HomeMy Public PortalAbout02.07.2023 City Council Meeting Packet Posted 2/3/2022 Page 1 of 1
AGENDA FOR THE REGULAR MEETING
OF THE MEDINA CITY COUNCIL
Tuesday, February 7, 2023
7:00 P.M.
Medina City Hall
2052 County Road 24
I. CALL TO ORDER
II. PLEDGE OF ALLEGIANCE
III. ADDITIONS TO THE AGENDA
IV. APPROVAL OF MINUTES
A. Minutes of the January 17, 2023, Regular City Council Meeting
V. CONSENT AGENDA
A. Approve Election Equipment Lease Agreement with Hennepin County
B. Approve Amended and Restated License Agreement for Collection and Disposal of Residential Solid
Waste, Recyclables, and Compostables with Randy’s Sanitation LLC
C. Approve Resolution Supporting Corridors of Commerce Funding Request to Resurface Highway 55 from
CR 118 to CR 19, with Two-Lane to Four-Lane Expansion
D. Approve Plans and Specs and Authorize Bidding for Willow Drive Lift Station
E. Approve Resolution Calling Hearing on Improvement for Clydesdale Trail
F. Approve Hiring of Planning and Permit Technician
G. Approve Road Materials and Equipment Bids
H. Approve Updated Safety Manual
VI. COMMENTS
A. From Citizens on Items Not on the Agenda
B. Park Commission
C. Planning Commission
VII. PRESENTATION
A. Resolution Recognizing Finance Director Erin Barnhart for 15 Years of Service
VIII. OLD BUSINESS
A. Loram and Scannell Preliminary Plat and Site Plan Review
1. Resolution Granting Preliminary Plat Approval
2. Resolution Granting Site Plan Review and Conditional Use Permit
IX. NEW BUSINESS
A. Hamel Townhomes
1. Resolution Granting Extension of Time to Record Hamel Townhomes Plat; Amending Resolution
No. 2022-64
X. CITY ADMINISTRATOR REPORT
XI. MAYOR & CITY COUNCIL REPORTS
XII. APPROVAL TO PAY BILLS
XIII. CLOSED SESSION: Consider Offers to Purchase Right-of-Way Easements on Property Located at 435, 545,
565, 625, and 655 Hackamore Road and Hennepin County PID 0111823220003 Pursuant to Minn. Stat. 13D.05,
subd. 3(c)(3).
XIV. ADJOURN
Meeting Rules of Conduct to Address
the City Council:
• Fill out & turn in comment card
• Give name and address
• Indicate if representing a group
• Limit remarks to 3-5 minutes
MEMORANDUM
TO: Medina Mayor and City Council
FROM: Scott Johnson, City Administrator
DATE OF REPORT: February 2, 2023
DATE OF MEETING: February 7, 2023
SUBJECT: City Council Meeting Report
V. CONSENT AGENDA
A. Approve Election Equipment Lease Agreement with Hennepin County – Hennepin County
has created a new agreement to combine all election equipment lease information into one
agreement and includes updates to vendor information and the types of equipment used.
Staff recommends approval.
See attached agreement.
B. Approve Amended and Restated License Agreement for Collection and Disposal of
Residential Solid Waste, Recyclables, and Compostables with Randy’s Sanitation. – The
City has contracted with Randy’s Sanitation, a Republic Services company, with an
exclusive license for solid waste, recyclables, and compostables since 2008. The current
agreement expires June 30, 2023. Randy’s sanitation has proposed five-year renewal
pricing that reflects a 4% price increase per year. The City Council provided comments at
the December 20, 2022, work session. Staff, the City Attorney, and the Mayor worked
with Randy’s to address the comments from the December 20 meeting. The comments
have been addressed. Staff recommends approval.
See attached agreement.
C. Approve Resolution Supporting Corridors of Commerce Funding Request to Resurface
Highway 55 from CR 118 to CR 19, with two-lane to four-lane expansion – The Highway
55 Corridor Coalition, in partnership with coalition membership, is requesting $43
million in funding for reconstruction of TH 55 from a two-lane undivided to a four-lane
divided roadway and access consolidation in Hennepin County from Arrowhead Drive in
the City of Medina to CR 19 north of Loretto. The Highway 55 Corridor Coalition has
requested a resolution of support from the City of Medina. Staff recommends approval.
See attached resolution.
2
D. Approve Resolution Approving Plans and Specs for Willow Drive Lift Station and
Ordering the Advertisement for Bids – The Willow Drive/TH 55 Regional Lift Station
Project will serve properties to the east & west of Willow Drive that are not serviceable
with gravity sewer, including the proposed Adams Pest Control development and future
Cates Industrial Park projects. The City Council authorized a feasibility study for the lift
station in September 2019 and final design of the lift station in July 2022, spurred on by
this proposed development in the area. The next step is for City Council to approve final
plans/specifications and authorize advertisements for bidding of the project. The
proposed bid date is Thursday March 2, 2023 at 2:00 PM. With that schedule in mind, it
is anticipated that bids will be presented at the City Council meeting on March 21st for
consideration of award. Staff recommends approval.
See attached memo and resolution.
E. Approve Resolution Calling Hearing on Improvement for Clydesdale Trail – On
December 6, 2022 the City Council adopted a resolution authorizing the preparation of an
engineering feasibility report for the proposed Clydesdale Trail Pavement Rehabilitation
Project. The project was initiated as a part of the City’s capital improvement planning
and is intended to replace deteriorating infrastructure that includes the existing roadway
surface. The City Council received the feasibility report at the January 17th meeting and
ordered the preparation of plans and specifications. City staff also held a neighborhood
meeting on January 31st at the public works building. The next step is for the City
Council to consider the enclosed resolution calling for the public improvement hearing.
Staff recommends approval.
See attached memo and resolution.
F. Approve Hiring of Planning and Permit Technician – On December 6, 2022, Council
authorized staff to recruit to fill the vacant planning and permit technician position. Staff
recommends the appointment of Maria Rucke to the position of Planning and Permit
Technician.
See attached memo.
G. Approve Road Materials and Equipment Bids – Public Works Director Steve Scherer has
attached a memo that outlines the various bids that we received to provide road
maintenance improvements in the City. Staff recommends approval of the road material
and equipment bids as presented for 2023.
See attached memo and bids.
H. Approve Updated Safety Manual – The Safety Committee and the Public Works
Department has updated the safety manual to consolidate various policies, rules, and
regulations regarding safety into one manual. Staff recommends approval.
The manual is available electronically here
3
VII. PRESENTATION
A. Resolution Recognizing Finance Director Erin Barnhart for 15 Years of Service – Erin
Barnhart has contributed greatly to Medina during her 15 years of service to the City.
Mayor Martin will read the resolution and honor Erin for her 15 years of service.
See attached resolution.
VIII. OLD BUSINESS
A. Loram and Scannell Preliminary Plat and Site Plan Review – At the January 17, 2023
meeting, the City Council reviewed the proposed preliminary plat and site plan review for
the Loram/Scannell warehouse project east of Arrowhead Drive, south of Loram’s existing
facility. Staff recommends that the City Council act on the preliminary plat application and
site plan review/CUP at this time. Staff will continue to analyze options related to park
dedication and report back to the Council at the time of final plat.
Potential Motions:
1. Motion to adopt the resolution granting preliminary plat approval for Loram
Industrial Addition.
2. Motion to adopt the resolution granting site plan review and conditional use permit
for Loram Industrial Addition.
IX. NEW BUSINESS
A. Hamel Townhomes – The applicant has requested an extension of time to record the Hamel
Townhomes plat until August 11, 2023. Staff has reviewed the information and thinks it is
reasonable if the City Council would like to approve the request.
Potential Motion: Move to adopt resolution granting extension of time to record Hamel
Townhomes plat; amending resolution No. 2022-64.
XII. APPROVAL TO PAY BILLS
Recommended Motion: Motion to approve the bills, EFT 006687E-006720E for
$1,138,518.83, and order check numbers 053914-053985 for $495,292.03, payroll EFT
0512441-0512505 for $135,443.90.
XIII. CLOSED SESSION: Consider Offers to Purchase Right-of-Way Easements on Property
Located at 435, 545, 565, 625, and 655 Hackamore Road and Hennepin County PID
0111823220003 Pursuant to Minn. Stat. 13D.05, subd. 3(c)(3).
4
INFORMATION PACKET:
• Planning Department Update
• Police Department Update
• Public Works Department Update
• Claims List
Medina City Council Meeting Minutes
January 17, 2023
1
DRAFT 1
2
MEDINA CITY COUNCIL MEETING MINUTES OF JANUARY 17, 2023 3
4
The City Council of Medina, Minnesota met in regular session on January 17, 2023 at 5
7:01 p.m. in the City Hall Chambers. Albers presided. 6
7
I. ROLL CALL 8
9
Members present: Albers, Cavanaugh, DesLauriers, Martin, and Reid. 10
11
Members absent: None. 12
13
Also present: City Administrator Scott Johnson, City Clerk Caitlyn Walker, Attorney 14
Dave Anderson, Finance Director Erin Barnhart, City Engineer Jim Stremel, City 15
Planning Director Dusty Finke, Public Works Director Steve Scherer, and Chief of Police 16
Jason Nelson. 17
18
II. MOTION TO DELEGATE DUTIES TO PRESIDE OVER THE MEETING TO 19
COUNCILMEMBER ALBERS 20
Moved by Cavanaugh, seconded by Reid, to delegate duties to preside over the meeting 21
to Councilmember Albers. 22
23
A roll call vote was performed: 24
25
Cavanaugh aye 26
Reid aye 27
Martin aye 28
DesLauriers aye 29
Albers aye 30
31
Motion passed unanimously. 32
33
III. PLEDGE OF ALLEGIANCE (7:01 p.m.) 34
35
IV. ADDITIONS TO THE AGENDA (7:02 p.m.) 36
The agenda was approved as presented. 37
38
V. APPROVAL OF MINUTES (7:02 p.m.) 39
40
A. Approval of the January 3, 2023 Work Session City Council Meeting 41
Minutes 42
Albers stated that prior to the meeting Johnson distributed changes as proposed by 43
Martin for incorporation. 44
45
Moved by Albers, seconded by Cavanaugh, to approve the January 3, 2023 work 46
session City Council meeting minutes as amended. 47
48
A roll call vote was performed: 49
50
Cavanaugh aye 51
Medina City Council Meeting Minutes
January 17, 2023
2
Reid aye 1
Martin aye 2
DesLauriers aye 3
Albers aye 4
5
Motion passed unanimously. 6
7
B. Approval of the January 3, 2023 Regular City Council Meeting Minutes 8
Albers noted that prior to the meeting Johnson distributed changes for incorporation. 9
10
Cavanaugh noted on page three, lines 41 and 42, it should state, “…portion for future 11
services…Medina will…” 12
13
Moved by Cavanaugh, seconded by Reid, to approve the January 3, 2023 regular City 14
Council meeting minutes as amended. 15
16
A roll call vote was performed: 17
18
Cavanaugh aye 19
Reid aye 20
Martin aye 21
DesLauriers aye 22
Albers aye 23
24
Motion passed unanimously. 25
26
VI. CONSENT AGENDA (7:05 p.m.) 27
28
A. Approve Purchase Agreement for Butterfly Marsh Wetland Banking Credits 29
B. Approve Resolution for Willow Drive Lift Station Quote for Electrical Panel 30
Equipment 31
C. Approve 2023 Goals 32
D. Accept Donation from Doboszenski & Sons Inc. 33
E. Accept Donation from Steve Lundell 34
F. Approve Amendment to Special Assessment Policy 35
Albers thanked Mr. Lundell and Doboszenski & Sons for the generous donations. 36
37
Moved by Cavanaugh, seconded by Reid, to approve the consent agenda. 38
39
A roll call vote was performed: 40
41
Cavanaugh aye 42
Reid aye 43
Martin aye 44
DesLauriers aye 45
Albers aye 46
47
Motion passed unanimously. 48
49
VII. COMMENTS (7:07 p.m.) 50
51
Medina City Council Meeting Minutes
January 17, 2023
3
A. Comments from Citizens on Items not on the Agenda 1
There were none. 2
3
B. Park Commission 4
Scherer reported that the Park Commission will meet the following night to discuss park 5
maintenance and baseball. 6
7
DesLauriers asked if Hunter field will not be used in 2023 because of the damage done 8
from the vehicle incident. 9
10
Scherer stated that part of the issue was the drought. He stated that they will need to 11
recultivate the field. He stated that if the growing season were successful, perhaps the 12
field could be used for practice in the fall. 13
14
C. Planning Commission 15
Planning Commissioner John Jacob reported that the Planning Commission met the 16
previous week and received an update from Albers on recent Council activity and 17
discussions with Representative Robbins. He stated that the Commission also reviewed 18
the updated plans for Medina Park and Boardwalk and unanimously recommended 19
approval. He stated that the Commission also elected Rhem as Chair and Popp as Vice 20
Chair for the year. 21
22
VIII. NEW BUSINESS 23
24
A. Loram and Scannell Preliminary Plat and Site Plan Review (7:12 p.m.) 25
Johnson stated that the applicant is requesting development of approximately 396,000 26
square feet of office/warehouse space on the subject property. He noted that Loram 27
would occupy the warehouse space in building one while the other buildings would be 28
available for lease and managed by Scannell. He stated that this proposal includes a 29
request for preliminary plat, site plan review and conditional use permit. 30
31
Finke stated that the City Council reviewed this concept in the fall, specifically in regard 32
to the wetland replacement plan. He stated that since that review, the applicant has 33
made some changes including inclusion of the eastern lot which would allow the 34
applicant to meet the impervious surface requirements for the development. He stated 35
that no development is proposed on the eastern lot at this time, with the active 36
development to occur on the lots to the west. He presented the amended preliminary 37
plat, which includes two outlots. He presented the landscaping plan, architectural 38
rendering, and wetland replacement plan. He also provided details on traffic and 39
transportation improvements and recommended a condition to be added related to 40
potential future development of the eastern lot and the road improvement that would be 41
needed to support that. 42
43
Cavanaugh asked if petition and waiver would be required and whether it was required 44
in a previous development proposal for another property. 45
46
Finke stated that petition and waiver is not recommended at this time. He did not 47
believe petition and waiver was required for the other mentioned development but noted 48
that he could follow up with those details prior to the final consideration of this request. 49
He provided details on park dedication, the review criteria for preliminary plat and 50
recommended conditions, parking, outdoor storage, architectural design, site plan and 51
Medina City Council Meeting Minutes
January 17, 2023
4
conditional use permit. He stated that the Planning Commission recommended approval 1
in the fall and in its recent review in January. 2
3
DesLauriers referenced the land proposed for park dedication and asked if the crossing 4
would occur in the wetlands and whether that area is capable of supporting a crossing. 5
6
Finke identified upland in that area where the structure could begin. 7
8
DesLauriers asked if staff is confident that would work, as this would be in lieu of over 9
$300,000 in park dedication. 10
11
Finke replied that it has not been engineered at this time but preliminary input from the 12
Park District was that this would be a good opportunity. He acknowledged that there 13
would likely be wetland impacts. He confirmed that acquisition would also be necessary 14
on the north side and noted that there are a few options for potential acquisition on the 15
north side. 16
17
DesLauriers asked if this cost should be borne by the Park District for the Diamond Lake 18
Regional Trail (DLRT) versus the City of Medina forfeiting park dedication. 19
20
Finke replied that ultimately if the Park District decided to move forward, they would be 21
responsible for acquisition in the future and the City would be reimbursed for the land in 22
the future. 23
24
DesLauriers asked if that is the location and the Park District moves forward with DLRT 25
in that location, would the City then be reimbursed the $308,000 it forfeited in park 26
dedication. 27
28
Finke replied that the City would be reimbursed up to the assessed market value of the 29
property, as is the case of any property acquisition for park use. 30
31
DesLauriers asked how valuable the land would be after the development of Loram, as 32
most of it is wetland and would not be buildable. He was unsure that the market value 33
would be $308,000 at a later time. 34
35
Finke stated that the risk would be that the land would not be able to be acquired at 36
market value and the crossing could not occur. 37
38
Cavanaugh stated the City is taking the risk and the financial commitment in the 39
meantime. 40
41
Finke replied that the Park District could not move forward until the chosen route is 42
solidified. 43
44
Albers stated that he was unsure he was willing to take that risk at this time. He 45
believed that the better choice would be to accept the park dedication funds and let the 46
Park District pursue acquisition when it is ready. 47
48
Martin commented that the City could accept the park dedication and purchase the 49
wetland for $100,000. She stated that she does not understand what the fair market 50
Medina City Council Meeting Minutes
January 17, 2023
5
value would be for the wetlands. She noted a wetland purchase in the past where the 1
City paid $43,000 for wetlands but was unsure the related acreage for that purchase. 2
3
Anderson provided details on a case being reviewed by the Minnesota Supreme Court 4
related to commercial development and park dedication. 5
6
Finke commented that there is upland adjacent to the wetland. 7
8
Martin noted that the requested action tonight is to direct staff to prepare the documents 9
to consider for approval, therefore this could come back as old business with more 10
information on park dedication. She stated that she would not want to forgo park 11
dedication. She noted that the additional time would allow for the Minnesota Supreme 12
Court decision to be made and perhaps the conditional use permit could be linked to the 13
park dedication. 14
15
Finke stated that there could be more global discussion on credit and a lower fee that 16
would be palatable to the applicant along with the land. 17
18
Martin applauded the developer and staff for working through the different issues in this 19
process, noting that the wetland replacement plan challenges were new but believed the 20
process worked well and that this would be a good development for Medina. 21
22
Moved by DesLauriers, seconded by Cavanaugh, to direct staff to prepare resolutions 23
granting preliminary plat, site plan review, and conditional use permit approval, subject 24
to the conditions noted in the staff report and the discussion requested between staff 25
and the developer related to park dedication. 26
27
A roll call vote was performed: 28
29
Cavanaugh aye 30
Reid aye 31
Martin aye 32
DesLauriers aye 33
Albers aye 34
35
Motion passed unanimously. 36
37
B. Medina Ventures – Medina Park and Boardwalk – 1472 Highway 55 – PUD 38
General Plan; Pre-Plat (7:39 p.m.) 39
Cavanaugh recused himself from this discussion as an adjacent landowner. 40
41
Johnson stated that the applicant has updated the architectural plans to reflect the 42
lodging space above the event venue. He noted that the residential units were also 43
updated as those would be sold as single-family homes. 44
45
Finke summarized some of the technical changes that have been incorporated into the 46
applicant’s plans, noting that the primary change is the architectural information. He 47
displayed the updated plans compared to the previous plans and reviewed the 48
differences. He stated that some flexibility is requested for a sloped roof on the 49
residential units. He noted that the Planning Commission discussed signage and staff 50
has since provided some suggested limitations for signage, after discussions with the 51
Medina City Council Meeting Minutes
January 17, 2023
6
applicant and provided details. He stated that the Planning Commission did 1
unanimously recommend approval of the request as presented tonight. 2
3
Martin referenced the proposed conditions related to enhanced architectural features (18 4
and 19) and suggested adding the language “to the satisfaction of City staff”. She also 5
asked for details on the plans submitted as of a certain date mentioned in condition 24 6
and suggested that language be clarified. 7
8
DesLauriers thanked the applicant for taking on this project. He stated that he believes 9
a pitched roof will blend better with adjacent residential development. He also noted two 10
areas that could benefit from additional architectural details. 11
12
Chris Pederson, applicant, agreed with the comments of DesLauriers. 13
14
DesLauriers commented that this is a great plan and looks forward to the progress as 15
they move forward. 16
17
Albers asked if there would be any signage on the north parts facing Meander. 18
19
Pederson stated that there would not be signage on the top. He stated that there would 20
be signage on the first level. He did not believe that these signage restrictions would 21
create a challenge. He stated that the only issue could be the retail building facing 22
Highway 55, if there were three tenants, noting that it would depend on the names of the 23
businesses. 24
25
Martin thanked the applicant and stated that she is excited about the development. 26
27
Albers applauded the applicant for the updated plans and believed it would be a great 28
addition to Medina. 29
30
Pederson thanked all of those that provided feedback to this point as he believed it 31
helped them to create a better product. 32
33
