
<I0 VoH2S-Hydrogen Sulfide
<25 VoCO-Carbon Monoxide
Indicate elevation test is taken from:
Name or Initial ofTester:
Test Time:
YES NO N/A Equipment Descri tion
(I) Gas meter Name:ModeUType s/n
(ii) Ventilating Fan / Blower
(iii) Communications
(iv) Personal Protectiye Equipment:
Hearing
Face shield
irator aln IRSaferotectionHarness E
IIard Hats
ecial Clothin
GloYes tr'oot
(v) Lighting
(vi) Barriers / Shields
Pedestrian vehicle
Tralfic control
other
(vii) Safe Ingress / Egress Ladder(s)
(viii) Rescue and Emergency Iloists Lifclines
(ix) Other Safety Equipment or Other Informa tion for this particular confined space to
ensure employee safery:
City of Lebanon
CONFINED SPACE ENTRY PERMIT
Department Telephone-
11) Test rcsults to be recorded at be ntn , and twent minute inte als once en b ns:
Telep hone
Name- Telephone-
13)Communicati nroccdures to be used bv authorized e ntrants. attendan ts and entrY suDerYisor:
At a minimum, radio/phone communication is to be established between the entry supervisor and City of
Lebanon Public Safety Dispatch in the event emergency personnel are to be summoned' Establish
communication between entrants aDd attendant before entry begins and maintained throughout entire entry
procedure. Method of communication is to be established by entry supervisor. Example communication
methods are verbal, visual, walkie-talkie, city radio, rope tug, etc.
14 ent su ied and to be used the em lo ce:
15) Additional Permitted Activities:
Explain:
Hot Work Other
THIS CONTINED SPACE ENTRY PERMIT HAS BEEN CANCELLED:
BY AM/PM
'ri €D!1e
ReYisloD Date: June 11,200?
Test 1
Record
12) Rescue and Emergency SerYices AYailsble:
Name-
ItT-
f- T_-f-T
I
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
CONFINED SPACE ENTRY PERMIT (Extended duration test recording log)
Depaftment
1) Address of Entry
2) Permit Space to be cntered
3) Purpose of Entry
4) Date of Ertr Authorized Duation of
Page- of _
Parameter
Permissible
Entry I-evels
Test 7
Record
Test 8
Record
Test 9
Record
Test 10
Record
Test 1 1
Record
Test 12
Record
( 7o) - Percent Oxygen 19.5 Vo to 23.5 Vo
LEL - Combustibles <10 Vo
H2S-Hydrogen Sulhde <10 9o
CO-Carbon Monoxide <25 7o
Indicate elevation test is laken from:
Name or Initial of Tester:
Test Time
l'arameter
Permissible
Entry Irvels
Test 13
Record
Test 14
Record
Test 15
Record
Test 16
Record
Test 17
Record
Test 18
Record
(%) - Percent Oxygen 79.5 Vo to 23.5 %
LEL - Combustibles
H2S-Ilydrogen Sulfide <70 Vo
C0-Carbon Monoxide
Indicate elevation test is taken from:
Name or Initial of Tester:
Test Time:
Parameter
Permissible
Entry Irvels
Test 19
Record
Test 20
Record
Test 21
Record
Test 23
Record
Test 24
Record
(%) - Percent Oxygen 19,5 Vo to 23.5 Vo
LEL - Combustibles < 7tl 9o
H2S-Hydrogen Sulfide < 1.0 Va
CO-Carbon Monoxide
Indicate elevation test is taken from
Name or Initial of Tester:
Test Time;
I'arameter
Permissible
Entry kvels
Test 25
Record
Test 26
Record
Test 27
Record
Test 28
Record
Test 29
Record
(7o) - Percent Oxygen \9.5 Vo to 23.5 ?o
LEL * Combustibles <10 7o
H25-Hydrogen Sulfide
CO-Carbon Monoxide <25 Vo
Indicate elevation test is taken from:
Name or Initial of Tester:
Test Time:
Revtsion Date: Jure 11,2007
Telephone
<10 7o
<25 Vo
Test 22
Record
<25 Vo
Test 30
Record
<lO Vo
=
=
=
H
rT---ltt
-t
tl
---+---+---_---T---_-|_-
:
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City of Lebanon
CONFINED SPACE ENTRY PERMIT (Extended duration test recording log)
Department
Telep hone
l) Address of Entry
2) Permit Space to be entered
3) Purpose of Eutry
4) Date of Entry Authorized Duration of Entry
Permissible Test-Test _Test Test _
Record
Test _
Record
Test _
RecordParameterEnLevelsRecordRecordRecord
( 7o) - Percent O en 19.5 Vo to 23,5 Vo
LEL - Combustibles <10 Vo
H2S-dro Sulfide <10 Vo