George Stickney, representing the Marsh Pointe Preserve development and the others 34
that signed his petition, noted that 46 of the 48 homeowners like the change from rental 35
lodging to for sale single-family homes. He stated that he would like to see covenants 36
for single-family housing with no short-term lease option for this general area. 37
38
Finke stated that language is included in the PUD ordinance. 39
40
Moved by DesLauriers, seconded by Martin, to adopt the ordinance establishing a 41
planned unit development district for Meander Park and Boardwalk and amending the 42
official zoning map. 43
44
A roll call vote was performed: 45
46
Reid aye 47
Martin aye 48
DesLauriers aye 49
Albers aye 50
51
Medina City Council Meeting Minutes
January 17, 2023
7
Motion passed unanimously. 1
2
Moved by DesLauriers, seconded by Albers, to adopt the resolution authorizing 3
publication by title and summary. 4
5
A roll call vote was performed: 6
7
Reid aye 8
Martin aye 9
DesLauriers aye 10
Albers aye 11
12
Motion passed unanimously. 13
14
Moved by DesLauriers, seconded by Albers, to adopt the resolution granting preliminary 15
plat and PUD general plan approval for Meander Park and Boardwalk with the changes 16
proposed by Martin and the architectural improvements suggested by DesLauriers. 17
18
A roll call vote was performed: 19
20
Reid aye 21
Martin aye 22
DesLauriers aye 23
Albers aye 24
25
Motion passed unanimously. 26
27
Cavanaugh rejoined the Council. 28
29
C. Clydesdale Trail Pavement Rehabilitation Project – Feasibility Report (8:01 30
p.m.) 31
Johnson stated that at the December 6th meeting the Council authorized preparation of 32
the Feasibility Report for the project. Stremel will present the report. 33
34
Stremel reviewed the proposed project area, existing conditions, and proposed 35
improvements. He provided the estimated project cost and next steps. He provided 36
details on the request for the benefits appraisal which will help to determine the 37
appropriate assessment for the different parcels in this project area. He stated that staff 38
recommends approval of the three actions presented tonight. 39
40
DesLauriers asked if there is someone in mind to complete the appraisal. 41
42
Stremel commented that there are not many appraisers that do this type of reporting, but 43
they have spoken with a firm that would be able to provide the report within the proposed 44
timeline. 45
46
DesLaurier asked the cost for the appraisal. 47
48
Stremel replied that the cost would be about $18,500. 49
50
DesLauriers asked why that was not included in the project cost. 51
Medina City Council Meeting Minutes
January 17, 2023
8
1
Scherer stated that the appraisal would be done as a check to the assessment policy 2
and because the project is unique. 3
4
Anderson provided additional details on assessments, noting that an assessment can 5
only be related to the benefit provided to the property by the project. He stated that it is 6
not certain that the appraisal would be needed, but staff would like that authorization 7
should they feel it necessary. He stated that the appraisal would also help guide the City 8
to determine whether its assessment policy needs further amendment. 9
10
Albers asked and received confirmation that staff would be reaching out to the property 11
owners prior to completing the appraisal. 12
13
DesLauriers confirmed that the reason the appraisal is not included in the project cost is 14
because the City does not want to pass that cost on to homeowners. He referenced 15
improvements mentioned to 101. 16
17
Scherer provided details on pedestrian walkways and trails. 18
19
DesLauriers asked how the appraisal cost would be funded as that is not budgeted. 20
21
Barnhart provided different options for financing that cost. 22
23
DesLauriers asked if this project would be completed in phases as this stretch of road is 24
heavily used. 25
26
Scherer agreed there is a lot to be done along with coordination with other entities. 27
28
Moved by DesLauriers, seconded by Cavanaugh, to approve WSB’s proposal for final 29
design. 30
31
A roll call vote was performed: 32
33
Cavanaugh aye 34
Reid aye 35
Martin aye 36
DesLauriers aye 37
Albers aye 38
39
Motion passed unanimously. 40
41
Moved by DesLauriers, seconded by Cavanaugh, to adopt the resolution receiving the 42
feasibility report and ordering the preparation of plans and specifications. 43
44
A roll call vote was performed: 45
46
Cavanaugh aye 47
Reid aye 48
Martin aye 49
DesLauriers aye 50
Albers aye 51
Medina City Council Meeting Minutes
January 17, 2023
9
1
Motion passed unanimously. 2
3
Moved by DesLauriers, seconded by Cavanaugh, to authorize completion of benefit 4
appraisal for the project at staff’s direction. 5
6
A roll call vote was performed: 7
8
Cavanaugh aye 9
Reid aye 10
Martin aye 11
DesLauriers aye 12
Albers aye 13
14
Motion passed unanimously. 15
16
D. Pioneer Highlands Storm Sewer Improvement Tax District – Public Hearing 17
(8:20 p.m.) 18
Johnson stated that the applicant has requested a delay to finalize the location of 19
wetland buffers. He stated that this public hearing had been noticed and therefore staff 20
recommends the public hearing be held and then action on the storm sewer tax district 21
be tabled to the time of final plat. 22
23
Albers opened the public hearing. 24
25
No comments made. 26
27
Albers closed the public hearing. 28
29
Moved by DesLauriers, seconded by Cavanaugh, to table consideration of the ordinance 30
establishing the Pioneer Highlands Storm Sewer Improvement Tax District until the final 31
plat review. 32
33
A roll call vote was performed: 34
35
Cavanaugh aye 36
Reid aye 37
Martin aye 38
DesLauriers aye 39
Albers aye 40
41
Motion passed unanimously. 42
43
IX. CITY ADMINISTRATOR REPORT (8:21 p.m.) 44
Johnson stated that Scherer has been in contact with the Hamel Athletic Club and will 45
provide an update. 46
47
Scherer provided an update on email correspondence and related discussions for 48
enrollment/registration. He commented that they are attempting to be cognizant of 49
parking to ensure there is not overlap. He stated that HAC has agreed that priority for 50
enrollment should be provided to Medina residents. He noted that the next step will be 51
Medina City Council Meeting Minutes
January 17, 2023
10
to address details within the HAC contract. He noted that HAC has been very 1
cooperative throughout this process. 2
3
X. MAYOR & CITY COUNCIL REPORTS (8:27 p.m.) 4
Albers stated that he will not be at the first meeting in February. 5
6
XI. APPROVAL TO PAY THE BILLS (8:28 p.m.) 7
Moved by Cavanaugh, seconded by DesLauriers, to approve the bills, EFT 006670E-8
006686E for $106,648.22, order check numbers 053851-053913 for $358,232.41, and 9
payroll EFT 0512406-0512440 for $64,422.99. 10
11
Further discussion: Cavanaugh asked for additional details on a large payment to an 12
individual. 13
14
Barnhart provided additional details noting that the person submitted a cashier’s check in 15
lieu of a letter of credit and therefore the payment back is being made to that individual 16
rather than the company. 17
18
A roll call vote was performed: 19
20
Cavanaugh aye 21
Reid aye 22
Martin aye 23
DesLauriers aye 24
Albers aye 25
26
Motion passed unanimously. 27
28
XII. ADJOURN 29
Moved by Cavanaugh, seconded by Reid, to adjourn the meeting at 8:30 p.m. 30
31
A roll call vote was performed: 32
33
Cavanaugh aye 34
Reid aye 35
Martin aye 36
DesLauriers aye 37
Albers aye 38
39
Motion passed unanimously. 40
41
42
__________________________________ 43
Kathy Martin, Mayor 44
Attest: 45
46
____________________________________ 47
Caitlyn Walker, City Clerk 48
Agreement No. A2311618
HENNEPIN COUNTY/CITY OF Medina
LEASE AGREEMENT
THIS AGREEMENT, made by and between the COUNTY OF HENNEPIN and the CITY OF Medina
both political subdivisions of the State of Minnesota, hereinafter referred to as the “County” and the
“City” respectively. For purposes of this Agreement, the address of the County is A2300 Government
Center, Minneapolis, Minnesota 55487 and the address of the City is 2052 County Road No 24, Medina
MN 55340.
PREAMBLE
WHEREAS, the Hennepin County Board of Commissioners in Resolution Number 99-6-426
authorized the purchase of ES&S election equipment for a countywide digital scan voting system,
election hardware and services; and
WHEREAS, the Hennepin County Board of Commissioners in Resolution Number 20-0039
authorized the purchase of Assistive Voting Devices (hereinafter “AVT Equipment”) using the County’s
Joint Powers Agreement with Minnesota Counties Computer Cooperative (MnCCC); MnCCC holds the
agreement with SeaChange (including Democracy Live).
WHEREAS, the Hennepin County Board of Commissioners in Resolution Number 16-0064
authorized the purchase of Poll Book Equipment (hereinafter “Poll Book Equipment”) for election
hardware and services; and
WHEREAS, the County pursuant to Minn. Stat. § 383B.145, Subd. 9 may transfer property to the
City for its use; and
WHEREAS, the County and the City are parties to an agreement for the lease of various election
equipment and the County and City desire to terminate that lease agreement and replace it with this
agreement A2311618.
WHEREAS, the County and the City are parties to an agreement for the lease of Poll Book
Equipment and the County and City desire to terminate that lease agreement and replace it with this
agreement A2311618.
WHEREAS, the County desires to lease various ES&S election equipment, AVT Equipment, and
Poll Book Equipment (collectively herein “Election Equipment”) to the City and City desires to lease said
Election Equipment from County for use in all elections conducted in Hennepin County.
NOW THEREFORE, in consideration of the mutual undertakings and agreements hereinafter set
forth, the County and the City agree as follows:
Section 1
Agenda Item #5A
TERMINATION AND REPLACEMENT OF EXISTING AGREEMENTS BETWEEN COUNTY AND CITY
All prior agreements between the County and City for the lease of various election equipment are
terminated and replaced by this Agreement A2311618.
All prior agreements between the County and City for the lease of poll book equipment are terminated
and replaced by this Agreement A2311618.
Section 2
SCOPE OF AGREEMENT
2.1 The County hereby leases to the City at the cost identified below and subject to the terms and
conditions of this Agreement, and the City hereby agrees to lease from the County Election
Equipment for use within the City identified as:
a. 4 DS200 Digital Scan Precinct Count Units
b. 4 DS200 Plastic Ballot Boxes
c. 0 DS950 Digital Scan Central Count Units
d. 3 OmniBallot Tablets (including 3-button device, headphones, navigation pad, OmniBallot
Tablet key, OmniBallot Tablet case, stylus, power cord, hard and soft printer cases, printer
power cable, printer USB cable, QR code scanner, USB hub key, 3-plug extension cord)
e. 3 OmniBallot Printers
f. 10 Poll Books (including stand arm, ID tray, styluses, white AC adapter, white cable, green
lightning USB cable, base, printer, printer power supply, printer power cord, poll book case)
g. 0 Meraki Access Points.
2.2 Subject to the terms and conditions of this Agreement, the parties may agree to increase or
decrease Election Equipment or add new equipment. Any agreed upon changes shall be
documented by County when County sends an annual equipment inventory statement to City.
2.3 Herein, Election Systems and Software (ES&S), SeaChange, and KNOWiNK may be referred to as
“vendor”.
Section 3
OWNERSHIP
3.1 The City acknowledges that the County owns or leases the Election Equipment and that the City
is authorized to use said Election Equipment for official election related purposes that the City is
otherwise duly authorized to perform under Minnesota Statutes. Use of the Election Equipment
for any other purpose is strictly prohibited absent express written consent of the County’s
Elections Director.
3.2 The City acknowledges and agrees that the Election Equipment may contain proprietary and
trade secret information that is owned by a third party, including Election Systems and Software
(ES&S), Democracy Live, and KNOWiNK, is protected under federal copyright law or other laws,
rules, regulations, and decisions. The City shall protect and maintain the proprietary and trade
secret status of the Election Equipment unless the City is required to disclose such information
under MN Statute, section 13.37 or any other applicable law or regulation.
Section 4
HANDLING OF EQUIPMENT AND INDEMNIFICATION
4.1 The City shall be responsible for the Election Equipment it leases from the County under this
Agreement, including Election Equipment the City subleases to a school district under Section
8.6 below. The City, either through insurance or a self-insurance program, shall be responsible
for all costs, fees, damages, and expenses including but not limited to personal injury, storage,
damage, repair, and/or replacement of the Election Equipment consistent with the City’s
defense and indemnity obligations contained in Section 8.7 herein.
4.2 The City shall be responsible for the transporting of the Election Equipment from and to the
County. Upon termination of this Agreement, the City shall forthwith deliver the Election
Equipment to the County or its designee, complete and in good order and working condition.
The City shall be responsible for all costs, including but not limited to shipping, related to the
repair or replacement of lost, stolen, destroyed, or damaged Election Equipment.
Section 5
TERM, TERMINATION
5.1 The City and the County agree that this Agreement is in effect during the period commencing
upon signature by the County and terminating February 28, 2031. The City and County agree
that this Agreement may terminate sooner if and when the City and County mutually agree that
the Election Equipment will no longer be used for the City’s elections. The City agrees that
should the County’s contract for the Election Equipment with ES&S and/or KNOWiNK and/or
SeaChange/MnCCC, respectively, terminate or expire, the Election Equipment and/or services
subject to that agreement may no longer be available to the City and City shall immediately
return the equipment to the County upon County’s request. A particular piece of Election
Equipment may be retired from use by the City upon mutual agreement between the City and
County and without this Agreement terminating. City represents and warrants that it will use
the Election Equipment for its intended purpose and in a manner consistent with prior practice
under the previous agreements referenced in Section 1 above until the Agreement terminates.
Section 6
MAINTENANCE AND PRICING
6.1 Maintenance (ES&S Election Equipment). The County has entered into an agreement with ES&S
for the purchase, warranty, and maintenance of the ES&S Election Equipment. ES&S shall
provide the same warranty and maintenance services to the City as it provides to the County.
The annual maintenance fee paid by the City to the County for said ES&S Election Equipment
shall be Two Hundred and Six dollars ($206.00) per digital scan precinct count unit and Five
Thousand Six Hundred and Twenty-Five dollars ($5,625.00) per digital scan central count unit. If
and when ES&S increases the fee to the County, the County may increase the fee to the City.
6.2 Maintenance (AVT Equipment). The County has entered into an agreement with
SeaChange/MnCCC for the purchase, warranty, and maintenance of the AVT Equipment.
SeaChange shall provide the same warranty and maintenance services to the City as it provides
to the County The annual maintenance fee paid by the City to the County for said AVT
Maintenance shall be an amount not to exceed Two Hundred and Twenty Five dollars ($225) per
unit. If and when SeaChange increases the fee to the County, the County may increase the fee to
the City.
6.3 Maintenance Agreement (Poll Book Equipment). The County has entered into an agreement
with KNOWiNK for the purchase/lease, warranty, and maintenance of the Poll Book Equipment.
KNOWiNK shall provide the same warranty and maintenance services to the City as it provides
to the County. There shall be no annual maintenance fee paid by the City to the County for said
Poll Book Equipment maintenance.
6.4 The City agrees not to make any repairs, changes, modifications, or alterations to the Election
Equipment that are not authorized by Hennepin County and said vendors.
6.5 After reasonable notice, the County shall have the right to enter the premises where the
Election Equipment is located for the purposes of inspecting the same or observing its use. On
an annual basis, during the term of this Agreement, the City shall comply with the County’s
request for verification of Election Equipment inventory.
6.6 The City agrees to provide notice to Election Systems & Software of any defects or malfunctions
with the Election Equipment, to provide notice to SeaChange of any defects or malfunctions
with the AVT Equipment, and to provide notice to KNOWiNK of any defects or malfunctions with
the Poll Book Equipment within twenty-four (24) hours. The City also agrees to provide the
County with notice of such malfunctions or defects and Election Systems & Software’s,
SeaChange’s, or KNOWiNK’s response within a reasonable time. The County agrees to track via a
log all such equipment malfunctions.
Section 7
PROGRAMMING AND ACCUMULATION
7.1 Programming (Election Equipment). The County will be responsible for programming the
Election Equipment at no charge to jurisdictions for all races in all elections. In the case of an
election that crosses county lines, the County will determine programming responsibilities with
the other involved counties.
7.2 For Cities with a primary and/or general election, as described in Minn. Stat. § 205.065 and
205.07, in the even-numbered years, the County will provide results transmission and
accumulation of results of City races in the primary and general election at no cost to the City.
Section 8
OTHER TERMS AND CONDITIONS
8.1 No Waiver. No delay or omission by either party hereto to exercise any right or power occurring
upon any noncompliance or default by the other party with respect to any of the terms of this
Agreement shall impair any such right or power or be construed to be a waiver thereof unless
the same is consented to in writing. A waiver by either of the parties hereto of any of the
covenants, conditions, or agreements to be observed by the other shall not be construed to be a
waiver of any succeeding breach thereof or any covenant, condition, or agreement herein
contained. All remedies provided for in this Agreement shall be cumulative and in addition to,
and not in lieu of, any other remedies available to either party at law, in equity, or otherwise.
8.2 Governing Law. This Agreement shall be governed by and construed in accordance with the laws
of the State of Minnesota.
8.3 Entire Agreement. It is understood and agreed that the entire Agreement between the parties is
contained herein and that this Agreement supersedes all oral agreements and negotiations
between the parties relating to the subject matter hereof. All items referred to in this
Agreement are incorporated or attached and are deemed to be part of this Agreement. Any
alterations, variations, modifications, or waivers of provisions of this Agreement shall only be
valid when they have been reduced to writing as an amendment to this Agreement signed by
the parties hereto.
8.4 No Assignment. Neither party shall assign, sublet, or transfer this Agreement, either in whole, or
in part, without prior written consent of the other party, and any attempt to do so shall be void
and of no force and effect.
8.5 No Warranty. The City agrees that the County is furnishing the Election Equipment on an “as is”
basis, without representation or any express or implied warranties, other than those provided
by ES&S, SeaChange, or KNOWiNK, including but not limited to, fitness for particular purpose,
merchantability or the accuracy and completeness of the Election Equipment.
The County does not warrant that the Election Equipment will be error free.
The County disclaims any other warranties, express or implied, respecting this Agreement or the
Election Equipment.
8.6 City may sublease Election Equipment to school districts within the County. Under any such
sublease, the City is fully responsible and liable for the school district complying with the terms
and conditions of this Agreement, and County shall have no liability whatsoever to the school
district.
8.7 In no event shall the County be liable for actual, direct, indirect, special, incidental,
consequential damages (even if the County has been advised of the possibility of such damage)
or loss of profit, loss of business or any other financial loss or any other damage arising out of
performance or failure of performance of this Agreement by the County. The County and the
City agree each will be responsible for their own acts and omissions under this Agreement and
the results thereof and shall to the extent authorized by law defend, indemnify, and hold
harmless the other party for such acts. Each party shall not be responsible for the acts, errors, or
omissions of the other party under the Agreement and the results thereof. The parties’
respective liabilities shall be governed by the provisions of the Municipal Tort Claims Act,
Minnesota Statutes Chapter 466, and other applicable law. This paragraph shall not be
construed to bar legal remedies one party may have for the other party’s failure to fulfill its
obligation under this Agreement. Nothing in this Agreement constitutes a waiver by the City or
County of any statutory or common law defenses, immunities, or limits on liability. The City’s
exclusive remedy and the County’s sole liability for any substantial defect which impairs the use
of the Election Equipment for the purposes stated herein shall be the remedy provided by the
vendor.
8.8 Notice. Any notice or demand shall be in writing and shall be sent registered or certified mail to
the other party addressed as follows:
To the City: City of Medina
2052 County Road No 24
Medina MN 55340
To the County: Hennepin County Administrator
Government Center MC 233
Minneapolis MN 55487
Copy to: Hennepin County Elections
Government Center MC 012
Minneapolis MN 55487
8.9 Audit Provision. Both parties agree that either party, the State Auditor, or any of their duly
authorized representatives at any time during normal business hours, and as often as they may
reasonably deem necessary, shall have access to and the right to examine, audit, excerpt, and
transcribe any books, documents, papers, records, etc., which are pertinent to the accounting
practices and procedures of the other party and involve transactions relating to this Agreement.
Such materials shall be maintained and such access and rights shall be in force and effect during
the period of the contract and for six (6) years after its termination or cancellation.
8.10 Whereas Clauses. The matters set forth in the “Whereas” clauses on page one of this Agreement
are incorporated into and made a part hereof by this reference.
8.11 Survival of Provisions. It is expressly understood and agreed that the obligations and warranties
of the City and County hereof shall survive the completion and performance and termination or
cancellation of this Agreement.
8.12 Authority. The person or persons executing this Lease Agreement on behalf of the City and
County represent that they are duly authorized to execute this Lease Agreement on behalf of
the City and the County and represent and warrant that this Lease Agreement is a legal, valid,
and binding obligation and is enforceable in accordance with its terms.
8.13 The parties shall comply with applicable law including but not limited to the provision of the
Minnesota Government Data Practices Act, Minnesota Statutes, Chapter 13 (MGDPA).
THE REMAINDER OF THIS PAGE IS BLANK.
COUNTY AND CITY APPROVAL
COUNTY OF HENNEPIN
Reviewed for COUNTY by the STATE OF MINNESOTA
County Attorney’s Office:
By:
By: Name: David Hough
Name: Jeffrey Wojciechowski Title: County Administrator
Date: Date:
CITY OF Medina
CITY warrants that the person who executed this
Agreement is authorized to do so on behalf of CITY.
By: ___________________________________________
Name: Kathleen Martin
Title: Mayor
Date: _________________________________________
By: ___________________________________________
Name: Scott Johnson
Title: City Administrator
Date: _________________________________________
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AMENDED AND RESTATED CITY OF MEDINA LICENSE
AGREEMENT FOR COLLECTION AND DISPOSAL OF
RESIDENTIAL SOLID WASTE, RECYCLABLES, AND COMPOSTABLES
1. License; Agreement. This amended and restated license agreement (the
"License Agreement") is entered into this ____ day of _____________, 2023, by the city of
Medina, a Minnesota municipal corporation (the "City"), and Randy's Sanitation, LLC, a
Minnesota limited liability company dba Randy's Environmental Services (the "Hauler"), pursuant
to Minnesota Statutes, section 115A.94. This License Agreement amends and supersedes all other
licenses and agreements between the City and the Hauler. The Hauler represents that it or its
subsidiaries are legally entitled to perform the duties of the Hauler described or intended by this
License Agreement and that in carrying out those duties it will not be in violation of any Hennepin
County, City, or State of Minnesota ordinance, rule, statute or regulation.
2. Purpose. The purpose of this License Agreement is to provide for the exclusive
residential collection and disposal of (i) mixed municipal solid waste, as defined in Minnesota
Statutes, section 115A.03, subd. 21, and Minnesota Rules 7035.0300, subp. 100, as further limited
by Sections 3 and 5 of this License Agreement ("Solid Waste"); (ii) source separated recyclable
materials, as defined in Minnesota Statutes, section 115A.03, subd. 25a and 32b, and Minnesota
Rules 7035.0300, subp. 87a, as further limited by Sections 3 and 6 of this License Agreement
("Recyclables"); and (iii) source separated compostable materials, as defined in Minnesota Statutes,
section 115A.03, subd. 32a, as further limited by Section 3 of this License Agreement
("Compostables") in the City, the boundaries of which are depicted on Exhibit A attached hereto,
in a timely, orderly and economical fashion that complies with the statutes and policies of
Minnesota, the directives of the Minnesota Pollution Control Agency, and the policies and
ordinances of Hennepin County. The statutes, ordinances, goals and policies include, but are not
limited to:
a. the abatement of the use of landfills for unprocessed waste;
b. reduction in the amount of waste generated;
c. separation and recovery of materials and energy from waste;
d. reduction in indiscriminate dependence on disposal of waste;
e. coordination of solid waste management among political subdivisions;
f. orderly and deliberate development and financial security of waste,
recyclable, and composting facilities;
g. compliance with Hennepin County ordinances related to solid waste management;
h. conformance to the Hennepin County Solid Waste Management Master
Plan, as it may be amended;
i. compliance with Minnesota Statutes, Chapter 115A; and
j. compliance with Minnesota Rules, Chapter 7035.
3. Scope of License Agreement.
Subd. 1. Residential Limitation. This License Agreement applies to residential
dwellings and complexes in the City with four residential units or fewer ("Residential" or
"Residences"). This License Agreement is not applicable to residential dwelling units and
complexes with more than four residential units or those that combine their Solid Waste in
a dumpster with commercial operations on the same premises. It is the responsibility
Agenda Item #5B
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of the City to maintain an accurate list of Residences, and it is the responsibility of the
Hauler to keep an accurate list of customers.
Subd. 2. Solid Waste. The Hauler will provide weekly Solid Waste collection
services for all Residences in the City on Wednesday of each week and dispose of the
Solid Waste in accordance with all applicable government regulations, goals, policies
and permits.
Subd. 3. Recyclables. The Hauler will provide bi-weekly, single-sort
Recyclables collection services for all Residences in the City on Wednesdays. The
Hauler will process the Recyclables at the Hauler's recycling facility in accordance
with all applicable government regulations, goals, policies and permits.
Subd. 4. Compostables. The Hauler will provide Compostables collection
services (aka Blue Bag Organics), as was provided by Hauler during the previous five-
year agreement, for all Residences in the City on Wednesday of each week. The Hauler
will process the Compostables in accordance with all applicable government
regulations, goals, policies and permits. The City, in its sole discretion, may opt to
change Compostable collection services to a subscription basis for its Residences at the
end of any calendar year by providing Hauler with at least 60 days’ written notice prior
to the end of such calendar year. Additionally, in the event that market conditions,
economic conditions or government regulations prevent Contractor from offering the
Compostable co-collection service as required above, Contractor reserves the right to
cease offering such co-collection of Compostables by providing no less than 120 days’
written notice of such decision to the City. Immediately following such written notice,
the Hauler agrees to negotiate, in good faith, a transition to a cart-based collection
program for Compostables. Should such negotiations fail, the City reserves the right
to terminate this License Agreement or otherwise seek alternative services for the
collection of Compostables from any third party of its choosing to any extent
authorized under law.
Subd. 5. Collection Services. Solid Waste, Recyclables, and Compostables
collection services are as described in this Section, hereinafter collectively and generally
referred to as "Collection" or "Collections", unless otherwise described or limited.
Subd. 6. Service Area. The municipal boundaries and service area are depicted
in Area 1, Area 2, and Area 3 on Exhibit A attached hereto and made a part hereof.
4. Rates. During the term of this License Agreement, the Hauler will charge
Collection rates according to the schedule attached as Exhibit B. Such rates are subject to a 4%
annual increase on the anniversary of this License Agreement. No additional rate increases may be
implemented without written approval of both parties.
5. Solid Waste. The Hauler will deliver all Solid Waste to Hennepin County's
resource recovery facility or transfer facility. The Hauler will deliver Solid Waste to a site other
than these county facilities only with the express written permission of the Hennepin County
administrator and the City. In no event will the Hauler manage the Solid Waste using a waste
management practice that is ranked lower on the list of preferred waste management practices, as
specified in Minnesota Statutes, section 115A.02(b), than the waste management practice
selected for Solid Waste by Hennepin County.
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Subd. 1. Items Refused for Pick-Up. The Hauler will provide the City with a
list of items or types of solid waste that will not be picked up, that require special
preparation before being collected (e.g., paint cans, tires, etc.), or any other limits on
collection. The list of items will not be changed without the approval of the City's
designated representative to this License Agreement.
Subd. 2. Notice of Non-Conforming Containers or Waste. The Hauler will
notice or tag and empty all nonconforming containers, bundles, or waste if reasonably
possible. The tag will explain the reason why the waste was not collected or why the
container is non-conforming.
6. Recyclables. The Hauler will collect the following Recyclables on a bi-weekly
basis:
a. Newspaper and inserts
b. Cardboard boxes
c. Glass food and beverage containers
d. Metal food and beverage cans
e. All plastic containers and lids, #1 - Polyethylene Terephthalate (PET, PETE), #2
High density Polyethylene (HDPE), #3 - Vinyl Polyvinyl Chloride (PVC), #4 -
Low Density Polyethylene (LDPE), #5 - Polypropylene (PP) plastic bottles, #6,
and #7, except those that previously contained hazardous materials or motor oil
f. Magazines and catalogs
g. Cereal, cracker, pasta, cake mix, shoe, gift, and electronics boxes
h. Boxes from toothpaste, medications and other toiletries
i. Aseptic and gable-topped containers
j. Mail, office and school papers
7. Collection Restrictions.
Subd. 1. Collection Day. The City may, by order of the City Council and in
consultation with the Hauler, annually establish a different Collection day upon sixty
(60) days' notice to the Hauler.
Subd. 2. Holidays. The Hauler will not engage in Collection Services on New
Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, or
Christmas Day. When a Collection date, as described in Section 3, falls on one of the
holidays listed herein, Collection will occur one (1) business day after the holiday. By
December 1 of the preceding year, the Hauler will annually provide the City's
designated representative with the specific dates of holidays affecting service for the
coming year.
Subd. 3. Hours of Collection. The Collection times will be between the hours
of 7:00 a.m. and 7:00 p.m. on the scheduled Collection day, unless otherwise
authorized by the City's designated representative.
Subd. 4. Collection. Routes. The Hauler will efficiently establish Collection
routes so as to prevent damage to City's streets, roads, culverts, drainage ways and other
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DOCSOPEN-ME230-1A-848673.v6-1/17/23
public facilities and to private driveways within the City and to minimize the cost of
Collection to City residents. Upon request by the City, the Hauler will provide to the
City's designated representative a map of the Collection routes followed by the Hauler
within the City.
8. Performance Standards. The Hauler will be responsible for program
management according to the following operating and personnel standards:
a. The Hauler's vehicles will be operated in accordance with all applicable laws,
ordinances, goals, and policies.
b. Collection services will be provided as described in this License Agreement
unless otherwise permitted by the City's designated representative.
c. The Hauler will employ only competent and trustworthy employees and
supervisors.
d. The Hauler's employees and supervisors will conduct themselves in a courteous,
honest, and professional manner. The Hauler will take immediate action to
correct the behavior of any employee or supervisor who is insolent, disorderly,
careless, unobservant, dishonest, or acting in any way that is detrimental to the
satisfactory progress of work under this License Agreement.
e. The Hauler's employees will be dressed in a manner that is professional and
as neat and clean as circumstances permit.
f. The Hauler will exercise reasonable care and diligence in handling waste
containers. Any waste spilled while emptying the containers will be
completely and immediately cleaned up by the Hauler.
g. Except as otherwise provided for in this License Agreement, the Hauler will
provide and maintain suitable Collection containers at its cost. The Hauler will
exercise due care in preventing damage to containers and will replace cans in an
upright position with the lids replaced or placed adjacent to the container, except
during windy conditions when the containers may be laid on their side to prevent
the containers from blowing away. The Hauler will be responsible for the
replacement of any containers damaged by its employees.
h. The Hauler will have at least one field supervisor dedicated to overseeing the
performance of the Hauler's employees in the City. The supervisor will
familiarize himself/herself with the City and the services required under these
specifications.
i. The Hauler will maintain an office and provide staff persons for the receipt of
service calls and complaints. This office will be open and available for calls, at a
minimum, Monday through Friday from 8 a.m. to 5 p.m. CST as well as any time
when the Hauler is performing services under this License Agreement. This office
will contain at least two local or toll-free telephone lines listed under the Hauler's
name in the City's local telephone directory. This office will have the ability to
communicate with personnel while they perform services under this License
Agreement.
j. Each complaint will be investigated by the Hauler and responded to within one
(1) business day unless mutually extended by the Hauler and the complaining
party. If the complaint concerns the failure of the Hauler to collect any of its
Collection Services as required by this License Agreement, the Hauler will make
the Collection by noon the following calendar day. There will be no exception
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DOCSOPEN-ME230-1A-848673.v6-1/17/23
to this requirement unless Collection has been altered due to a holiday listed in
Section 7(2) or unforeseen circumstances and authorized by the City's designated
representative.
k. The City has the right to inspect all books and records of the Hauler relating
to any aspect of Collection subject to this License Agreement.
l. The vehicles used for Collection should be completely enclosed, watertight body,
and will be properly designed so that the wheel and axle loads with a fully-loaded
body will not exceed the schedule of weights allowed by the laws of the State of
Minnesota, Hennepin County, and the City. If it is not possible to fully load the
body and stay within the limits of the law, the Hauler will be required to reduce the
loads in the body until it complies with the applicable law. During the period of
seasonal weight restrictions, the Hauler will strictly comply with the vehicular
weight limits posted on the streets highlighted on Exhibit C attached hereto and will,
with respect to all other streets within the City, make its best effort to reduce
vehicular load weights and the number of trips in order to minimize wear and tear
on all City streets.
m. The Hauler's vehicles and equipment will be painted uniformly and will be
maintained in proper working order, appearance, and sanitary condition at all
times. Each vehicle and piece of equipment will include the Hauler's name and
each vehicle will be assigned a number that is prominently painted on the vehicle.
n. Sufficient equipment and personnel will be furnished by the Hauler so that
Collections can be completed within one (1) calendar day.
9. Term of License. The term of this License Agreement is for the period
commencing on July 1, 2023 and ending on June 30, 2028. Prior to its expiration, the parties
may agree to extend this License Agreement for another five years. Any such extension must
be in writing.
10. Billing and Collecting. It is the responsibility of the Hauler to bill and collect
charges for Collections from the owner or occupant of each Residence in the City. The City
bears no responsibility in that contractual relationship.
11. Collection Reporting.
Subd. 1. Recyclables. The Hauler will provide monthly documentation and
reports for the total tons of Recyclables collected, the percentage of the total that each
material type represents, and the markets used for the sale of the recyclable materials.
These reporting requirements are required for the City's annual recycling report to
Hennepin County.
Subd. 2. Compostables. The Hauler will provide monthly documentation and
reports for the amount of Compostable material collected, recycled, and disposed. The
Hauler will also track and provide an annual report to the City by October 31st of each
year with the following:
a. Number of households requesting Compostables service, the
change in garbage cart size, and collection frequency
b. Number of participating households that cancel Compostables service
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c. Set out rates
d. Tons of Compostables diverted
e. Educational activities
f. Survey results of users and non-users
12. Collection Point. The Hauler agrees to Collections at the curb or at any other
location upon which the Hauler and the customer mutually agree. If the Hauler, in the
reasonable exercise of its judgment, determines that a driveway may sustain damage from the
passage of the Hauler's vehicles, the Hauler may require a release from liability from the owner
for such damage.
13. Insurance. The Hauler agrees to provide and maintain public liability
insurance, including general liability and automobile liability including loading and unloading
liability, with the following minimum coverages:
a. $5,000,000 when the claim is one for death by wrongful act or omission and
$5,000,000 to any claimant in any other case;
b. $5,000,000 for any number of claims arising out of a single occurrence; and
c. twice the limits provided in clauses a and b when the claim arises out of the
release or threatened release of a hazardous substance, whether the claim is
brought under Minnesota Statutes, sections 115B.01 to 115B.15, or under any
other law.
The insurance will be placed with insurers licensed to conduct business in the State of
Minnesota, and the City will be named as an additional insured via blanket-form endorsement.
The Hauler will provide a certificate of insurance to the City to demonstrate compliance with
the above requirements.
14. Indemnity. The Hauler agrees to take all precautions necessary to protect the
public against injury and will defend, indemnify, and hold the City harmless from any liability,
costs of defense, claims, damages, costs, judgments, or other expenses which may arise by
reason of any third-party claim for bodily or personal injury, property damage, disease, or death
resulting directly or indirectly from any negligent act or omission of the Hauler.
15. Damage to Property. Hauler will take all necessary precautions to protect
public and private property. Except for reasonable wear and tear, Hauler will repair or replace
any private or public property, including, but not limited to sod, mailboxes, or recycling bins,
which are damaged by Hauler’s negligence. Such property damage will be addressed for repair
or replacement, at no charge to the property owner, within forty-eight (48) hours with property
of the same or equivalent value at the time of the damage.
16. Performance Bond. The Hauler agrees to post and maintain a performance
bond in the amount of $50,000 to guarantee full compliance with the terms of this License
Agreement. The City may charge any cost related to the Hauler's failure to perform the services
required, against any monies due or to become due to the Hauler.
17. Accommodation of Disabled Persons. In accordance with the Americans with
Disabilities Act, the Hauler will provide a reasonable accommodation to disabled residents who
are unable to place their Solid Waste, Recyclables, and Compostables out for Collection. Disabled
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DOCSOPEN-ME230-1A-848673.v6-1/17/23
residents must request a reasonable accommodation. The City will not publicize this service but
will advise the Hauler of any requests for a reasonable accommodation submitted to the City. The
Hauler will determine the accommodation offered and the cost, if any, to the disabled resident
based on the nature of the disability and subject to the requirements of the Americans with
Disabilities Act. The City will be provided with a copy of the Hauler's written documentation on
any request for a reasonable accommodation.
18. Annual City Clean-Up. The Hauler agrees to provide up to six (6) thirty (30) yard
roll off dumpsters for the City's use during its annual City Clean-Up in each year of this License
Agreement. The dates of the annual City Clean-Up will be set by the City. There will be no charge
to the City except for disposal of the Solid Waste collected during the annual clean-up.
19. Public Education. The Hauler will coordinate with the City to promote
recycling, composting, and the proper disposal of Solid Waste to Residences at no charge.
Public education efforts may include brochures, signs, videos, and presentations to classes and
community groups.
20. City Facilities Collection. The Hauler agrees to provide, at its own expense,
containers for the weekly collection of Solid Waste and Compostables and bi-weekly collection of
Recyclables at the City facilities listed below. Hauler will provide containers for Collections at
each of the facilities listed below and said containers will be painted, or otherwise prepared, so that
the waste may be source separated. City reserves the right to add additional facilities, containers
sizes or service levels if needed.
a. Lakeshore Park
b. Maple Park
c. Morningside Park
d. Holy Name Park
e. Hunter Park
f. Hamel Legion Park
g. The Park at Fields of Medina
h. Hamel Community Building
i. City Hall
j. Public Works and Police Building
Two 95 -gallon carts
Two 95 -gallon carts
Two 95 -gallon carts
Two 95 -gallon carts
Two 95 -gallon carts
Five 95 -gallon carts
Two 95 -gallon carts
Two Commercial Dumpsters
Two Commercial Dumpsters
Two Commercial Dumpsters
Additionally, between April 1 and September 30 of each year, the Hauler agrees to
provide increased collection of Solid Waste at Hamel Legion Park based on demand
and direction from City staff. The Hauler will also provide document destruction
service at City Hall and the Public Works and Police Building at no charge to the City
throughout the entire term of this License Agreement.
21. Emergency or Disaster Services. The Hauler will provide, upon the
request of the City, any additional collections requested and reasonably necessary during a
declared emergency that endangers life or property in the City. The cost of this service will
be mutually negotiated between the Hauler and the City.
22. Review Process. Each year a representative from the Hauler and the
City will meet to review services and costs.