CO-Carbon Monoxide <25 4o
Indicate elevation test is taken from:
Name or Initial ofTester
Test Time
Permissible Test _
Record
Test _
Record
Test _
Record
Test _
Record
Test _
Record
Test _
RecordParameterEnIrvels
%- Percent CN 19.5 Vo to 23.5 Vo
LEL - Combustibles <10 Va
H2S-dro Sulfide < lO o/a
Co-Carbon Monoxide <25 1o
Indicate elevation test is taken from:
Name or Initial of Tester
Test Time:
Permissible Test _
Record
Test _
Record
Test -Record
Test -Record
Test -RecordParametcrEnLevels
9o - Percent O cn 19,5 Vo to 23.5 Vo
LEL - Combustibles <70 4o
H2S-l'o n Sulfide <10 Vo
CO-Carbon Monoxide <25 9o
Indicate elevation test is taken from
Name or Initial of Tester;
Test Time:
Permissible Test _
Record
Test
-Record
Test -Record
Test
-Record
Test _
RecordParameterEnLevels
(7o) - Percent 19.5 7o to 23.5 Vo
LEL - Combustibles <10 7o
II2S-H dro Sulfide <10 Vo
Co-Carbon Monoxide <25 9o
Indicate elevation test is taken from
Name or Initial of Tester:
Test Time
ReYisionDate: Jurc 11, 2007 Page of
Test -Record
T - _l
-_T_
=
Test
n""nla
F
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
City Manager
CITY OF LEBANON
SAFETY POLICY
NOISE EXPOSURE POLICY
Date:Updated: _
To protect employees fiom hazards assooiated with occupational noise exposure.
To ensure compliance with New Hampshire Departrnent of Labor Standiud 1403.51' Nolse
Exposure-
Each Department shall:
l. Monitor noise levels in their $/orkplace to ensure they do not exceed al eight (8) hour
time weighted avcrage of90 db
Exposure Levels
Noise levels are measured in decibels (dBA). We talk at about 70 deoibels. Decibels are
measured on a scale like the one for eadhquakes- So when the decibels go up a little, the noise
goes up a lot. Seventy tlree decibels is 2 timas as loud as T0 OSIIA has rules conceming how
long you may be exposed to a noise level beforc you must weax hearing protection:
AUowld to b. Enprotc.r.d
Up to I hours
Up lo I tou.
90 dicib.ls
95 dcciblls
105 dccibcls
When the noise level is 95 decibels, OSHA says you may work with no hearing protection for
only 4 hours. Even so, this noise level is not safe; L in 5 people exposed regularly to 90 decibels
(as OSTIA allows) will lose some hearing. Short, very loud (impact) noises can do the most
harm.
Ifyou have to raise your voice for someone 3 feel dwoy to heor you, the sile may be too nbb)t
and yoa need hefilng protedlon.
Most constuotion noise comes from equipmeflt. Thc follou'ing decibel levels have been
measured:
Addendum A5
I
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
d€clb€Is
9046
90,96
8?-95
87-94
86-94
84-93
The noise levels change. The noise from a gradeall earthmover is 94 decibels from 10 feet away.
The noise is only 82 decibels if you ne 70 feet away. A crane lifting a load can make 96 decibels
ofnoise; at rest, it may make less than 80 decibels.
2. When possible the Departrnent will institute engineering and administrative controls to
reduce employee noise exposures wh6u necessary.
3. Each Department will provide hearing protection, free of charge, when engineering and
administrative controls fail to reduce employee noise exposures.
The most common reason employees resist wearing ear protection is because theyjust don't
think they need it. This is a frightening fact because hearing loss is gradual, and by the time it is
realized, the ability to hear is not as good as before. It may be too late.
Another reason individuals give for not wearing ear protection is that they think the proteotion
vi ill be uncomfortable. The following are several tlpes of ear ptugs which give good protection,
are comfortable, and are easy to use:
- ,., - ^,. .-- Plugs are spqngy, soft compressed or shaPed prior !o lnsertiotl: expan dable toFormaole t,lugs proiide a snug fli. Ttrese are dllposable plugs and are not toleuse.