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DOCSOPEN-ME230-1A-848673.v6-1/17/23
23. Termination. In addition to any other right of termination provided
herein, this License Agreement may be terminated by the Medina City Council upon
30 days’ written notice and a hearing for failure of the Hauler to perform any material
condition hereof, provided that said failure to perform is not sufficiently cured, in the
City’s discretion, within 30 days following such written notice.
24. Exclusive License. This License Agreement grants the Hauler an exclusive
license to provide and offer the Collections in the City as described herein. In the event the
Hauler has reason to believe that other solid waste, recycling, or compostable collection
haulers are operating in a manner that is contrary to this License Agreement, the Hauler will
first notify the City and may take legal and appropriate steps to ensure its Collection as an
exclusive license holder under the terms of this License Agreement.
25. Definitions.
Applicable Law. Applicable Law means any applicable law (whether statutory or common), including statutes, ordinances, regulations, rules, governmental orders, governmental decrees, judicial judgments, constitutional provisions, and requirements of any kind and nature promulgated or issued by any governmental authority claiming or having jurisdiction.
Excluded Waste. Excluded Waste means: (1) Hazardous Waste; (2) radioactive, volatile, corrosive, highly flammable, explosive, biomedical, infectious, biohazardous, or toxic waste as defined by Applicable Law; or (3) any otherwise regulated waste. Hazardous Waste. Hazardous waste includes, but is not limited to, any amount of waste listed or characterized as hazardous by the United States Environmental Protection Agency or any state agency pursuant to RCRA, and including future amendments thereto, and any other Applicable Law. Recyclable Material. Recyclable Material consists of any material or substance at City’s locations that can be put to beneficial re-use or sold in recognized markets for purposes other than disposal, including, without limitation, uncontaminated non-hazardous corrugated cardboard, white paper, newsprint and other paper; plastics and plastic film; ferrous and non-ferrous metals; and glass. Solid Waste. Solid Waste is any nonhazardous solid waste generated at City’s locations that is not excluded by the provisions of this License Agreement. Solid Waste will not include any Excluded Waste. Waste Material. Waste Material is all Solid Waste and Recyclable Material that are not excluded by this License Agreement. Waste Material does not include any Excluded Waste. 26. Title and Right to Refuse or Reject Excluded Waste and Recycling Market Conditions. Title to Waste Material will pass to Hauler when loaded into Hauler’s collection vehicle or otherwise received by Hauler. Title to and liability for any Excluded Waste will at no time pass to Hauler.
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DOCSOPEN-ME230-1A-848673.v6-1/17/23
If Excluded Waste is discovered before it is collected by Hauler, Hauler may refuse to collect the entire waste container that contains the Excluded Waste. In the event Excluded Waste is present but not discovered until after it has been collected by Hauler, Hauler may, in its sole discretion, remove, transport, and dispose of such Excluded Waste at a facility authorized to accept such Excluded Waste in accordance with Applicable Law and charge the depositor or generator of such Excluded Waste for all direct and indirect costs incurred due to the removal, remediation, handling, transportation, delivery, and disposal of such Excluded Waste. The City will provide reasonable assistance to Hauler to conduct an investigation to determine the identity of the depositor or generator of the Excluded Waste, except to the extent that such Excluded Waste is determined to be generated by the City.
If market conditions develop that limit or inhibit Hauler from selling some or
all of the Recyclable Materials, Hauler may dispose of the Recyclable Materials in a
landfill if approved by the Minnesota Pollution Control Agency. Recycling means the
collection of Recyclable Materials pursuant to this License Agreement, including any
delivery of, Recyclable Materials called for by this License Agreement. Recyclable
Material means any items classified as recyclable materials under this License
Agreement. 27. Force Majeure. Any failure or delay in performance under this License Agreement due to contingencies beyond a party’s reasonable control, including, but not limited to, strikes, riots, pandemics, inclement weather, terrorist acts, compliance with Applicable Laws or governmental orders, fires, bad weather and acts of God, will not constitute a breach of this License Agreement. 28. Governing Law. This License Agreement will be construed in accordance with, and governed in all respects by, the laws of the State of Minnesota. Any dispute will be resolved exclusively in the state and federal courts located in Hennepin County, Minnesota.
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DOCSOPEN-ME230-1A-848673.v6-1/17/23
CITY OF MEDINA
By: ______________________________
Kathleen Martin
Its: Mayor
By: _______________________________
Scott T. Johnson
Its: City Administrator
RANDY'S SANITATION, LLC.
By: _________________________________
Its: _________________________________
By: _________________________________
Its: _________________________________
A-1
DOCSOPEN-ME230-1A-848673.v6-1/17/23
EXHIBIT A
MEDINA TRASH SERVICE AREAS
B-1
DOCSOPEN-ME230-1A-848673.v6-1/17/23
EXHIBIT B
COLLECTION RATES
Service Monthly Price
35G trash $11.92
65G trash $15.68
95G trash $18.17
Extra trash cart $6.10
Recycling EOW $5.40
Organics Co-Collection Program No charge
Yard Waste (Optional Service) $10.26
Optional Drive Up Service $10.60 per truck
Additional Trash Cart $6.05
All prices are subject to a 4% annual increase on the anniversary date of the License
Agreement during the term of the License Agreement.
C-1
DOCSOPEN-ME230-1A-848673.v6-1/17/23
EXHIBIT C
MAP OF STREETS WITH VEHICULAR WEIGHT LIMITS
AMENDED AND RESTATED CITY OF MEDINA LICENSE
AGREEMENT FOR COLLECTION AND DISPOSAL OF
RESIDENTIAL SOLID WASTE, RECYCLABLES, AND COMPOSTABLES
License; Agreement. This amended and restated license agreement (the1.
"License Agreement") is entered into this ____ day of _____________, 2023, by the city of
Medina, a Minnesota municipal corporation (the "City"), and Randy's Sanitation, LLC, a
Minnesota limited liability company dba Randy's Environmental Services (the "Hauler"),
pursuant to Minnesota Statutes, section 115A.94. This License Agreement amends and
supersedes all other licenses and agreements between the City and the Hauler. The Hauler
represents that it or its subsidiaries are legally entitled to perform the duties of the Hauler
described or intended by this License Agreement and that in carrying out those duties it will not
be in violation of any Hennepin County, City, or State of Minnesota ordinance, rule, statute or
regulation.
2.Purpose. The purpose of this License Agreement is to provide for the
exclusive residential collection and disposal of (i) mixed municipal solid waste, as defined in
Minnesota Statutes, section 115A.03, subd. 21, and Minnesota Rules 7035.0300, subp. 100, as
further limited by Sections 3 and 5 of this License Agreement ("Solid Waste"); (ii) source
separated recyclable materials, as defined in Minnesota Statutes, section 115A.03, subd. 25a and
32b, and Minnesota Rules 7035.0300, subp. 87a, as further limited by Sections 3 and 6 of this
License Agreement ("Recyclables"); and (iii) source separated compostable materials, as defined
in Minnesota Statutes, section 115A.03, subd. 32a, as further limited by Section 3 of this License
Agreement ("Compostables") in the City, the boundaries of which isare depicted on Exhibit A
attached hereto, in a timely, orderly and economical fashion that complies with the statutes and
policies of Minnesota, the directives of the Minnesota Pollution Control Agency, and the policies
and ordinances of Hennepin County. The statutes, ordinances, goals and policies include, but are
not limited to:
the abatement of the use of landfills for unprocessed waste;a.
reduction in the amount of waste generated;b.
separation and recovery of materials and energy from waste;c.
reduction in indiscriminate dependence on disposal of waste;d.
coordination of solid waste management among political subdivisions;e.
orderly and deliberate development and financial security off.
waste, recyclable, and composting facilities;
compliance with Hennepin County ordinances related to solid wasteg.
management;
conformance to the Hennepin County Solid Waste Management Masterh.
Plan, as it may be amended;
compliance with Minnesota Statutes, Chapter 115A; andi.
compliance with Minnesota Rules, Chapter 7035.j.
3.Scope of License Agreement.
Subd. 1.Residential Limitation. This License Agreement applies to residential
dwellings and complexes in the City with four residential units or fewer ("Residential" or
"Residences"). This License Agreement is not applicable to residential dwelling units
and complexes with more than four residential units or those that combine their Solid
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DOCSOPEN-ME230-1A-848673.v46-1/917/23
Waste in a dumpster with commercial operations on the same premises. It is the
responsibility of the City to maintain an accurate list of Residences, and it is the
responsibility of the Hauler to keep an accurate list of customers.
Subd. 2.Solid Waste. The Hauler will provide weekly Solid Waste
collection services for all Residences in the City on Wednesday of each week and
dispose of the Solid Waste in accordance with all applicable government regulations,
goals, policies and permits.
Subd. 3.Recyclables. The Hauler will provide bi-weekly, single-sort
Recyclables collection services for all Residences in the City on Wednesdays. The
Hauler will process the Recyclables at the Hauler's recycling facility in accordance
with all applicable government regulations, goals, policies and permits.
Subd. 4.Compostables. The Hauler will provide Compostables collection
services (aka Blue Bag Organics), as was provided by Hauler during the previous
five-year agreement, for all Residences in the City on Wednesday of each week. The
Hauler will process the Compostables in accordance with all applicable government
regulations, goals, policies and permits. The City, in its sole discretion, may opt to
change Compostable collection services to a subscription basis for its Residences at
the end of any calendar year by providing Hauler with at least 60 days’ written notice
prior to the end of such calendar year. Additionally, in the event that market
conditions, economic conditions or government regulations prevent Contractor from
offering the Compostable co-collection service as required above, Contractor
reserves the right to cease offering such co-collection of Compostables by providing
no less than 120 days’ written notice of such decision to the City. Immediately
following such written notice, the Hauler agrees to negotiate, in good faith, a
transition to a cart-based collection program for Compostables. Should such
negotiations fail, the City reserves the right to terminate this License Agreement or
otherwise seek alternative services for the collection of Compostables from any third
party of its choosing to any extent authorized under law.
Subd. 5.Collection Services. Solid Waste, Recyclables, and Compostables
collection services are as described in this Section, hereinafter collectively and generally
referred to as "Collection" or "Collections", unless otherwise described or limited.
Subd. 6. Service Area. The municipal boundaries and service area are depicted
in Area 1, Area 2, and Area 3 on Exhibit A attached hereto and made a part hereof.
Rates. During the term of this License Agreement, the Hauler will charge4.
Collection rates according to the schedule attached as Exhibit B. Such rates are subject to a 4%
annual increase on the anniversary of this License Agreement. No additional rate increases may be
implemented without written approval of both parties.
Solid Waste. The Hauler will deliver all Solid Waste to Hennepin County's5.
resource recovery facility or transfer facility. The Hauler will deliver Solid Waste to a site other
than these county facilities only with the express written permission of the Hennepin County
administrator and the City. In no event will the Hauler manage the Solid Waste using a waste
management practice that is ranked lower on the list of preferred waste management practices, as
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DOCSOPEN-ME230-1A-848673.v46-1/917/23
specified in Minnesota Statutes, section 115A.02(b), than the waste management practice
selected for Solid Waste by Hennepin County.
Subd. 1.Items Refused for Pick-Up. The Hauler will provide the City with a
list of items or types of solid waste that will not be picked up, that require special
preparation before being collected (e.g., paint cans, tires, etc.), or any other limits on
collection. The list of items will not be changed without the approval of the City's
designated representative to this License Agreement.
Subd. 2.Notice of Non-Conforming Containers or Waste. The Hauler will
notice or tag and empty all nonconforming containers, bundles, or waste if
reasonably possible. The tag will explain the reason why the waste was not collected
or why the container is non-conforming.
Recyclables. The Hauler will collect the following Recyclables on a6.
bi-weekly basis:
Newspaper and insertsa.
Cardboard boxesb.
Glass food and beverage containersc.
Metal food and beverage cansd.
All plastic containers and lids, #1 - Polyethylene Terephthalate (PET, PETE), #2e.
High density Polyethylene (HDPE), #3 - Vinyl Polyvinyl Chloride (PVC), #4 -
Low Density Polyethylene (LDPE), #5 - Polypropylene (PP) plastic bottles, #6,
and #7, except those that previously contained hazardous materials or motor oil
Magazines and catalogsf.
Cereal, cracker, pasta, cake mix, shoe, gift, and electronics boxesg.
Boxes from toothpaste, medications and other toiletriesh.
Aseptic and gable-topped containersi.
Mail, office and school papersj.
7.Collection Restrictions.
Subd. 1.Collection Day. The City may, by order of the City Council and in
consultation with the Hauler, annually establish a different Collection day upon sixty
(60) days' notice to the Hauler.
Subd. 2.Holidays. The Hauler will not engage in Collection Services on
New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day,
or Christmas Day. When a Collection date, as described in Section 3, falls on one of
the holidays listed herein, Collection will occur one (1) business day after the
holiday. By December 1 of the preceding year, the Hauler will annually provide the
City's designated representative with the specific dates of holidays affecting service
for the coming year.
Subd. 3.Hours of Collection. The Collection times will be between the
hours of 7:00 a.m. and 7:00 p.m. on the scheduled Collection day, unless otherwise
authorized by the City's designated representative.
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DOCSOPEN-ME230-1A-848673.v46-1/917/23
Subd. 4.Collection. Routes. The Hauler will efficiently establish Collection
routes so as to prevent damage to City's streets, roads, culverts, drainage ways and other
public facilities and to private driveways within the City and to minimize the cost of
Collection to City residents. Upon request by the City, the Hauler will provide to the
City's designated representative a map of the Collection routes followed by the Hauler
within the City.
8.Performance Standards. The Hauler will be responsible for program
management according to the following operating and personnel standards:
The Hauler's vehicles will be operated in accordance with all applicablea.
laws, ordinances, goals, and policies.
Collection services will be provided as described in this License Agreementb.
unless otherwise permitted by the City's designated representative.
The Hauler will employ only competent and trustworthy employees andc.
supervisors.
The Hauler's employees and supervisors will conduct themselves in a courteous,d.
honest, and professional manner. The Hauler will take immediate action to
correct the behavior of any employee or supervisor who is insolent, disorderly,
careless, unobservant, dishonest, or acting in any way that is detrimental to the
satisfactory progress of work under this License Agreement.
The Hauler's employees will be dressed in a manner that is professional ande.
as neat and clean as circumstances permit.
The Hauler will exercise reasonable care and diligence in handling wastef.
containers. Any waste spilled while emptying the containers will be
completely and immediately cleaned up by the Hauler.
Except as otherwise provided for in this License Agreement, the Hauler willg.
provide and maintain suitable Collection containers at its cost. The Hauler will
exercise due care in preventing damage to containers and will replace cans in an
upright position with the lids replaced or placed adjacent to the container, except
during windy conditions when the containers may be laid on their side to prevent
the containers from blowing away. The Hauler will be responsible for the
replacement of any containers damaged by its employees.
The Hauler will have at least one field supervisor dedicated to overseeingh.
the performance of the Hauler's employees in the City. The supervisor will
familiarize himself/herself with the City and the services required under
these specifications.
The Hauler will maintain an office and provide staff persons for the receipt ofi.
service calls and complaints. This office will be open and available for calls, at a
minimum, Monday through Friday from 8 a.m. to 5 p.m. CST as well as any
time when the Hauler is performing services under this License Agreement.
This office will contain at least two local or toll-free telephone lines listed under
the Hauler's name in the City's local telephone directory. This office will have
the ability to communicate with personnel while they perform services under this
License Agreement.
Each complaint will be investigated by the Hauler and responded to within onej.
(1) business day unless mutually extended by the Hauler and the complaining
4
DOCSOPEN-ME230-1A-848673.v46-1/917/23
party. If the complaint concerns the failure of the Hauler to collect any of its
Collection Services as required by this License Agreement, the Hauler will
make the Collection by noon the following calendar day. There will be no
exception to this requirement unless Collection has been altered due to a
holiday listed in Section 7(2) or unforeseen circumstances and authorized by
the City's designated representative.
The City has the right to inspect all books and records of the Hauler relatingk.
to any aspect of Collection subject to this License Agreement.
The vehicles used for Collection should be completely enclosed, watertight body,l.
and will be properly designed so that the wheel and axle loads with a fully-loaded
body will not exceed the schedule of weights allowed by the laws of the State of
Minnesota, Hennepin County, and the City. If it is not possible to fully load the
body and stay within the limits of the law, the Hauler will be required to reduce the
loads in the body until it complies with the applicable law. During the period of
seasonal weight restrictions, the Hauler will strictly comply with the vehicular
weight limits posted on the streets highlighted on Exhibit C attached hereto and
will, with respect to all other streets within the City, make its best effort to reduce
vehicular load weights and the number of trips in order to minimize wear and tear
on all City streets.
The Hauler's vehicles and equipment will be painted uniformly and will bem.
maintained in proper working order, appearance, and sanitary condition at all
times. Each vehicle and piece of equipment will include the Hauler's name and
each vehicle will be assigned a number that is prominently painted on the
vehicle.
Sufficient equipment and personnel will be furnished by the Hauler so thatn.
Collections can be completed within one (1) calendar day.
9.Term of License. The term of this License Agreement is for the period
commencing on July 1, 2023 and ending on June 30, 2028. Prior to its expiration, the
parties may agree to extend this License Agreement for another five years. Any such
extension must be in writing.
Billing and Collecting. It is the responsibility of the Hauler to bill and10.
collect charges for Collections from the owner or occupant of each Residence in the City.
The City bears no responsibility in that contractual relationship.
Collection Reporting.11.
Subd. 1.Recyclables. The Hauler will provide monthly documentation and
reports for the total tons of Recyclables collected, the percentage of the total that each
material type represents, and the markets used for the sale of the recyclable materials.
These reporting requirements are required for the City's annual recycling report to
Hennepin County.
Subd. 2.Compostables. The Hauler will provide monthly documentation
and reports for the amount of Compostable material collected, recycled, and
disposed. The Hauler will also track and provide an annual report to the City by
October 31st of each year with the following:
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DOCSOPEN-ME230-1A-848673.v46-1/917/23
Number of households requesting Compostables service, thea.
change in garbage cart size, and collection frequency
Number of participating households that cancel Compostables serviceb.
Set out ratesc.
Tons of Compostables divertedd.
Educational activitiese.
Survey results of users and non-usersf.
12.Collection Point. The Hauler agrees to Collections at the curb or at any other
location upon which the Hauler and the customer mutually agree. If the Hauler, in the
reasonable exercise of its judgment, determines that a driveway may sustain damage from the
passage of the Hauler's vehicles, the Hauler may require a release from liability from the
owner for such damage.
13.Insurance. The Hauler agrees to provide and maintain public liability
insurance, including general liability and automobile liability including loading and
unloading liability, with the following minimum coverages:
$500,0005,000,000 when the claim is one for death by wrongful act ora.
omission and $500,0005,000,000 to any claimant in any other case;
$1,500,0005,000,000 for any number of claims arising out of a single occurrence;b.
and
twice the limits provided in clauses a and b when the claim arises out of thec.
release or threatened release of a hazardous substance, whether the claim is
brought under Minnesota Statutes, sections 115B.01 to 115B.15, or under any
other law.
The insurance will be placed with insurers licensed to conduct business in the State of
Minnesota, and the City will be named as an additional insured via blanket-form
endorsement. The Hauler will provide a certificate of insurance to the City to demonstrate
compliance with the above requirements.
14.Indemnity. The Hauler agrees to take all precautions necessary to protect the
public against injury and will defend, indemnify, and hold the City harmless from any
liability, costs of defense, claims, damages, costs, judgments, or other expenses which may
arise by reason of any third-party claim for bodily or personal injury, property damage,
disease, or death resulting directly or indirectly from any negligent act or omission of the
Hauler.
15.Damage to Property. Hauler will take all necessary precautions to protect
public and private property. Except for reasonable wear and tear, Hauler will repair or
replace any private or public property, including, but not limited to sod, mailboxes, or
recycling bins, which are damaged by Hauler’s negligence. Such property damage will be
addressed for repair or replacement, at no charge to the property owner, within forty-eight
(48) hours with property of the same or equivalent value at the time of the damage.
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16.Performance Bond. The Hauler agrees to post and maintain a performance
bond in the amount of $50,000 to guarantee full compliance with the terms of this License
Agreement. The City may charge any cost related to the Hauler's failure to perform the
services required, against any monies due or to become due to the Hauler.
17.Accommodation of Disabled Persons. In accordance with the Americans
with Disabilities Act, the Hauler will provide a reasonable accommodation to disabled residents
who are unable to place their Solid Waste, Recyclables, and Compostables out for Collection.
Disabled residents must request a reasonable accommodation. The City will not publicize this
service but will advise the Hauler of any requests for a reasonable accommodation submitted to
the City. The Hauler will determine the accommodation offered and the cost, if any, to the
disabled resident based on the nature of the disability and subject to the requirements of the
Americans with Disabilities Act. The City will be provided with a copy of the Hauler's written
documentation on any request for a reasonable accommodation.
Annual City Clean-Up. The Hauler agrees to provide up to six (6) thirty (30) yard18.
roll off dumpsters for the City's use during its annual City Clean-Up in each year of this License
Agreement. The dates of the annual City Clean-Up will be set by the City. There will be no
charge to the City except for disposal of the Solid Waste collected during the annual clean-up.
Public Education. The Hauler will coordinate with the City to promote19.
recycling, composting, and the proper disposal of Solid Waste to Residences at no charge.
Public education efforts may include brochures, signs, videos, and presentations to classes
and community groups.
City Facilities Collection. The Hauler agrees to provide, at its own expense,20.
containers for the weekly collection of Solid Waste and Compostables and bi-weekly collection of
Recyclables at the City facilities listed below. Hauler will provide containers for Collections at
each of the facilities listed below and said containers will be painted, or otherwise prepared, so
that the waste may be source separated. City reserves the right to add additional facilities,
containers sizes or service levels if needed.
Lakeshore Parka.
Maple Parkb.
Morningside Parkc.
Holy Name Parkd.
Hunter Parke.
Hamel Legion Parkf.
The Park at Fields of Medinag.
Hamel Community Buildingh.
City Halli.
j. Public Works and Police Building
Two 95-gallon carts
Two 95-gallon carts
Two 95-gallon carts
Two 95-gallon carts
Two 95-gallon carts
Five 95-gallon carts
Two 95-gallon carts
Two Commercial Dumpsters
Two Commercial Dumpsters
Two Commercial Dumpsters
Additionally, between April 1 and September 30 of each year, the Hauler agrees to
provide, at its own expense, daily (non-holiday weekdays only) increased collection
of Solid Waste, Compostables and Recyclables at Hamel Legion Park based on
demand and direction from City staff. The Hauler will also provide document
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DOCSOPEN-ME230-1A-848673.v46-1/917/23
destruction service at City Hall and the Public Works and Police Building at no
charge to the City throughout the entire term of this License Agreement.
Emergency or Disaster Services. The Hauler will provide, upon the21.
request of the City, any additional collections requested and reasonably necessary during a
declared emergency that endangers life or property in the City. The cost of this service
will be mutually negotiated between the Hauler and the City.
Review Process. Each year a representative from the Hauler and the22.
City will meet to review services and costs.
Termination. In addition to any other right of termination provided23.
herein, this License Agreement may be terminated by the Medina City Council upon
30 days’ written notice and a hearing for failure of the Hauler to perform any material
condition hereof, provided that said failure to perform is not sufficiently cured, in the
City’s discretion, within 30 days following such written notice.
Exclusive License. This License Agreement grants the Hauler an exclusive24.
license to provide and offer the Collections in the City as described herein. In the event the
Hauler has reason to believe that other solid waste, recycling, or compostable collection
haulers are operating in a manner that is contrary to this License Agreement, the Hauler will
first notify the City and may take legal and appropriate steps to ensure its Collection as an
exclusive license holder under the terms of this License Agreement.
Definitions.25.
Applicable Law. Applicable Law means any applicable law (whether statutory or
common), including statutes, ordinances, regulations, rules, governmental orders,
governmental decrees, judicial judgments, constitutional provisions, and
requirements of any kind and nature promulgated or issued by any governmental
authority claiming or having jurisdiction.
Excluded Waste. Excluded Waste means: (1) Hazardous Waste; (2) radioactive,
volatile, corrosive, highly flammable, explosive, biomedical, infectious,
biohazardous, or toxic waste as defined by Applicable Law; or (3) any otherwise
regulated waste.
Hazardous Waste. Hazardous waste includes, but is not limited to, any amount of
waste listed or characterized as hazardous by the United States Environmental
Protection Agency or any state agency pursuant to RCRA, and including future
amendments thereto, and any other Applicable Law.
Recyclable Material. Recyclable Material consists of any material or substance at
City’s locations that can be put to beneficial re-use or sold in recognized markets for
purposes other than disposal, including, without limitation, uncontaminated
non-hazardous corrugated cardboard, white paper, newsprint and other paper;
plastics and plastic film; ferrous and non-ferrous metals; and glass.
8
DOCSOPEN-ME230-1A-848673.v46-1/917/23
Solid Waste. Solid Waste is any nonhazardous solid waste generated at City’s
locations that is not excluded by the provisions of this License Agreement. Solid
Waste will not include any Excluded Waste.
Waste Material. Waste Material is all Solid Waste and Recyclable Material that are
not excluded by this License Agreement. Waste Material does not include any
Excluded Waste.
Title and Right to Refuse or Reject Excluded Waste and Recycling Market26.
Conditions.Title to Waste Material will pass to Hauler when loaded into Hauler’s
collection vehicle or otherwise received by Hauler. Title to and liability for any
Excluded Waste will at no time pass to Hauler.
If Excluded Waste is discovered before it is collected by Hauler, Hauler may
refuse to collect the entire waste container that contains the Excluded Waste. In the
event Excluded Waste is present but not discovered until after it has been collected
by Hauler, Hauler may, in its sole discretion, remove, transport, and dispose of such
Excluded Waste at a facility authorized to accept such Excluded Waste in accordance
with Applicable Law and charge the depositor or generator of such Excluded Waste
for all direct and indirect costs incurred due to the removal, remediation, handling,
transportation, delivery, and disposal of such Excluded Waste. The City will provide
reasonable assistance to Hauler to conduct an investigation to determine the identity
of the depositor or generator of the Excluded Waste, except to the extent that such
Excluded Waste is determined to be generated by the City.
If market conditions develop that limit or inhibit Hauler from selling some or
all of the Recyclable Materials, Hauler may dispose of the Recyclable Materials in a
landfill if approved by the Minnesota Pollution Control Agency. Recycling means
the collection of Recyclable Materials pursuant to this License Agreement, including
any delivery of, Recyclable Materials called for by this License Agreement.
Recyclable Material means any items classified as recyclable materials under this
License Agreement.
Force Majeure. Any failure or delay in performance under this License27.
Agreement due to contingencies beyond a party’s reasonable control, including, but
not limited to, strikes, riots, pandemics, inclement weather, terrorist acts, compliance
with Applicable Laws or governmental orders, fires, bad weather and acts of God,
will not constitute a breach of this License Agreement.
Governing Law.This License Agreement will be construed in28.
accordance with, and governed in all respects by, the laws of the State of Minnesota.
Any dispute will be resolved exclusively in the state and federal courts located in
Hennepin County, Minnesota.
9
DOCSOPEN-ME230-1A-848673.v46-1/917/23
CITY OF MEDINA
By:______________________________
Kathleen Martin
Its:Mayor
By:_______________________________
Scott T. Johnson
Its:City Administrator
RANDY'S SANITATION, LLC.
By:_________________________________
Its:_________________________________
By:_________________________________
Its:_________________________________
10
DOCSOPEN-ME230-1A-848673.v46-1/917/23
EXHIBIT A
MEDINA TRASH SERVICE AREAS
A- 1
DOCSOPEN-ME230-1A-848673.v46-1/917/23
EXHIBIT B
COLLECTION RATES
Service Monthly Price
35G trash $11.92
65G trash $15.68
95G trash $18.17
Extra trash cart $6.10
Recycling EOW $5.40
Organics Co-Collection Program No charge
Yard Waste (Optional Service)$10.26
Optional Drive Up Service $10.60 per truck
Additional Trash Cart $6.05
All prices are subject to a 4% annual increase on the anniversary date of the License
Agreement during the term of the License Agreement.
B- 1
DOCSOPEN-ME230-1A-848673.v46-1/917/23
EXHIBIT C
MAP OF STREETS WITH VEHICULAR WEIGHT LIMITS
C- 1
DOCSOPEN-ME230-1A-848673.v46-1/917/23
C- 2
DOCSOPEN-ME230-1A-848673.v46-1/917/23
Document comparison by W orkshare 10.0 on Friday, January 20, 2023 2:00:23 PM
Input:
Document 1 ID PowerDocs://DOCSOPEN/848673/4
Description DOCSOPEN-#848673-v4-Updated_License_Agreement_(
Randy's)
Document 2 ID PowerDocs://DOCSOPEN/848673/6
Description DOCSOPEN-#848673-v6-Updated_License_Agreement_(
Randy's)
Rendering set Standard
Legend:
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Resolution No. 2023-##
February 7, 2023
Member _________ introduced the following resolution and moved its adoption:
CITY OF MEDINA
RESOLUTION NO. 2023-##
A RESOLUTION SUPPORTING CORRIDORS OF COMMERCE
FUNDING REQUEST TO RESURFACE HIGHWAY 55 FROM CR 118 TO
CR 19, WITH TWO-LANE TO FOUR-LANE EXPANSION
WHEREAS, the Minnesota Legislature has approved $200 million or more in
Trunk Highway bond funds for the 2022-2023 Corridors of Commerce program
(COC); and
WHEREAS, resurfacing Trunk Highway (TH) 55 from County Road (CR)
118 TO CR 19, with two-lane to four-lane expansion is eligible for funding in the fiscal
year 2022 COC program; and
WHEREAS, the Highway 55 Corridor Coalition, in partnership with coalition
membership, is requesting $43 million in funding for reconstruction of TH 55 from a
two-lane undivided to a four-lane divided roadway and access consolidation in
Hennepin County from Arrowhead Drive in the City of Medina to CR 19 north of
Loretto; and
WHEREAS, TH 55 provides for safe and efficient movement of goods,
services, and people between Hennepin and Wright counties as well as communities
and industries across northwestern Minnesota.; and
WHEREAS, the City of Medina confirms its support for the Highway 55
Corridor Coalition’s request for $43 million in 2022 Corridors of Commerce program
funding to resurface TH 55 from CR 118 to CR 19 with expansion from a two to a
four-lane highway; and
THEREFORE, BE IT RESOLVED, that the City of Medina does hereby
support a Highway 55 Corridor Coalition funding request through the Minnesota
Department of Transportation’s 2022-2023 Corridors of Commerce program for
construction, right-of-way, and engineering services necessary to resurface TH 55
from CR 118 to CR 19 with two-lane to four-lane expansion.
Agenda Item #5C
Resolution No. 2023-## 2
February 7, 2023
Dated: February 7, 2023.
By: ______________________
Kathleen Martin, Mayor
Attest:
By: ___________________________
Caitlyn Walker, City Clerk
The motion for the adoption of the foregoing resolution was duly seconded by member ________
and upon vote being taken thereon, the following voted in favor thereof:
And the following voted against same:
Whereupon said resolution was declared duly passed and adopted.
MEMORANDUM
TO: Mayor and City Council
FROM: Jim Stremel, City Engineer
DATE: February 2, 2023
MEETING: February 7, 2023
SUBJECT: Willow Drive/TH 55 Regional Lift Station Project – Approve Plans and
Specifications and Authorize Advertisement for Bids
Background:
The Willow Drive/TH 55 Regional Lift Station Project will serve properties to the east & west of
Willow Drive that are not serviceable with gravity sewer, including the proposed Adams Pest
Control development and future Cates Industrial Park projects. The City Council authorized a
feasibility study for the lift station in September 2019 and final design of the lift station in July
2022, spurred on by this proposed development in the area.
With the more recent approval of the Cates Industrial Park comprehensive plan amendment, the
Adams Pest Control project proceeding, and the lengthy timeframe for material procurement to
construct the lift station, the City recently approved a quote to procure the lift station electrical
panel and other long-lead materials ahead of time. The Adams Pest Control project is driving the
need for the lift station and this site will need sewer service prior to the end of 2023.
Final plans and specifications have been prepared for the lift station improvements that include a
forcemain along Willow Drive connecting into the existing manhole at Chippewa Road.
Enclosed is an abridged set of the construction plans showing the proposed improvements. A
complete set of construction plans are available for review at city hall.
The total estimated project cost is $1,029,000 which includes a 10% contingency factor and 25%
indirect costs for legal, engineering, administrative, and financing. The City is intending to fund
the project through the Sewer Capital Fund.
Next Steps:
The next step is for City Council to approve final plans/specifications and authorize
advertisements for bidding of the project. The proposed bid date is Thursday March 2, 2023 at
2:00 PM. With that schedule in mind, it is anticipated that bids will be presented at the City
Council meeting on March 21st for consideration of award.
City Council Action Requested:
Adopt the resolution approving plans/specifications and authorizing the advertisement for bids.
Agenda Item #5D
Resolution No. ________
February 7, 2023
Member ___________ introduced the following resolution and moved its adoption:
CITY OF MEDINA
RESOLUTION NO. _______
RESOLUTION APPROVING PLANS AND SPECIFICATIONS FOR
THE WILLOW DRIVE REGIONAL LIFT STATION PROJECT
AND ORDERING THE ADVERTISEMENT FOR BIDS
WHEREAS, on July 7, 2022, the city council passed a motion to order the Willow Drive
Regional Lift Station Project (the “Project”) authorizing WSB and Associates, Inc., the city
engineer, to prepare plans and specifications for such Project; and
WHEREAS, the city engineer has prepared plans and specifications for the Project, the
installation of a new lift station system along Willow Drive, sanitary sewer piping, and related
improvements; and
WHEREAS, on February 7, 2023, the plans and specifications were presented to the city
council for approval;
NOW, THEREFORE, BE IT RESOLVED, by the city council of the city of Medina, as
follows:
1. The plans and specifications for the Willow Drive Regional Lift Station Project
dated February 7, 2023 are hereby approved.
2. The city engineer is directed to insert in the official paper an advertisement for bids
upon the making of such improvement under such approved plans and specifications. The
advertisements shall be published for 14 days, shall specify the work to be done, shall state that
the bids will be received electronically until 2:00 p.m. on Thursday, March 2, 2023, at which time
they will be publicly opened electronically in the council chambers of the city hall by the
administrator and engineer, will then be tabulated, and will be considered by the council at 7:00
p.m. on March 21, 2023, in the council chambers of the city hall. Any bidder whose responsibility
is questioned during the consideration of the bid will be given an opportunity to address the council
on the issue of responsibility. No bids will be considered unless sealed and filed as set forth in the
instructions to bidders in compliance with the requirements of electronic bidding and bid security.
Adopted by the Council on February 7, 2023.
By: _______________________
Kathleen Martin, Mayor
Attest:
Resolution No. ________
February 7, 2023
2
By: ___________________________
Caitlyn Walker, City Clerk
The motion for the adoption of the foregoing resolution was duly seconded by member
___________ and upon vote being taken thereon, the following voted in favor thereof:
And the following voted against same:
Whereupon said resolution was declared duly passed and adopted.
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WILLOW DRIVE LIFT STATION
CITY OF MEDINA
SANITARY SEWER LIFT STATION AND FORCEMAINCONSTRUCTION PLAN FOR
LOCATED ON WILLOW DRIVE FROM CHIPPEWA ROAD TO 590' NORTH OF CATES RANCH DRIVE
PROJECT LOCATION MAP
F
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EXISTING PLAN SYMBOLS
PROPERTY LINES/RIGHT-OF-WAY
UTILITY EASEMENT
TREE LINE
SIGN
DECIDUOUS TREE
SHRUB
CONIFEROUS TREE
EXISTING UTILITY SYMBOLS
FIBER OPTIC LINE
GAS LINE
COMMUNICATIONS PEDESTAL
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CCOMMUNICATION LINE
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||WATER MAIN
>
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SANITARY SEWER
STORM SEWER
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HYDRANT
SANITARY SEWER MANHOLE
STORM SEWER MANHOLE
THE SUBSURFACE UTILITY INFORMATION IN THIS PLAN IS UTILITY QUALITY LEVEL D. THIS UTILITY QUALITY LEVEL WAS DETERMINED ACCORDING TO THE
GUIDELINES OF CI/ASCE 38-02, ENTITLED "STANDARD GUIDELINES FOR THE COLLECTION AND DEPICTION OF EXISTING SUBSURFACE UTILITY DATA."
GOPHER ONE CALL TICKET NUMBER: XXXXXXXX
UTILITY COORDINATION MEETING HELD ON: XXXXXXXXXXXX
APPROVED BYSHEET NO.DATE
PLAN REVISIONS
ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS AND ORDINANCES WILL BE
COMPLIED WITH IN THE CONSTRUCTION OF THIS PROJECT.
THIS PLAN SET CONTAINS 22 SHEETS
I HEREBY CERTIFY THAT THIS PLAN WAS PREPARED BY ME OR UNDER
MY DIRECT SUPERVISION, AND THAT I AM A DULY LICENSED PROFESSIONAL
ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA.
LICENSE NUMBER:DATE:02/07/2023 45782
JAMES L. STREMEL, P.E.
SHEET
22
OF
WSB PROJ. NO. 014877-000
PROJECT LOCATION
1
THIS PLAN SET HAS BEEN PREPARED FOR:
CITY OF MEDINA
2052 COUNTY RD 24
MEDINA, MN 55340
(763) 473-4643
PLAN SET INDEX
UTILITY INFORMATION
E
ST
S
N
SCALE IN FEET
0
H:
500 1000COUNTY:HENNEPIN
SECT 4, TWP 118, RNG 23W
PROJECT LOCATION
A CALL TO GOPHER STATE ONE (651-454-0002)
IS REQUIRED A MINIMUM OF 48 HOURS PRIOR
TO PERFORMING ANY EXCAVATION.
EXCAVATION NOTICE SYSTEM
HORIZONTAL DATUM:
VERTICAL DATUM:
HENNEPIN COUNTY COORDINATES, US FOOT
NAVD88
PORTIONS OF:
GOVERNING SPECIFICATIONS
THE 2020 EDITION OF THE MINNESOTA DEPARTMENT OF TRANSPORTATION "STANDARD
SPECIFICATIONS FOR CONSTRUCTION" SHALL GOVERN.
ALL TRAFFIC CONTROL DEVICES SHALL CONFORM TO THE LATEST EDITION OF THE
MINNESOTA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES, INCLUDING THE
LATEST FIELD MANUAL FOR TEMPORARY TRAFFIC CONTROL ZONE LAYOUTS.
SANITARY SEWER SHALL BE CONSTRUCTED IN ACCORDANCE WITH THE 2018 CITY
ENGINEER'S ASSOCIATION OF MINNESOTA STANDARD UTILITIES SPECIFICATION.
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PID: 0411823120004
ST LOUIS PARK
INVESTMENT CO.
PID: 0411823120007
4635 WILLOW DR
ST LOUIS PARK
INVESTMENT CO.
PID: 0411823120006
2590 CATES RANCH DR
JEFFREY CATES
PID: 0411823110002
2590 CATES RANCH DR
JEFFREY CATES
PID: 0411823110002
4385 WILLOW DR
GPI WG ACQUISITION SUB, LLC.
PID: 0411823130008
2575 CATES RANCH DR
JEFFREY CATES
PID: 0411823140004
JEFFREY CATES
PID: 0411823140005
4385 WILLOW DR
GPI WG ACQUISITION SUB, LLC.