EqulpBlent
Pncunatic chip haftmcr
Jackharrmer
Concrctc joint cuttlr
Skilsaw
Stud weld.r
BulldozEr
dcribds
103-l l3
102-r I I
99-102
B8-102
101
93-96
Equlplnlnl
Eanh Tarrlpcr
Crenc
Himmcr
GBdcall
F ont-cod ioadcr
Brckhoc
Premolded
Plugs
Plugs made ofsoft fexible mateial preformed to fit ho ear. Must be ftted (sized)
for eadl ear- These plugs are deslgned hr reuie and must be washed after each
use. They are good to use ln cabes when hean:hg proteclion is lsed on a regular
basis.
Earmuffs
4 Each Department will train employees in the correct fit and care ofhearing protection
devices.
Adjustable hoadband v/ith sdft cups and cushions thal sealaround lhe ear. Plugs
may be wom under muffs tor.addltonal protectjon, Mults may be more comfodable
b wear over a longerpeiod fian plugs, but shsuld not be wom tdlh eyeglasses o.
any olh€r obstuclion thal !,illl reduce lhelr ettectlveness.
2
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
Using Hearin g Protection Correctly
Actual attenuation achieved with any hearing protector depends on proper usage.
When using foam earplugs, roll in a crease-free manner and shape into a very thin cyliader by
squeezing liglttly and rolllug. Progressively apply greater pressurb as the plug becomes more
tightly compressed. Do not roll the plug into other shapes such as a cone or a bail. Foam
earplugs provide the most attenuation when inserted deeply into the ear canals. Foan earplugs
should not be readjusted while in the ear. Instead, they should be removed, re-rolled and re-
inserted
Pre-molded earplugs do not need to be rolled. To insert them into the ear canal, the wearer
shguld pull the ear outward and upwad and insert the earplug tightly into the ear opening (see
figures 3 and 4). Pre-molded earplugs can be readjusted while in the ear. When pre-molded
earplugs are properly inserted, they wiil create a plugged or blocked up feeling due to the airtight
seal.
Earmuffcups must firlly enclose the user's ears. They should not rest on the usefs ears. The
headband should be adjwted so that it sits conrfortably on the head. Long hair should be pulled
back to ensure the best possible seal.
Method of pulling the pinna ourward and upward
while inserting an earplug.
Demonstration of a proper (left) and improper (right)
fit ofa foam earplug.
3
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
Care of Hearing Protection
Foam earplugs are disposable and must be discarded after each shift and when
dirty.
Pre-molded earplugs can be used multiple times although care should be given to
prevent contarninatio[ with dirt, chemicals, etc., while in storage.
* Earmuffs should be cleaned with mild soap and water when dirty. The ear cups
need to be replaced when damaged or brittle to ensure effective protection.
* Never modiff al earplug or muff to improve comfort or improve communication.
Ifthe hearing protector is uncomfortable, choose a different hearing protector.
Implement alternate communication methods when necessary.
Monitor exposure to impulsive or impact noise to ensure employee exposure does not
exceed 140 db peak sound pressure level.
6. Keep records of sound level readings and employee taining.
The Employee shall:
Ilform employer when exposure to excessive noise is suspected.
5
Follow guidelines ofinstihrted engineering and administative contrcls that are designed to
reduce employee noise exposure.
Wear provided hearing protection when employer deems necessary.
4
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
CITY OF'LEBANON
SA.F'ETY POLICY
LO CKO AT- TAGO UT PROGRAM
ciry Updat€d:
Control ofhazardous energy is the purpose of the I-ockout- Tagout Program. This program is to
protect employees &om hazards associated with the isolation of both kinetic and poteotial
electical, chemical, thermal, hydrauLic aad pneumatic and gravitational energy prior and during
equipmeut repair, adjustment or removal. To ensure compliance with New Hampshire
Depanmenl of l.abor Standard 1403,45, Lockout.
Employee - An onplope who is primarily rasponrible fur his or her personal safety by locking
anil tagging ouf mscbincs or eguiprnent to service or maintain them.