PID: 0411823130008
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DESCRIPTIONSHEET NO.
SITE PLAN
GRADING PLAN
SANITARY SEWER FORCEMAIN PLAN
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X
X
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7 11
LIFT STATION
6 13
9 -12
10 -13
8 -12
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APPROXIMATE LOCATIONS
OF RECEIVING PITS
CATES RANCH DRIVE
APPROXIMATE LOCATION OF
RECEIVING PIT
APPROXIMATE LOCATION OF
RECEIVING PIT NOTE:
1. CONTRACTOR TO COORDINATE FINAL
LOCATION OF RECEIVING PITS IN FIELD.
APPROXIMATE LOCATION OF
RECEIVING PIT
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THE PLAT OF CATES RANCH
DRAINAGE & UTILITY EASEMENT
PER PLAT OF CATES RANCH
15'10'20'
R15'
R15'
15'
K:
\
0
1
4
8
7
7
-
0
0
0
\
C
a
d
\
P
l
a
n
\
0
1
4
8
7
7
-
0
0
0
-
C
-
S
I
T
E
-
P
L
A
N
.
d
w
g
1/2
4
/
2
0
2
3
5
:
1
9
:
4
9
P
M
6
AS SHOWN JLS
JLSMPM
SCALE:
PLAN BY:
DESIGN BY:
CHECK BY:
SHEET
OF
WSB PROJECT NO.
I H
E
R
E
B
Y
C
E
R
T
I
F
Y
T
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A
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T
H
I
S
P
L
A
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,
S
P
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C
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F
I
C
A
T
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O
N
,
OR
R
E
P
O
R
T
W
A
S
P
R
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P
A
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D
B
Y
M
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O
R
U
N
D
E
R
M
Y
DI
R
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C
T
S
U
P
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R
V
I
S
I
O
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A
N
D
T
H
A
T
I
A
M
A
D
U
L
Y
LI
C
E
N
S
E
D
P
R
O
F
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S
S
I
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N
A
L
E
N
G
I
N
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R
U
N
D
E
R
T
H
E
LA
W
S
O
F
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T
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O
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M
I
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E
S
O
T
A
.
LIC
.
N
O
:
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T
E
:
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V
I
S
I
O
N
S
NO
.
DA
T
E
DE
S
C
R
I
P
T
I
O
N
W
I
L
L
O
W
D
R
I
V
E
L
I
F
T
S
T
A
T
I
O
N
CI
T
Y
O
F
M
E
D
I
N
A
014877-000
JA
M
E
S
L
.
S
T
R
E
M
E
L
, P
.
E
.
45
7
8
2
02
/
0
7
/
2
0
2
3
22
SITE PLAN
N
SCALE IN FEET
0
H:
10 20
LOCATION
CATES RANCH DR
W
I
L
L
O
W
D
R
I
V
E
HIG
H
W
A
Y
5
5
CHIP
P
E
W
A
RD
CITY OF CORCORAN
CITY OF MEDINA
N
LEGEND
EXISTING STORM STRUCTUREST
EXISTING STORM SEWER PIPE>>
PROPOSED BITUMINOUS PAVEMENT
PROPOSED CONCRETE PAVEMENT
EXISTING WATERMAIN||
EXISTING HYDRANT W/ VALVE
PROPOSED SANITARY SEWER MAIN>
PROPOSED SANITARY STRUCTURES
APPROX. CONSTRUCTION LIMITS
PROPOSED TEMPORARY EASEMENT
PROPOSED PERMANENT EASEMENT
TE
PE
EXISTING WETLAND BOUNDARYWET
PROPOSED TURF SHOULDER
EDGE OF WETLAND
25'
WETLAND
BUFFER
25'
WETLAND
BUFFER
EDGE OF WETLAND
PROPOSED CONSTRUCTION
LIMIT
SEE LIFT STATION PLANS
SHEETS 14-17.
PROPOSED TEMPORARY
EASEMENT
PROPOSED PERMANENT
EASEMENT
WESTERLY DEVELOPMENT WILL BE
STUBBING FUTURE 8" SANITARY
SEWER TO THIS LOCATION. SEE
SANITARY SEWER PLANS, SHEET 11.
EX. 24" FES
INV: 974.34 (W)
EX. 24" FES
INV: 974.62 (E)
6" 8 BOX
6" 8 BOX
7" 9 9 BOX
10" ELM
C
18"
6"
OE
OE
OE
OE
OE
OE
OE
OE
OE
OE
OE
OE
OE
OE
CO
N
T
R
O
L
P
A
N
E
L
GE
N
E
R
A
T
O
R
(B
I
D
A
L
T
E
R
N
A
T
E
)
PE PE PE PE PE PE PE PE PE
PE
PE
PE
PE
PE
PE
PE
PE
PEPEPEPEPEPEPEPEPE
TE TE TE TE TE TE TE TE TE TE TE TE
TE
TE
TE
TE
TE
TE
TE
TE
TE
TE
TE
TE
TE
TE
TETETETETETETETETETETETE
21
3
+
0
0
21
4
+
0
0
S
S
S
S
>>>
>>
FMFMFMFM
FM
FM
FM
FM
FM
FM
FM
FM
>>>>>>>>
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SMH-4
6000
WET WELL
VALVE VAULT
EX 24" RCP
EX 6" DIP
EX
8
"
D
I
P
973
97
3
97
4
97
5
97
6
97
7
97
8
97
9
98
1
98
0
97
9
97
8
97
7
976
98
0
ST
L
O
U
I
S
P
A
R
K
IN
V
E
S
T
M
E
N
T
C
O
.
PI
D
:
0
4
1
1
8
2
3
1
2
0
0
0
7
46
3
5
W
I
L
L
O
W
D
R
ST
L
O
U
I
S
P
A
R
K
IN
V
E
S
T
M
E
N
T
C
O
.
PI
D
:
0
4
1
1
8
2
3
1
2
0
0
0
6
25
9
0
C
A
T
E
S
R
A
N
C
H
D
R
JE
F
F
R
E
Y
C
A
T
E
S
PI
D
:
0
4
1
1
8
2
3
1
1
0
0
0
2
979.27
979.56
979.93
980.29
979.85 979.26
979.17
978.93978.96
39+80 40+00
41+00 41+30
WET
WET
WETWETWETWET
WET
WET
WET
WET
WET
WET WET
WET
WET
WET
WET
WET
WET
WET
WET
WET
WET
WET
W
E
T
W
E
T
W
E
T
W
E
T
WETWETWETWET
FUT 8" PVC
8" PVC SDR 26
6" SAN FORCEMAIN
(FUSABLE) PVC C900
979.47
979.17
979.13
976
975
978
977
976
975
979.47 979.27
>
>
>
>
>
>
EX
.
E
D
G
E
O
F
B
I
T
U
M
I
N
O
U
S
EX
.
E
D
G
E
O
F
G
R
A
V
E
L
S
H
L
D
R
EX
.
E
D
G
E
O
F
B
I
T
U
M
I
N
O
U
S
EX
.
E
D
G
E
O
F
G
R
A
V
E
L
S
H
L
D
R
EX
.
E
D
G
E
O
F
B
I
T
U
M
I
N
O
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S
EX
.
E
D
G
E
O
F
G
R
A
V
E
L
S
H
L
D
R
EX
.
E
D
G
E
O
F
B
I
T
U
M
I
N
O
U
S
EX
.
E
D
G
E
O
F
G
R
A
V
E
L
S
H
L
D
R
66'
ROW
8" PVC S
A
N
(BY OTH
E
R
S
)
>
>
>
>
8" PVC S
D
R
3
5
TELEPHONE CABLE
EASEMENT
PER DOC. NO. 2929202
AND AS SHOWN ON
THE PLAT OF CATES RANCH
DRAINAGE & UTILITY EASEMENT
PER PLAT OF CATES RANCH
1.00%
4.00%
4.
0
0
%
1.00%
2.00%
2.00%
979
1.
9
4
%
4.
0
0
%
2.
0
0
%
979
974 973
973
974
977
97897
9
2.62%
975
980
985
990
975
980
985
990
98
0
.
5
40+00
97
9
.
7
5
97
8
.
0
40+25
97
9
.
1
1
97
4
.
1
40+50
97
9
.
2
8
97
3
.
2
40+75
97
3
.
0
41+00
97
3
.
1
41+25
2.00%-2.62%-1.00%
PV
I
S
:
4
0
+
1
1
.
8
9
PV
I
E
:
9
8
0
.
1
0
PV
I
S
:
4
0
+
7
5
.
1
0
PV
I
E
:
9
7
9
.
2
8
PV
I
S
:
4
0
+
9
5
.
1
0
PV
I
E
:
9
7
9
.
0
8
LP: 40+58.23
EL: 979.03
PVIS: 40+56.89
PVIE: 978.92
AD: 4.62%
K: 4.33
20.00' VC
BV
C
S
:
4
0
+
4
6
.
8
9
BV
C
E
:
9
7
9
.
1
8
EV
C
S
:
4
0
+
6
6
.
8
9
EV
C
E
:
9
7
9
.
1
2
EXISTING GROUND @ CL
LIFT STATION DRIVEWAY
PROPOSED GRADE OF LIFT STATION
& PAD @ CL OF DRIVEWAY
K:
\
0
1
4
8
7
7
-
0
0
0
\
C
a
d
\
P
l
a
n
\
0
1
4
8
7
7
-
0
0
0
-
C
-
G
R
A
D
-
P
L
A
N
.
d
w
g
1/
2
4
/
2
0
2
3
5
:
2
0
:
0
7
P
M
7
AS SHOWN JLS
JLSMPM
SCALE:
PLAN BY:
DESIGN BY:
CHECK BY:
SHEET
OF
WSB PROJECT NO.
I H
E
R
E
B
Y
C
E
R
T
I
F
Y
T
H
A
T
T
H
I
S
P
L
A
N
,
S
P
E
C
I
F
I
C
A
T
I
O
N
,
OR
R
E
P
O
R
T
W
A
S
P
R
E
P
A
R
E
D
B
Y
M
E
O
R
U
N
D
E
R
M
Y
DI
R
E
C
T
S
U
P
E
R
V
I
S
I
O
N
A
N
D
T
H
A
T
I
A
M
A
D
U
L
Y
LI
C
E
N
S
E
D
P
R
O
F
E
S
S
I
O
N
A
L
E
N
G
I
N
E
E
R
U
N
D
E
R
T
H
E
LA
W
S
O
F
T
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S
T
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N
E
S
O
T
A
.
LIC
.
N
O
:
DA
T
E
:
RE
V
I
S
I
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N
S
NO
.
DA
T
E
DE
S
C
R
I
P
T
I
O
N
W
I
L
L
O
W
D
R
I
V
E
L
I
F
T
S
T
A
T
I
O
N
CI
T
Y
O
F
M
E
D
I
N
A
014877-000
JA
M
E
S
L
.
S
T
R
E
M
E
L
, P
.
E
.
45
7
8
2
02
/
0
7
/
2
0
2
3
22
GRADING PLAN
N
SCALE IN FEET
0
H:
10 20
LOCATION
CATES RANCH DR
W
I
L
L
O
W
D
R
I
V
E
HIG
H
W
A
Y
5
5
CHIP
P
E
W
A
RD
CITY OF CORCORAN
CITY OF MEDINA
N
PROPOSED CONSTRUCTION
LIMITS
LEGEND
APPROX. CONSTRUCTION LIMITS
EXISTING CONTOUR (MAJOR)1019
EXISTING CONTOUR (MINOR)1019
965.77
965.77
PROPOSED SPOT ELEVATION
EXISTING SPOT ELEVATION
EXISTING EASEMENT
PROPOSED CONTOUR (MAJOR)1019
PROPOSED CONTOUR (MINOR)1019
EXISTING STORM STRUCTURE
PROPOSED DRAINAGE STRUCTURE
ST
EXISTING STORM SEWER PIPE
PROPOSED STORM SEWER PIPE>>
>>
EXISTING SANITARY SEWER MAIN>
PROPOSED SANITARY SEWER MAIN>
EXISTING SANITARY STRUCTURE
PROPOSED SANITARY STRUCTURE
S
S
PROPOSED TEMPORARY EASEMENT
PROPOSED PERMANENT EASEMENT
TE
PE
EXISTING WETLAND BOUNDARYWET
PROPOSED 4:1
SLOPE MAX
LIFT STATION DRIVEWAY
PROFILE
25'
WETLAND
BUFFER
25'
WETLAND
BUFFER
EX. 24" FES
INV: 974.34 (W)
EX. 24" FES
INV: 974.62 (E)
EDGE OF WETLAND
EDGE OF WETLAND
LIFT STATION
DRIVEWAY CL
(SEE PROFILE BELOW)
980
985
990
995
1000
1005
1010
1015
1020
980
985
990
995
1000
1005
1010
1015
1020
10+50
99
7
.
8
11+00
99
9
.
4
11+50
99
7
.
8
12+00
99
8
.
4
12+50
99
9
.
1
13+00
99
9
.
4
13+50
10
0
1
.
2
14+00
10
0
2
.
4
14+50
EXMH-273
INV: 981.51 (SW)
INV: 987.17 (N)
INV: 981.51 (S)
EXISTING GROUND @ CL
SAN FORCEMAIN
2' MIN
SEPARATION
CONNECT TO EXISTING
SANITARY STRUCTURE (CORE DRILL)
WITH 8" DROP CONNECTION AND 6"X8" REDUCER.
INV: 987.17
EX 8" PVC
@ 0.49%
EX 12" DIP
INV: 990.29
365' - 6" SAN FORCEMAIN
(FUSABLE) PVC C900
@ 0.36%
OEOEOE
X
24" 16 WILLOW
28" 20 WILLOW
16" WILLOW
14" WILLOW
9" 9 WILLOW
15" WILLOW
10" WILLOW
12" WILLOW
7" WILLOW
12" WILLOW
11" WILLOW
11" WILLOW
10" WILLOW
11" WILLOW
6" WILLOW
12" WILLOW
10" WILLOW10" WILLOW
10" WILLOW
7" WILLOW
10" WILLOW
10" WILLOW
10" WILLOW
10" WILLOW
10" WILLOW12" WILLOW
8" WILLOW
11" WILLOW
9" WILLOW
12" WILLOW
7" WILLOW
10" WILLOW
9" WILLOW
9" WILLOW
12" WILLOW
8" WILLOW11" WILLOW
8" 10 WILLOW8" WILLOW
10" WILLOW
8" 8 WILLOW9" WILLOW6" WILLOW
9" WILLOW9" WILLOW
10" WILLOW
10" WILLOW
10" WILLOW
10" WILLOW
7" WILLOW
10" WILLOW
8" WILLOW
10" WILLOW
11" WILLOW
11" WILLOW10" WILLOW
9" WILLOW7" WILLOW10" WILLOW
9" WILLOW10" WILLOW
7" 9 WILLOW8" WILLOW
11" WILLOW9" WILLOW
8" WILLOW
12" WILLOW
9" 9 WILLOW
10" WILLOW10" WILLOW9" WILLOW
8" WILLOW7" 7 WILLOW9" WILLOW
8" WILLOW6" WILLOW6" WILLOW
8" WILLOW9" WILLOW7" WILLOW8" WILLOW
11" WILLOW6" WILLOW11" WILLOW
9" WILLOW7" 8 WILLOW
9" WILLOW9" WILLOW6" WILLOW
8" WILLOW7" WILLOW8" 10 WILLOW8" WILLOW10" WILLOW
9" WILLOW9" WILLOW9" WILLOW8" WILLOW
10" WILLOW8" WILLOW7" WILLOW6" 7 WILLOW8" 8 WILLOW
8" WILLOW8" WILLOW10" WILLOW8" WILLOW11" WILLOW
6" 8 WILLOW9" 11 WILLOW6" WILLOW8" WILLOW9" 10 WILLOW7" WILLOW
9" WILLOW11" WILLOW
10" WILLOW9" 10 WILLOW
E
C
E
E
C
E
E
E
E
E
C
C C C C C C C
C
C C
C C C C
CC
C
C C C
C C C
HH
C
C C C C C
C
C C
C C C C
C
CF
C
C C
C
C C
E E E E E
E
G G G G G G G G G G
G
G G G
F
F F
F
F F F
F
F
F
F
18"6"6"
12"
12"
12"
12"
12"12"
12"12"
12"12"
12"
12"
12"
12"
8"
HH
OE
OE
OE
OE
OE
OEOEOEOEOEOEOEOEOEOEC
C
W
E
T
W
E
T
W
E
T
WET
S
>
>>>>>
FMFMFMFMFMFMFMFMFMFMFMFMFM
FM
FM
FM
>>
|||||||||||||||||||||
11
+
0
0
12+00 13+00 14+00
EX 12" DIP
EX 12" CMP
EXMH-273
EX 12" DIP EX 12" DIP
EX. EDGE OF BITUMINOUS
EX. EDGE OF GRAVEL SHLDR
EX. EDG
E
O
F
B
I
T
U
M
I
N
O
U
S
EX. EDG
E
O
F
B
I
T
U
M
I
N
O
U
S
EX. EDGE OF BITUMINOUS
EX. TREELINE
EX. TREELINE
EXISTING DRAINAGE &
UTILITY EASEMENT
4385 WILLOW DR
GPI WG ACQUISITION SUB, LLC.
PID: 0411823130008
2575 CATES RANCH DR
JEFFREY CATES
PID: 0411823140004
EX
8
"
P
V
C
EX 8" PVC
6" SAN FORCEMAIN
6"
S
A
N
F
O
R
C
E
M
A
I
N
K:
\
0
1
4
8
7
7
-
0
0
0
\
C
a
d
\
P
l
a
n
\
0
1
4
8
7
7
-
0
0
0
-
C
-
S
S
W
R
_
F
M
-
P
L
A
N
.
d
w
g
1/
2
4
/
2
0
2
3
5
:
2
0
:
3
2
P
M
SANITARY SEWER
FORCEMAIN PLAN
8
AS SHOWN JLS
JLSMPM
LOCATION
WILLOW DRIVE
SCALE:
PLAN BY:
DESIGN BY:
CHECK BY:
SHEET
OF
WSB PROJECT NO.
I H
E
R
E
B
Y
C
E
R
T
I
F
Y
T
H
A
T
T
H
I
S
P
L
A
N
,
S
P
E
C
I
F
I
C
A
T
I
O
N
,
OR
R
E
P
O
R
T
W
A
S
P
R
E
P
A
R
E
D
B
Y
M
E
O
R
U
N
D
E
R
M
Y
DI
R
E
C
T
S
U
P
E
R
V
I
S
I
O
N
A
N
D
T
H
A
T
I
A
M
A
D
U
L
Y
LI
C
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N
S
E
D
P
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S
S
I
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N
A
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N
G
I
N
E
E
R
U
N
D
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R
T
H
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LA
W
S
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.
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:
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I
N
A
014877-000
JA
M
E
S
L
.
S
T
R
E
M
E
L
, P
.
E
.
45
7
8
2
02
/
0
7
/
2
0
2
3
22
SE
E
S
H
E
E
T
-
M
A
T
C
H
L
I
N
E
S
T
A
-
14
+
5
0
9
CATES RANCH DR
W
I
L
L
O
W
D
R
I
V
E
HIG
H
W
A
Y
5
5
CHIP
P
E
W
A
RD
CITY OF CORCORAN
CITY OF MEDINA
N
CH
I
P
P
E
W
A
RO
A
D
CONNECT 6" SAN FORCEMAIN
TO EX. SSMH STRUCTURE.
LEGEND
EXISTING STORM STRUCTUREST
EXISTING STORM SEWER PIPE>>
PROPOSED DRAINAGE STRUCTURE
PROPOSED STORM SEWER PIPE>>
EXISTING WATERMAIN||
EXISTING HYDRANT W/ VALVE
PROPOSED SANITARY SEWER MAIN>
PROPOSED SANITARY STRUCTURES
APPROX. CONSTRUCTION LIMITS
NOTE:
ALL STATIONING ON THIS PLAN BASED ON
CENTERLINE OF SANITARY SEWER FORCEMAIN.