Bnergy Isolating Device - A mechanical device that physically prevents the transmission or
release ofenergy. Examples: slectrical circuit breakers, disconnect swilches, line valves or
blocks. fNote: push buttbns, selector switches and other control circuit-type devices are not
energy-isolating devicesl.
Lockout/fagout - the placement oflockout atrd tagout deviccs on an energr isolating device,
according to thc established procedures of this policy,
Locliout Devic€ - a Iock approved by the Depaiment head, or equivalent device.
'fagout Device - a warning tag approved by the Department head, or equiva.ient dcyice.
Employer shall:
Providc patllocks md othcrnecded equipment to employees, frec of charge, to be uscd for
locking out equipmeot wkeil requhed.
Ttsain employees in the proper and safe procedures for locking out poten'tially hazardous energy
when performing maintenance or repair.
Page I of 5
Addendum A6
./4
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
Identify all forms of potentially hazardous energy-
Examine equipment for all types ofpotentially hazardous energy including electrical, hydraulic,
steam, pneumatic, vacuum or mechanical.
Notify affected employees-
Preparatiotr for Shutdown
Before authorized or affected employees tum off a machine or piece of equipment, the
authorized employee will have knowledge ofthe type and magnitude of the energy, the
hazards of the energy to be controlled, and the means to conkol the energy.
Notify all affected Employees that the machinery equipment or process will be out of
service.
Shut down equipment through normal means-
The machine or equipment will be turned offor shut down using the specific procedures for that
specific machine. An orderly shutdown will be utilized to avoid any additional or increased
hazards to employees as a result of equipment de-energization.
Move switch or panel arrns to "Off' or "Open" positions and close all valves or other energy
isolating devices so that the energy source(s) are disconnected or isolated from the machinery or
equipment.
Machine or Equipment Isolation-
AlI energy control devices that are needed to control the energy to the machine or equipment will
be physically located and operated in such a manner as to isolate the machine or equipment from
the energy source
Apply lock to energy isolation device-
Page 2 of 5
Employee shall:
Effectively disconnect and make non-hazartlous all forms of energy capable of causing injury
during maintenance procedure.
Lock all energy soutces or switches in the "off'position prior to making any repairs.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
I lockout or tagout devices will be affixed to energy isolating devices by authorized
employees (A mechanical device that physically prevents the transmission or release of
energy). Lockout devices will be affixed in a manner that will hold the energy isolating
devices from the "safe" or "off' position.
Where tagout devices are used they will be affixed in such a manner that will clearly state
that the operation or ths movement ofenergy isolating devices from the "safeu or 'off'
position(s) is prohibited.
The tagout devices will be attached to the same point a lock would be attached lf the tag
cannot be affixed at that poin! the tag will be located as close as possible to the device in
a position that q/ill be immediately obvious to anyone attempting to operate the device.
l,oct and tag out all energy devices by use ofhasps, chains and valve covers with
assigned individual lock(s).
Release all excess energy from machinery-
,, Foliowing the application ofthe lockout or tagout devices to the energy isolating devices,
all potential or residual energl will be relieved, disconnected, restrained, and otherwise
rendered safe.
2.
4
:r.
1
3
2.
'-stored energy (capacitors, springs, elevated members, rotating fly wheels, and
hydraulic/airlgas/steam systems) must be relieved or restrained by grounding,
repositioning, blocking antVor bleeding the system.
2
Verifi cation of Isolation-
Prior to starting work on machines or equipment that have been locked or tagged out, the
authorized employee(s) will verify that isolation or de-energization ofthe machine or
equipment have been accomplished.
After assuring that no employee will be placed in danger, test all lock and tag outs by
following the norrnal stad up procedues (depress start button, etc.).
Cuution: Affer Test, place controls in neutral position.
Perform maintenance or repair work on machinery-
1. Conduct any repair or maintenance work on the equipment that has been tested.
Page 3 of 5
Where the re-accumulation of stored energy to a hazardous energy level is possible,
verification ofisolation will be continued until the maintenance or servicing is complete.
3.
1
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
2 Should the shift end or change before the machinery or equipment can be restored to
service, the lock and tag out must remain. If the task is reassigaed to the next shift, those
employees must lock and tag out before the previous shift may remove their lock and tag
Release from LOCKOUT/TAGOUT-
Before lockout or tagout devices are removed and the energy restored to the machine or
equipment, the following actions will be taken:
The work area will be thoroughly inspected to ensure that nonessential items have been
removed and that machine oi equipment components are operational.
The work are will be checked to ensure that all employees have been safely positioned or
removed. Before the lockout or tagout devices are removed, the affected, employees will
be notihed that the lockout or tagout devices are bei::g removed.
Each lockout or tagout device will be removed from each energy isolating device by the
employee who applied the device.
EQUIPMENT-
This procedure covers all eleclrical plug-type equipment such as battery chargers, some product
'pumps, oIfice equipment, powered hand tools, powered bench tools, lathes, fans, etc. When
working on, repairing, or adjusting the above equipment, the following procedures must be
utilized to prevent acsidental or sudden startup:
1. Unplug electrical qquipment from wall socket or in-line socket.
2. Attach "Do Not Operate" tag and plug box and lock on end ofpower cord.
An exception is granted to not lock and tag the plug if the cord and plug remain in the
exclusive control of the employee working on, adjusting or inspecting the equipment.
3. Test equipment to assure power source has been removed by depressing the "Start" or
"On" switch.
4. Perform required operations.
5. Replace a1l guards that were removed.
6. Remove lock and plug box and tag.
7. Inspect power cord and socket before plugging equipment into power source. A:ry
defects must be repaired before placing the equipment back in service.
NOTE: Occasionally used equipment maybe unplugged from power source when not in use.
2
3
Page 4 of 5
I
Restart equipment-
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
1. Ensure that people, tools, etc., are clear ofmachine before stad up
Page 5 of5
-'I-
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
Addendum A7
CITY OF LEBANON
SAFETY POLICY
ent
Date:Updstod:
--
All applicable departments are responsible for perforrning and documentiflg liazard
Assessment Suweys in the work enviroDment and preyenting persoonel exposure to
Ioown or foresecable safety hazards. Installing appropriate engineerilg controls or
guards is generally the first cou$e of action to prcvent such injuries from occurring.
To ensure compEance wi& New Ha$pshire Depaflment of Labor Standard 1403.53,
Personal Protective Equipment.
Employer shall:
Evaluate the workplace to detemine hazardous envtonmetrts in which workers
pedorrn tasks.
Attempt to elimiDate those hazards through engineering controls, administrative
controls or work practice controls.
Determir:e the apflication of personal pmtectiva equipment if the hazard cannot
be eliminated with the previous three methods.
Provide personal protective equipmenL $/ithout cost, Io those employees who
must wear it according to the findings of &e workplacc h^zard analysis.
Provide US Coast Guard-approved lifejackcts or buoyant work vests, ryitiout
cost, to all enployees working over or near water or where the danger of
drowning exists (wells, rivers, ponds, wastewater lagoons, etc.).
Each depetment will put together speeialized standard operating procedures for
prctective equipment in speciality areas that they perform.
Employee shallr
1. Wear/use all personal protective equipment provided by the employer.
Wear/use all psrSonal protective equipment according to matrufacturer's
guidelines.
Inspect personal prolective equipment prior to every use to eDsure its integrity
and abiuty to pl]otect from hazards.
Replace all personal pmtective equiprnent that is daDaged, wom through or no
Ionger prot€ce ftom the hazards of the work task-
1
2.
3-
4.
6
,
J.
4.
Page I of 6
City
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
5
6
Use pmvided US Coast Guard-approved life jackets or buoyant work vests
whenever working over or near water or where the danger of drowning exits
(wells, riven, ponds, wastewater lagoons, etc.),
Shall follow all City of kbanon and Departrnent Standard Operating Procedures.
Types of Personal Protective Equipment
Eye and Face Protection
Employees, contractors, and visitorc shail wear the appropriate eye and face protection
when involved in activities where there is the potential for eye and face injury from:
Handling of hot solids, liquids, or molten metals.
Flying particles from chiseling, milling, sawing, n[ning, shapirg, cutting,
etc.
Heat treatDcent, tempering, or kiln firing of any metal or other materials.
Intense light radiation from gas or electric arc welding, glassblowing,
torch brazing, oxygeo cutting, laser use, etc.
Repair or servicilg of any vehicle.
Handling of chemicals aird gases,
Eye protection choices include the following:
Safety Glasses
Ordinary prescription glasses do not provide adequate protection. Eye protection must
conform to the American National Standards Iastitute (ANSI), Standard 287.1-1989.
Look for this stamp on the inside of the safety glass frame.