REMOVE TREE
REMOVE GRAVEL SHOULDER
N SCALE IN FEET
0
H:
20 40
SCALE IN FEET
0
V:
5 10
EDGE OF WETLAND
25'
WETLAND
BUFFER
2'
APPROXIMATE LOCATION OF
RECEIVING PIT. CONTRACTOR TO
COORDINATE FINAL LOCATION
IN FIELD.
APPROXIMATE LOCATION OF
RECEIVING PIT. CONTRACTOR TO
COORDINATE FINAL LOCATION
IN FIELD.
10'
45° BEND
60° BEND
X
8" 10 WILLOW8" WILLOW10" WILLOW
9" WILLOW9" WILLOW9" WILLOW8" WILLOW
10" WILLOW8" WILLOW7" WILLOW6" 7 WILLOW8" 8 WILLOW
8" WILLOW8" WILLOW10" WILLOW8" WILLOW11" WILLOW
6" 8 WILLOW9" 11 WILLOW6" WILLOW8" WILLOW9" 10 WILLOW7" WILLOW
9" WILLOW11" WILLOW
10" WILLOW9" 10 WILLOW
19" WILLOW14" WILLOW
6" WILLOW11" WILLOW10" WILLOW9" WILLOW9" WILLOW9" WILLOW
16" WILLOW
31" WILLOW
9" WILLOW8" WILLOW
11" WILLOW9" WILLOW
32" OAK
8" WILLOW9" WILLOW14" WILLOW9" WILLOW9" WILLOW
11" WILLOW
16" 23 OAK
6" ELM
6" ELM
13"
6" ELM
8" ELM8" ELM7" ELM
9" OAK
BOX" 9
12" ELM
6" 8 ELM
7" OAK
6" OAK
26" OAK
8" 9 BASS
8" ASH
6" BOX11" BASS
10" BOX
6" BOX
14" 26
8" OAK
16" COT
10" HICK
8" 10 BOX
14" BOX
12" BOX
18" BOX
15" BASS14" BASS
9" BASS 9" BOX
13" ASH
C C C
CCCCCCCCCCCCCC
C C C C C C C
C C
C C C C
C
C C C C C
E
E
C C
G G
G G G G G G G G G
G G G G G
C
C
C C C C C C C
C C
C C C C
C
C
C C C
MB
MB
18"18"
18"
18"
18"
18"
18"12"
12"
18"
OEOEOEOEOEOEOEOEOEOEOEOEOE
OE
OE
OE
OE
OE
OEOE
FMFMFMFMFMFMFMFMFMFMFMFMFMFMFMFMFMFMFMFM
>>
||||
|
|
||||||||||||||||
|
15+00 16+00 17+00 18+00
EX 12" DIP EX 8" DIP
EX
6
"
D
I
P
EX 8" DIP
EX 18" CMP
EX. EDGE OF BITUMINOUS
EX. EDGE OF BITUMINOUS
EX. TREELINE
EX. TREELINE
EX. TREELINE
EX. TREELINE
EX. TREELINE
EXISTING DRAINAGE &
UTILITY EASEMENT
4385 WILLOW DR
GPI WG ACQUISITION SUB, LLC.
PID: 0411823130008
2575 CATES RANCH DR
JEFFREY CATES
PID: 0411823140004
6" SAN FORCEMAIN
980
985
990
995
1000
1005
1010
1015
1020
980
985
990
995
1000
1005
1010
1015
1020
10
0
2
.
4
14+50
10
0
3
.
0
15+00
10
0
3
.
9
15+50
10
0
3
.
4
16+00
10
0
1
.
8
16+50
99
9
.
2
17+00
99
5
.
9
17+50
99
3
.
2
18+00
99
1
.
7
18+50
EXISTING GROUND @ CL
SAN FORCEMAIN
273' - 6" SAN FORCEMAIN
(FUSABLE) PVC C900
@ -0.36%127' - 6" SAN FORCEMAIN
(FUSABLE) PVC C900
@ -2.19%
K:
\
0
1
4
8
7
7
-
0
0
0
\
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a
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3
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0
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0
P
M
SANITARY SEWER
FORCEMAIN PLAN
9
AS SHOWN JLS
JLSMPM
N SCALE IN FEET
0
H:
20 40
SCALE IN FEET
0
V:
5 10
LOCATION
WILLOW DRIVE
SCALE:
PLAN BY:
DESIGN BY:
CHECK BY:
SHEET
OF
WSB PROJECT NO.
I H
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014877-000
JA
M
E
S
L
.
S
T
R
E
M
E
L
, P
.
E
.
45
7
8
2
02
/
0
7
/
2
0
2
3
22
SE
E
S
H
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T
-
M
A
T
C
H
L
I
N
E
S
T
A
-
14
+
5
0
8
SE
E
S
H
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T
-
M
A
T
C
H
L
I
N
E
S
T
A
-
18
+
5
0
10
CATES RANCH DR
W
I
L
L
O
W
D
R
I
V
E
HIG
H
W
A
Y
5
5
CHIP
P
E
W
A
RD
CITY OF CORCORAN
CITY OF MEDINA
N
LEGEND
EXISTING STORM STRUCTUREST
EXISTING STORM SEWER PIPE>>
PROPOSED DRAINAGE STRUCTURE
PROPOSED STORM SEWER PIPE>>
EXISTING WATERMAIN||
EXISTING HYDRANT W/ VALVE
PROPOSED SANITARY SEWER MAIN>
PROPOSED SANITARY STRUCTURES
APPROX. CONSTRUCTION LIMITS
NOTE:
ALL STATIONING ON THIS PLAN BASED ON
CENTERLINE OF SANITARY SEWER FORCEMAIN.
REMOVE TREE
REMOVE GRAVEL SHOULDER
2'
APPROXIMATE LOCATION OF
RECEIVING PIT. CONTRACTOR TO
COORDINATE FINAL LOCATION
IN FIELD.
X X X X
X
X
10" HICK
8" 10 BOX
14" BOX
12" BOX
18" BOX
15" BASS14" BASS
9" BASS 9" BOX
13" ASH
13" ELM
16" ELM
18" ELM
18" ELM 10" ASH
EEEEEE
E
E E
C
C
C C C C
E
E
G G G G G G G
GC
C
C
C
C C
C C C C C
C
C
C
C
C
C
C C C C
C C C
C
C C
C C
MB MBMB
OEOEOEOEOEOEOEOEOEOEOEOEOEOE
FMFMFMFMFMFMFMFMFMFM
>>
|||||||||||||
|||||||
|
||
19+00 20+00 21+00 22+00
EX 18" CMP
EX 8" DIP
EX 8" DIP
EX. EDGE OF BITUMINOUS
EX. EDGE OF BITUMINOUS
EX. TREELINE
EX. TOP OF BERM
DIRECTIONALLY DRILLED
OPEN CUT
TELEPHONE CABLE
EASEMENT
PER DOC. NO. 2929202
AND AS SHOWN ON
THE PLAT OF CATES RANCH
ROAD EASEMENT
PER DOC. NO. A10254796
DRAINAGE & UTILITY EASEMENT
PER PLAT OF CATES RANCH
DRAINAGE & UTILITY EASEMENT
PER PLAT OF CATES RANCH
2590 CATES RANCH DR
JEFFREY CATES
PID: 0411823110002
4635 WILLOW DR
ST LOUIS PARK INVESTMENT CO.
PID: 0411823120006
FMFMFMFMFMFMFMFMFM6" SAN FORCEMAIN
965
970
975
980
985
990
995
1000
1005
965
970
975
980
985
990
995
1000
1005
99
1
.
7
18+50
99
0
.
9
19+00
98
9
.
4
19+50
98
7
.
7
20+00
98
6
.
0
20+50
98
4
.
6
21+00
98
2
.
8
21+50
98
1
.
2
22+00
98
0
.
3
22+50
EXISTING GROUND @ CL
SAN FORCEMAIN
8' MIN
DEPTH
DIRECTIONALLY DRILLED
OPEN CUT
150' - 6" SAN FORCEMAIN
(FUSABLE) PVC C900
@ -2.19%
193' - 6" SAN FORCEMAIN
(FUSABLE) PVC C900
@ -3.20%
57' - 6" SAN FORCEMAIN
(FUSABLE) PVC C900
@ -2.15%
K:
\
0
1
4
8
7
7
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0
0
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2
3
5
:
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0
:
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5
P
M
SANITARY SEWER
FORCEMAIN PLAN
10
AS SHOWN JLS
JLSMPM
N SCALE IN FEET
0
H:
20 40
SCALE IN FEET
0
V:
5 10
LOCATION
WILLOW DRIVE
SCALE:
PLAN BY:
DESIGN BY:
CHECK BY:
SHEET
OF
WSB PROJECT NO.
I H
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R
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B
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JA
M
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S
L
.
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L
, P
.
E
.
45
7
8
2
02
/
0
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/
2
0
2
3
22
SE
E
S
H
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T
-
M
A
T
C
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18
+
5
0
9
SE
E
S
H
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T
-
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A
T
C
H
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I
N
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S
T
A
-
22
+
5
0
11
CATES RANCH DR
W
I
L
L
O
W
D
R
I
V
E
HIG
H
W
A
Y
5
5
CHIP
P
E
W
A
RD
CITY OF CORCORAN
CITY OF MEDINA
N
CA
T
E
S
R
A
N
C
H
DR
I
V
E
LEGEND
EXISTING STORM STRUCTUREST
EXISTING STORM SEWER PIPE>>
PROPOSED DRAINAGE STRUCTURE
PROPOSED STORM SEWER PIPE>>
EXISTING WATERMAIN||
EXISTING HYDRANT W/ VALVE
PROPOSED SANITARY SEWER MAIN>
PROPOSED SANITARY STRUCTURES
APPROX. CONSTRUCTION LIMITS
NOTE:
ALL STATIONING ON THIS PLAN BASED ON
CENTERLINE OF SANITARY SEWER FORCEMAIN.
REMOVE TREE
REMOVE GRAVEL SHOULDER
2'
APPROXIMATE LOCATION OF
RECEIVING PIT. CONTRACTOR TO
COORDINATE FINAL LOCATION
IN FIELD.
955
960
965
970
975
980
985
990
995
955
960
965
970
975
980
985
990
995
98
0
.
3
22+50
97
9
.
6
23+00
97
8
.
8
23+50
97
9
.
1
3
97
3
.
4
24+00
97
9
.
3
2
97
3
.
1
24+50
97
3
.
2
25+00
97
3
.
4
25+17
PROPOSED GRADE @
CL OF SAN FORCEMAIN
EXISTING GROUND @ CL
SAN FORCEMAIN
EX 24" RCP
INV: 974.39
VALVE VAULT
RI
M
:
9
7
9
.
4
0
ST
A
2
4
+
2
3
.
9
8
,
0
.
0
0
'
TY
P
E
:
8
4
"
D
I
A
.
IN
V
:
9
7
0
.
0
0
(
N
)
IN
V
:
9
7
0
.
0
0
(
S
)
-
WET WELL
RI
M
:
9
7
9
.
4
0
ST
A
2
4
+
3
8
.
9
8
,
0
.
1
4
'
R
T
TY
P
E
:
9
6
"
D
I
A
.
IN
V
:
9
5
5
.
0
0
(
N
)
IN
V
:
9
7
0
.
0
0
(
S
)
-
6000
RI
M
:
9
7
9
.
2
1
ST
A
2
4
+
5
5
.
1
5
,
0
.
0
0
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TY
P
E
:
4
8
"
D
I
A
.
D
R
O
P
M
H
IN
V
:
9
6
4
.
1
9
(
W
)
IN
V
:
9
5
5
.
0
9
(
E
)
IN
V
:
9
5
5
.
0
9
(
S
)
-
16' - 8" PVC SSWR @ 0.53%
2' MIN
SEPARATION
8' MIN
DEPTH
INSTALL 8" DROP
CONNECTION.
INV: 964.19
EMBANKMENT -
COMMON BID ITEM
EMBANKMENT -
LIFT STATION
STRUCTURES BID ITEM
113' - 6" SAN FORCEMAIN
(FUSABLE) PVC C900
@ 2.15%
61' - 6" SAN FORCEMAIN
(FUSABLE) PVC C900
6" 7 7 BOX
6" 8 BOX
6" 8 BOX
7" 9 9 BOX
9" ASH 10" ELM
E
C C
18"
6"
OEOEOEOEOEOEOEOEOEOE OE OE OE
W
E
T
W
E
T
WE
T
W
E
T
W
E
T
W
E
T
W
E
T
W
E
T
WET
WETWET
W
E
T
CONTROL PANELGENERATOR
(BID ALTERNATE)
PE
PE
PE
PE
PEPEPEPEPE
PE
PE
PE
PE
TE
TE
TE
TE
TE
TE
TE
TE
TE
TE
S SS
S
>
>
FM
FM
FMFMFMFMFM
>>
>>
|
|||||||||
SMH-4
6000
WET WELL
VALVE VAULT
EX
2
4
"
R
C
P
EX
6
"
D
I
P
EX 8" DIP
23+00
24
+
0
0
25+00 25+16
>
>
>EX. EDGE OF BITUMINOUS
EX. EDGE OF BITUMINOUS
EX. EDGE OF GRAVEL SHLDR
EX. EDGE OF GRAVEL SHLDR
>
>
TELEPHONE CABLE
EASEMENT
PER DOC. NO. 2929202
AND AS SHOWN ON
THE PLAT OF CATES RANCH
DRAINAGE & UTILITY EASEMENT
PER PLAT OF CATES RANCH
ST LOUIS PARK INVESTMENT CO.
PID: 0411823120004
ST LOUIS PARK INVESTMENT CO.
PID: 04118231200074635 WILLOW DR
ST LOUIS PARK INVESTMENT CO.
PID: 0411823120006
EX. EDGE OF BITUMINOUS
EX. EDGE OF GRAVEL SHLDR
EX. EDGE OF BITUMINOUS
EX. EDGE OF GRAVEL SHLDR
2590 CATES RANCH DR
JEFFREY CATES
PID: 0411823110002
38' - 8" PVC SDR 26
8"
P
V
C
S
A
N
(B
Y
O
T
H
E
R
S
)
8" PVC SDR 35
SANITARY SEWER STUB
CONNECT TO 8" PVC SSWR (BY OTHERS)
COORDINATE WITH UTILITY CONTRACTOR
FOR ADJACENT DEVELOPMENT.
STA: 23+63.35
56.16', LT
INV: 965.31
58
'
-
8
"
P
V
C
S
D
R
3
5
8" PVC SDR 35
SANITARY SEWER STUB
(CAP END)
STA: 24+55.15
38.33', RT
INV: 955.24
6" SAN FORCEMAIN
LTRL -SMH4 - STUB
955
960
965
970
975
980
985
955
960
965
970
975
980
985
98
0
.
4
0+50
97
9
.
0
1
97
4
.
3
1+00
97
9
.
0
5
97
3
.
0
1+50 1+90
6000
78' - 8" PVC SAN
(BY OTHERS)
@ 1.92%
58' - 8" PVC SDR 35 SSWR
@ 1.92%
INV: 964.19 (W)
INV: 955.09 (E)
INV: 955.09 (S)
INSTALL 8" DROP
CONNECTION.
INV: 964.19
CONNECT TO EXISTING
INV: 965.31
38' - 8" PVC SDR 26 SSWR
@ 0.40%
CAP END
INV: 955.24
PROPOSED GRADE @ CL
SAN SEWER
EXISTING GROUND @ CL
SAN SEWER
K:
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P
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SANITARY SEWER
FORCEMAIN PLAN
11
AS SHOWN JLS
JLSMPM
LOCATION
WILLOW DRIVE
SCALE:
PLAN BY:
DESIGN BY:
CHECK BY:
SHEET
OF
WSB PROJECT NO.
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CHIP
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A
RD
CITY OF CORCORAN
CITY OF MEDINA
N
SEE LIFT STATION PLANS AND DETAILS,
SHEETS 14-17.
SEE LIFT STATION PLANS & DETAILS,
SHEETS 14-17.
FUTURE SSMH
(BY OTHERS)
LEGEND
EXISTING STORM STRUCTUREST
EXISTING STORM SEWER PIPE>>
PROPOSED DRAINAGE STRUCTURE
PROPOSED STORM SEWER PIPE>>
EXISTING WATERMAIN||
EXISTING HYDRANT W/ VALVE
PROPOSED SANITARY SEWER MAIN>
PROPOSED SANITARY STRUCTURES
APPROX. CONSTRUCTION LIMITS
NOTE:
ALL STATIONING ON THIS PLAN BASED ON
CENTERLINE OF SANITARY SEWER FORCEMAIN.
REMOVE TREE
REMOVE GRAVEL SHOULDER
PROPOSED CONSTRUCTION
LIMITS
N SCALE IN FEET
0
H:
20 40
SCALE IN FEET
0
V:
5 10
PROPOSED TEMPORARY
EASEMENT
PROPOSED PERMANENT
EASEMENT
EDGE OF WETLAND
25'
WETLAND
BUFFER
2'
EX. 24" FES
INV: 974.34 (W)
EX. 24" FES
INV: 974.62 (E)
SEE LATERAL PROFILE
BELOW, RIGHT.
15'-0"
GENERAL NOTES
FIELD VERIFY ALL ELEVATIONS AND LOCATIONS PRIOR TO FABRICATION & CONSTRUCTION.
ALL PIPING AND PIPE JOINTS SHALL BE PROPERLY RESTRAINED TO PREVENT EXCESS
MOVEMENT IN ANY DIRECTION DURING OPERATION AND TESTING. ALL EXTERIOR PIPE
SHALL BE MECHANICAL JOINT W/ MEGALUG RESTRAINT JOINTS. PIPE SUPPORTS SHALL BE
LOCATED IN FIELD.
PAINT ALL EXPOSED DIP PIPING PER SPECIFICATIONS.
PROVIDE EXTERNAL JOINT SEAL INFi-SHIELD OR GATOR WRAP EQUAL ON ALL MANHOLE SECTION JOINTS.
PLUG ALL LIFTING HOLES WITH NON SHRINK GROUT AND COVER WITH A PIECE OF EXTERNAL
JOINT SEAL, INFRASHIELD OR EQUAL.
LOCATE INLET PIPE(S), VENT PIPE, AND ELECTRICAL CONDUITS AS REQUIRED PER SITE
CONDITIONS.
CONTRACTOR SHALL VERIFY ALL EXISTING CONDITIONS PRIOR TO BIDDING.
CLEAR OPENING OF ALUMINUM HATCHES SHALL BE SIZED APPROPRIATELY FOR REMOVAL
OF PUMPS AND VALVES. PUMP SUPPLIER/MANUFACTURER TO CONFIRM HATCH SIZE.
ALL INTERIOR PIPING SHALL BE WELDED FLANGED CLASS 53 DIP.
ALL BURIED DIP SHALL BE ENCASED IN POLYETHYLENE PER ANSI/AWWA C105.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
ALL BOLTS AND FASTENERS SHALL BE 316 STAINLESS STEEL.
1.
96"Ø PRECAST CONC. WET WELL
SUBMERSIBLE PUMP, TYP. OF 2
HYDROMATIC MODEL C4SXP
2" 316SS GUIDE BAR, TYP. OF 2 PER PUMP2" SCH. 80 PVC DRAIN @ 2.00%
6" MJ SLEEVE W/ MEGALUG RESTRAINT (TYP. OF 2)
8" PVC SANITARY SEWER @ 0.53%
(SEE SHEET 11)
CAST PIPE PENETRATION (SEE DETAIL B/17)
TYP. CAST PIPE PENETRATION (SEE DETAIL B/17)
2" DUCK BILL CHECK VALVE
6" FL CHECK VALVE (TYP. OF 2)
6" FL GATE VALVE (TYP. OF 2)
TYP. CAST PIPE OPENING W/ SEAL (SEE DETAIL B/17)
6" FL 90° ELBOW (TYP. OF 2)
1'-
4
"
1'-
4
"
6"X6" FL WYE, 6" FL 45° ELBOW, 6"
FL GATE VALVE & CAM LOCK CPLG.