Prescription safety glasses are recommended for employees who must routinely wear
safety glasses in lieu of fitting safety glasses over their personal glasses. A11 safety
glasses should have side shields. Whenever protection against splashing is a concem,
"Chemical Splash Goggles" must be worn.
Goggles
Use - Goggles are intended for use when protection is needed against chemicals or
particles. hnpact prctection goggles which contain perforations on the sides of goggle
are not to be used for chemical splash protection, therefore are not gecornmended. Splash
goggles which cootain shielded vents at the top of the goggle are appropriate for
chemical splash pmtection, and also provide Iimited eye impact protection. Goggles only
prctect the eyes, offering no protection for the face and neck.
a.
b.
d.
t.
Page2 of 6
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
Face Shields
Full face shields provide the face and tkoat and partial protection from flying particles
and l-iquid splash. For maximum protection against chemical spiash, a full face shield
ehould bo uaod ia oombination with chcmical sp.lash gogglcs. Facc shields arc
appropriate as secondary protection when implosion (e.g vacuum appLications) or
explosion hazards are present. Face shields which are contoured to prctect the sides of
the neck as well as frontal protection are preferred.
Eye Protection for Intense Light Sources
(welding, gas welding, oxygen cutting, torch brazing, laser use, etc.)
The radiation produced by welding covers a broad range of the spectrum of light.
Exposure to ultraviolet light (rV-B) ftom welding operations can cause "welders flash,"
a painful hflammation of the outer layer of the comea. Arc welding or arc cutting
operations, including submerged arc welding, require the use of welding helmets with an
appropriate filter lens. Goggles with filter piates or tinted glass are available for
glassblowing and other operations where intense light sources are encountered, including
but not limited to, gas welding or oxygen cutting operations. SPectacles with suitable
filter lenses may be appropriate for light gas welding operalions, torch brazing, or
inspection.
Hand Protection
Employees shall use hand protection when exposed to hazards including:
Skin absorption of hamful substances
I-acerati ons
Severe cuts
S evere abrasions
PuDctues
Chemical bums
Thermal bums
Ilarrnfu I temperature extremes
Wear proper hand pmtection whenever the potential for contact with chemicals, sharp
objects, or very hot or cold materials exists. Select gloves based on fie properties of the
material in use, the degree of protection needed, and the nature of the work ( direct
contact necessary, dexterity needed, etc) kather gloves may be used for protection
against sharp edged objects, such as when picking up broken glassware or inserting glass
tubes into stoppers. When working at lempexature extremes, use insulated gloves.
Materials such as Nomex and Kevlar may be used briefly up to 1000 F. Do not use
gloves containing asbestos. Asbestos is regulated as a carcinogen under OSHA. When
considering chemical gloves, note that glove materials wili be permeated (pass through)
by chemicals.
Page 3 of 6
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
The permeation rate varies, depending on the chemical, glove material, and thickness.
Double gloving is recommended when handlhg highly toxic or carcinogenic materials.
Before each use, inspect the gloves for discoloration, puncturcs and tears. Before
removal, wash gloves if the glove material is impermeable to water. Observe any changes
lu glove colol'afld rcxufe, lcludlng hardening or softemng, wluch may be mdrcahons ol
glove degradation.
Body Protection
Employees working arouad hazard materials or machinery shall not wear loose clothing
(e.g. saris, dangling neckties, necklaces ) or unrestrained long hair. Loose clothing,
jewelry, and unresftained long hair can become ensnared in moving pads of machinery or
contact chemicals. Fhger rings can damage gloves aDd trap chemicals against the skin.
Tyvek coveralls can beused over stxeet clothes for protection against particles and low
hazard Iiquids, but do not provide complete protection against liquids.
Vhyl or rubber aprons and sleeves should be used wfren dispensing corrosive liquids.
Where contact with hazardous materials with your protective clothing is likeiy, such as
during spill cleanup or pesticide application, polyethylene-coated Tyvek or similar
ciothing should be used to provide additional protection. The limitations of the
protective clothing must always be understood, particularly in sinrations where contact
with the material is likely.
Employees should know the appropriate techniques for removing protective apparel,
especialiy any that has become contaminated. Special procedures may need to be
followed for cleaning and/or discarding contaminated apparel. Chemical spi1ls on leather
clothing accessories (watchbands, shoes, belts and such) can be especially hazardous
because many chemjcals can be absorbed in the leather and then held close to the skin for
long periods. Such items must be removed prompdy and typically be discarded to
prevent the possibility of cherrical bums.
Occupation Foot Protection
Page 4 of 6
Safety toe footwear sha1l conform to the requirements and specifications of ANSI 241.1-
1991, "Men's Safety-Toe Footwear."
Wear proper shoes, not sandals or open toed shoes, in work areas where chemicais are
used or stored. Perforated shoes, sandals or cloth sneakers should not be wom in areas
where mechanical work is being dooe.
Safety shoes arc required for protection against injury from heavy falling objects
@andling of objects weighing 661s than tfteen pounds which, if dropped, would likely
result in a foot injury), agdinst crushing by rolling objects (warehouse, loadhg doclis,
etc.), and against laceration or penetration by sharp objects.
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
When working outside in slippery ice conditions additional frictiou on shoes may be
required. The use of such devices as Yak-Tracks, or other comparable devices, may be
advised.
Resplr[iory Protectlofl
See the Noise Exposure Policy section of the Loss Prevention manual for more
information.
Occupational Heatl Protection
Helmets desigrcd to protect the head from impact and penetration from falling/flying
objects and from limited electric shock and bum shall meet the requiremenls and
specificadons established in ANSI289.1- 1986, "Requirements for Industrial llead
Protection. "
Fire Department Protective Clothing
The Fire Department Protective Clothjng will meet the appropriate NFPA Standards. All
Firefighters shall be certified in the use of protective clothing to the New Hampshire Fire
Standards and Training Commission Standards.
All Police Officers shall use all protective clothing in accordance to National Police
Standards. A11 Police Officers shall be certified in the use of protecflve clothing to the
New llampshire Police Standards.
Iligh Visibility Apparel
The Standard ANSyISEA 107-1999 - establishes a set of performance criteria for high-
visibility apparel. The standard defines three gamrent categories (a1so known as
Conspicuousness Classes), which are based on worker hazards and tasks, compiexity of
the work environment or background, and vehicular traffic and speed.
Paile 5 ot 6
See the Respiratory Protection Policy Section of the Loss Prevention Policy for more
information.
Hearing Protection
Electrical Protection
Specific design and performance, use, and care requirements apply to protective
equipment used for isolation against electrical hazards. Persons selecting for purchase,
maintaining, and using such equipment (insulating blankets, matting, covers, Iine hose,
gloves, and sleeves made of rubber) must be familiar with these requirements.
Police Department
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99
AIi City of Irbanon Personnel will weat High Visibility Apparel foilowing the
following ANSI/6EA Guide lines:
Class 1 garl clll-s uu intcnded for use l acdvl{es that peftdt the wearff's fuIl ald
undivided attention to approaching tlaffic. There should be ample separation of the
worker from traffic, which should be travelng no faster than 25 miles per hour,
Examples of workers who use Class 1 apparel:. Parking lot attendants.. People retrieving shopping carts from pmking lots.. Workers exposed to warchouse equipment traffic.. Roadside "right of way" ot sidewalk maintenance workers.
Class 2 garments are intended for use ia activities where greater visibility is necessary
during inclement weather conditions or in work environments with risks that exceed
those for Class 1. Garments in this class also cover workers who perform tasks that
divert their attention from approaching traffic, or that put them in close proximity to
passing vehicles traveling at 25 miles per hour or higher.
Examples of workers who use Class 2 apparel include:. Foresky operations. Ship cargo loading operations
Roadway construction, utility and railway worfteff. Survey crews. School crossiag guards. Delivery vehicle drivers. High volume parking and/or to1l gate persomel. Airport baggage handlers/ground crew. Emergency response and law enforcement pelsonnel. Trash collection and rccycling operafions. Accident site investigators. Railroad inspection and maintenance crews
Page 6 of 6
Class 3 garrnents provide the highest 1eve1 of visibility, and are intended for workers who
face serious hazards z[rd often have high task loads that require attention away from their
work. Garments for these workers should provide enhanced Yisibility to more of the
body, such as the a.rms and legs.
Examples of workers who use Class 3 apparel include:.. Roadway construction personnel and flaggers. Utility workers
Survey crews. Emergency response personnel
DocuSign Envelope ID: D5A840C2-0ABC-4E13-B78D-3AF3E9F44D99