(STYLE AS DIRECTED BY OWNER)
EMBEDDED POLYPROPYLENE COATED
STEEL MANHOLE STEPS @ 16" O.C.
84"Ø PRECAST CONC. VALVE VAULT
6" MJ 45° BEND W/ MEGALUG RESTRAINT
6"X6" MJ WYE W/ MEGALUG RESTRAINT
6" MJ X HDPE ADAPTOR
6" HDPE FORCEMAIN (SEE SHEET 11)
2" FERNCO CPLG.
120"Ø PRECAST CONC. BASE SLAB
106"Ø PRECAST CONC. BASE SLAB
12" FL TO FL SPOOL PIECE
SCALE IN FEET
0 2'4'
SECTIONAL PIPING & EQUIPMENT PLANAN
16
A
16
A
SCALE:
PLAN BY:
DESIGN BY:
CHECK BY:
SHEET
OF
WSB PROJECT NO.
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LIFT STATION
PLANS
14
AS SHOWN JC
JCGG
GENERAL NOTES
FIELD VERIFY ALL ELEVATIONS AND LOCATIONS PRIOR TO FABRICATION & CONSTRUCTION.
ALL PIPING AND PIPE JOINTS SHALL BE PROPERLY RESTRAINED TO PREVENT EXCESS
MOVEMENT IN ANY DIRECTION DURING OPERATION AND TESTING. ALL EXTERIOR PIPE
SHALL BE MECHANICAL JOINT W/ MEGALUG RESTRAINT JOINTS. PIPE SUPPORTS SHALL BE
LOCATED IN FIELD.
PAINT ALL EXPOSED DIP PIPING PER SPECIFICATIONS.
PROVIDE EXTERNAL JOINT SEAL INFI-SHIELD GATOR WRAP OR EQUAL ON ALL MANHOLE SECTION JOINTS.
PLUG ALL LIFTING HOLES WITH NON SHRINK GROUT AND COVER WITH A PIECE OF EXTERNAL
JOINT SEAL, INFRASHIELD OR EQUAL.
LOCATE INLET PIPE(S), VENT PIPE, AND ELECTRICAL CONDUITS AS REQUIRED PER SITE
CONDITIONS.
CONTRACTOR SHALL VERIFY ALL EXISTING CONDITIONS PRIOR TO BIDDING.
CLEAR OPENING OF ALUMINUM HATCHES SHALL BE SIZED APPROPRIATELY FOR REMOVAL
OF PUMPS AND VALVES. PUMP SUPPLIER/MANUFACTURER TO CONFIRM HATCH SIZE.
ALL INTERIOR PIPING SHALL BE WELDED FLANGED CLASS 53 DIP.
ALL BURIED DIP SHALL BE ENCASED IN POLYETHYLENE PER ANSI/AWWA C105.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
DESCRIPTION ELEVATION (FT.)
HIGH WATER ALARM 954.50
PUMP 2 ON 953.70
PUMP 1 ON (ALTERNATE)953.20
PUMPS OFF 952.00
LOW WATER ALARM 951.50
(TO BE FIELD SET AFTER INSTALLATION)
ALL BOLTS AND FASTENERS SHALL BE 316 STAINLESS STEEL.
1.
EL. 979.40
L EL. 970.25
ELEC. CONDUITS (SEE ELECTRICAL)
CONTROL PANEL SHOWN OUT OF SECTION (SEE ELECTRICAL)
8" CONC. SLAB (SEE DETAIL E/17)
EL. 979.40
INV. EL. 955.00
EL. 950.00
CL EL. 970.25C
EL. 968.25
EL. 968.42
L EL. 968.33CEL. 968.67 2" SCH. 80 PVC DRAIN @ 2.00%
8" CONC. SLAB (SEE DETAIL E/17)
8" PVC SANITARY SEWER @ 0.53% (SEE SHEET 11)
6" HDPE SANITARY FORCEMAIN (SEE SHEET 11)
6" DIP MJ TO HDPE ADAPTOR
6"X6" MJ WYE W/ MEGALUG RESTRAINT
EL. 953.00
4" WELDED STEEL VENT PIPE PRIMED & PAINTED
HUNTER GREEN (SEE DETAIL C/17)
30"X54" CLEAR OPENING ALUM. HATCH RATED FOR HS-20 WHEEL LOAD
W/ S.S.UPPER GUIDE BAR BRACKET, S.S. CHAIN HOOKS, S.S. CABLE RACK,
HINGED POWDER COATED ALUM. SAFETY GRATE & POSITIVE LOCK @ 90°
OPEN POSITION. VERIFY HATCH SIZE & LOCATION W/ PUMP MFR.
SET ON 2 ROWS KENT SEAL NO. 2 (TYP. PERIMETER)
114" DIA. PRECAST CONC. COVER SLAB RATED FOR HS-20 WHEEL LOAD
CAST PIPE PENETRATION W/ SEAL (SEE DETAIL B/17)
TYP. COVER ANCHORAGE (SEE DETAIL D/17)
100" DIA. PRECAST CONC. COVER SLAB RATED FOR HS-20 WHEEL LOAD
36"X36" CLEAR OPENING ALUM. HATCH RATED FOR HS-20 WHEEL LOAD W/ HINGED
POWDER COATED ALUM. SAFETY GRATE & POSITIVE LOCK @ 90° OPEN POSITION
SET ON 2 ROWS KENT SEAL NO. 2 (TYP. PERIMETER)
COVER SLAB ANCHORAGE (SEE DETAIL D/17)
8" CONC. SLAB
(SEE DETAIL E/17)
EMBEDDED POLYPROPYLENE COATED STEEL MANHOLE STEPS @ 16" O.C.
96"Ø PRECAST CONC. WET WELL
84"Ø PRECAST CONC. VALVE VAULT
6" FL GATE VALVE
6" MJ SLEEVE
W/ MEGALUG
RESTRAINT
6" CL. 53 DIP (TYP.)
6" FL CHECK VALVE
2" FERNCO CPLG.
6" CL. 53 DIP (TYP.)
12" FL TO FL SPOOL PIECE
6"X6" FL WYE
6" FL 45° ELBOW
6" FL GATE VALVE
6" BYPASS CONNECTION W/ MALE QUICK CONNECT CPLG. (STYLE BY OWNER)
POWER & CONTROL CABLES
316SS PUMP LIFT CHAINS
6" FL 90° ELBOWS
2" DUCK BILL CHECK VALVE
2" 316SS PUMP GUIDE BARS (TYP. OF 2 PER PUMP)
TYP. CAST PIPE OPENING W/
SEAL (SEE DETAIL B/17)
6" CL. 53 DIP PUMP DISCHARGE
CAST PIPE PENETRATION W/ SEAL (SEE DETAIL B/17)
TYP. FLOAT SWITCH PUMP CONTROL & ALARM BACKUP
SELECT GRANULAR BACKFILL
COMPACTED TO 100% SPD
SELECT GRANULAR BACKFILL
COMPACTED TO 100% SPD
1:1
1:1
1:1
1:1
NON-SHRINK GROUT SLOPE
TYP. BASE ANCHORAGE (SEE DETAIL D/17)
1:1
1:1
SET ON 2 ROWS KENT SEAL NO. 2 (TYP. PERIMETER)
TYP. PIPE SUPPORT (SEE DETAIL A/17)
NON-SHRINK GROUT SLOPE
106"Ø PRECAST CONC. BASE SLAB
6"X4" FL ECC. REDUCER
12" MIN. COARSE FILTER AGGREGATE
(MnDOT 3149.2H) ON TYPE 4 GEOTEXTILE
12" MIN. COARSE FILTER AGGREGATE
(MnDOT 3149.2H) ON TYPE 4 GEOTEXTILE
SET ON 2 ROWS KENT SEAL NO. 2 (TYP. PERIMETER)120"Ø PRECAST CONC. BASE
ANCHOR & PRESSURE TRANSDUCER
SUBMERSIBLE PUMP W/ 4" BASE ELBOW
HYDROMATIC MODEL C4SXP
EMBANKMENT -
COMMON BID ITEM
EMBANKMENT -
LIFT STATION STRUCTURES
BID ITEM
APPROXIMATE EXISTING GROUND
SCALE IN FEET
0 2'4'
PIPING & EQUIPMENT SECTIONA
SCALE:
PLAN BY:
DESIGN BY:
CHECK BY:
SHEET
OF
WSB PROJECT NO.
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P
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LIFT STATION
PLANS
16
AS SHOWN JC
JCGG
MEMORANDUM
TO: Mayor and City Council
FROM: Jim Stremel, City Engineer
DATE: February 2, 2023
MEETING: February 7, 2023
SUBJECT: 2023 Clydesdale Trail Pavement Rehabilitation Project – Calling Public
Improvement Hearing
Background:
On December 6, 2022 the City Council adopted a resolution authorizing the preparation of an
engineering feasibility report for the proposed Clydesdale Trail Pavement Rehabilitation Project.
The project was initiated as a part of the City’s capital improvement planning and is intended to
replace deteriorating infrastructure that includes the existing roadway surface.
The City Council received the feasibility report at the January 17th meeting and ordered the
preparation of plans and specifications. City staff also held a neighborhood meeting on January
31st at the public works building. Three of the property owners attended and had an opportunity
to ask questions and discuss the project.
Next Steps:
The next step is for the City Council to consider the enclosed resolution calling for the public
improvement hearing. The City Council has already authorized the preparation of plans and
specifications, and this work is underway.
City Council Action Requested:
Consider adopting the resolution calling for the public improvement hearing.
Agenda Item #5E
Resolution No. 2023-XX
February 7, 2023
Member ___________ introduced the following resolution and moved its adoption:
CITY OF MEDINA
RESOLUTION NO. 2023-XX
RESOLUTION
CALLING HEARING ON IMPROVEMENT
WHEREAS, pursuant to resolution of the city council adopted December 5, 2023, a report has
been prepared by the city engineer with reference to the proposed 2023 Clydesdale Trail
Pavement Rehabilitation Project, the improvement of Clydesdale Trail from 100 feet east of the
City’s public works driveway to County Road 101 by reconstruction of the roadway pavement
surface layer, spot concrete curb replacement, and trail repair; and
WHEREAS, the report provides information regarding whether the proposed improvement is
necessary, cost-effective, and feasible; whether it should be made as proposed or in connection
with some other improvement; the estimated cost of the improvement as recommended; and a
description of the methodology used to calculate the individual assessments for affected parcels;
and
WHEREAS, the city council received the feasibility report on January 17, 2023 and authorized
the preparation of plans and specifications; and
NOW, THEREFORE, BE IT RESOLVED, by the city council of Medina Minnesota, as
follows:
1. The city council will consider the improvement of such street in accordance with the
report and the assessment of abutting property for all or a portion of the cost of the
improvement pursuant to Minnesota Statutes, Chapter 429 at an estimated total cost of
the improvement of $518,000.
2. A public hearing shall be held on such proposed improvement on the 21st day of
February 2023, in the council chambers of the city hall at 7:00 PM and the clerk shall
give mailed and published notice of such hearing and improvement as required by law.
Dated: February 7, 2023.
By: _______________________
Kathleen Martin, Mayor
Attest:
By: ___________________________
Caitlyn Walker, City Clerk
Resolution No. ________
February 7, 2023
2
The motion for the adoption of the foregoing resolution was duly seconded by member
___________ and upon vote being taken thereon, the following voted in favor thereof:
And the following voted against same:
Whereupon said resolution was declared duly passed and adopted.
1
TO: Medina City Council
FROM: Caitlyn Walker, City Clerk/Assistant to City Administrator
DATE OF REPORT: February 2, 2023
DATE OF MEETING: February 7, 2023
SUBJECT: Planning and Permit Technician Appointment
Background
On December 6, 2022, the City Council authorized staff to begin the recruitment process
to fill the Planning and Permit Technician opening.
Based on the final scoring of applicants, committee interviews, background/reference
checks, we are recommending the appointment of Maria Rucke to the position of
Planning and Permit Technician. Rucke has verbally accepted the position with a starting
date of February 9, 2023 contingent on City Council approval.
Appointee Background
Rucke has over 20 years of experience working with local government software
solutions, including building permit software, at LOGIS (Local Government Information
Systems) and Avolve Software where she assisted in the implantation of software with
many cities.
Rucke’s educational background includes a Bachelor of Arts Degree in Psychology from
the University of Minnesota. The City of Medina has confidence in her abilities,
communication, character, and problem-solving skills.
Selection Process
• The City Council directed staff to recruit for full-time position on December 6,
2022.
• Advertisements for the position were published through the League of Minnesota
Cities, Crow River News, social media, and the City Website.
• Applications were received, reviewed, and scored by City Clerk Caitlyn Walker.
• The interview was conducted by Dusty Finke, Deb Dion, and Caitlyn Walker on
January 17, 2023.
• The Medina Police Department conducted a background check on January 24,
2023, which she passed.
• Rucke’s starting date will be February 9, 2023, with an hourly wage (non-exempt)
of $30.81/hr., benefits to be at the same rate as other employees, in accordance
with the City Personnel Policies. Following a six-month probationary period,
Rucke’s performance will be reviewed, with a positive review, Rucke will
become a non-probationary employee. Rucke has been notified that our
recommendation is contingent upon City Council approval.
MEMORANDUM
Agenda Item #5F
2
Recommendation
We recommend the appointment of Maria Rucke to the position of Planning and
Permit Technician effective February 9, 2023, with an hourly wage (non-exempt) of
$30.81/hr, other benefits to be at the same rate as other full-time employees, in
accordance with the City Personnel Policies.
1
TO: Honorable Mayor and City Council Members
FROM: Steve Scherer, Public Works Director
DATE February 1, 2023
MEETING: February 7, 2023
SUBJECT Road Materials and Equipment Bid Tabulation
Summary
Thirteen sealed bid responses were received prior to the deadline and opened in public on
Tuesday, January 31 at 10:00 a.m. Contractor responses have been recorded in the enclosed
spreadsheet, Road Materials and Equipment Bid Tabulation - 2023 (Exhibit A).
Staff Recommendation
Accept the low or sole bids with the intention to hire those contractors whenever possible. If
unexpected issues arise (i.e., scheduling/delivery needs), it may be necessary to engage the
contractor with the second lowest bid.
Low / sole bid details are recorded as follows:
Bituminous Mixtures for paving and patching roads (#1, & #2, & #3, & #4)
• GMH Asphalt (delivered/placed on city streets)
• Martin Marietta (picked up)
Bituminous Mixtures for paving and patching trails (placed on city trails) (#5)
• GMH Asphalt
Bituminous Fine Mix/Sand Mix (#6)
• Omann Brothers Inc.
Bituminous Integral Curb Installation (#7)
• Omann Brothers Inc.
Bituminous Integral Curb Installation (#8)
• Omann Brothers Inc.
Milling of Bituminous Surface (which includes Milling Removal) (#9)
• GMH Asphalt
Miscellaneous Milling Services (#10)
• Omann Brothers Inc. – 60” Machine Width
• GMH Asphalt - 24” Machine Width
MEMORANDUM
Agenda Item #5G
2
Reclaim Roadway (#11)
• GMH Asphalt
Sealcoating/Installed CRS-2 Liquid Asphalt (#12A & #12B)
• Pearson Brothers Inc.
Fog Seal/Installed CSS-1hD50 Cationic Emulsion (#13)
• Pearson Brothers Inc.
Curb Installation (#14 & #15 & #16)
• Schmidt Curb
Non-reinforced Concrete Flat Work (#17)
• Schmidt Curb
Crushed Limestone (delivered to site) (#18 & #19 & #20)
• Kraemer Mining & Mat Inc.
Clean Crushed Limestone (delivered to site) (#21)
• Kraemer Mining & Mat Inc.
Crushed Recycled Material-Bituminous (#22)
• Bryan Rock Products Inc.
Class 5 Gravel (delivered to site) (#23)
• Fehn Companies, Inc.
Winter Sand (delivered to site) (#24)
• Hassan Sand & Gravel
Clean Crushed Limestone Chips (delivered to site) (#25)
• Bryan Rock Products Inc.
Granite or Trap Rock (#26)
• Bryan Rock Products Inc.
Rip Rap (delivered to site) (#27)
• Kraemer Mining & Mat Inc.
Equipment Rental (#28 - #31) – Equipment Rental items varied slightly and therefore, each
rental would be evaluated for the type and size of equipment needed for the job.
Miscellaneous Equipment & Other Bid Details (listed in Additional Remarks section)
Attachment
Road Materials and Equipment Bid Tabulation - 2023 (Exhibit A)
City of Medina Road Materials and Equipment Bid Tabulation ‐ 2023 ‐ Exhibit A blue = notations yellow = lowest or sole bid
Company Name Designing
Nature
Kraemer
Mining &
Materials
Pearson
Bros
KD & Co
Recycling Fehn Martin Marietta Hassan Sand & Gravel Bryan Rock
Products DMJ Asphalt GMH Asphalt Omann Schmidt
Curb
Allied
Blacktop
Material/Bid
#1 MN‐D.O.T. SPNWB230(B) MIX
Picked up $59.95
Delivered to site
Placed on city streets $79.45 $81.90
#2 MN‐D.O.T. SPNWB330(B) MIX
Picked up $58.65
Delivered to site
Placed on city streets $78.15 $81.50
# 3 MN‐D.O.T. SPWEB240(B) MIX
Picked up $58.65
Delivered to site
Placed on city streets $80.30 $82.90
#4 MN‐D.O.T. SPWEB340(C) MIX
Picked up $72.35
Delivered to site
Placed on city streets $90.50 $91.20
#5 MN‐D.O.T. SPWEA240(B) MIX
less than 8.5'W paving
requires addt'l charge for
little paver rental
Placed on city trails $128.50 $103.00 $115.60
#6 BITUMINOUS FINE MIX/SAND
MIX
Picked up $87.00
Delivered to site
#7 AGGREGATE SHOULDERING
PLACED (MnDOT 2118)Class 5 Rec mat'l
Delivered to site per ton $31.50
Mobilization Fee $1,200.00
#8 BITUMINOUS INTEGRAL CURB
INSTALLATION
Installation Price per Lin Ft $8.00 $5.00
#9 MILL BITUMINOUS SURFACE AT
DEPTH PER SQ YD (INCLUDING
MILLING REMOVAL)
0 ‐ 2" Depth per sq yard $1.00 $1.95
2 ‐ 4" Depth per sq yard $1.40 $3.05
4 ‐ 6" Depth per sq yard $1.80 $4.95
Mobilization Fee $1,500.00 $500.00
City of Medina Road Materials and Equipment Bid Tabulation ‐ 2023 ‐ Exhibit A blue = notations yellow = lowest or sole bid
Company Name Designing
Nature
Kraemer
Mining &
Materials
Pearson
Bros
KD & Co
Recycling Fehn Martin Marietta Hassan Sand & Gravel Bryan Rock
Products DMJ Asphalt GMH Asphalt Omann Schmidt
Curb
Allied
Blacktop
Material/Bid
#10 MISCELLANEOUS MILLING
SERVICES AT PER HOUR RATE
Width of Machine 24" 60"
Per Hour Rate $210.00 $525.00
Mobilization Fee $400.00 $500.00
#11 RECLAIM ROADWAY AT DEPTH
PER SQUARE YARD & INCLUDING
GRADE & COMPACT
includes grade &
compact
6' Rear drum reclaimer
includes grade &
compact
0 ‐ 2" Depth per sq yard $1.74 $2.25
2 ‐ 4" Depth per sq yard $1.74 $2.40
4 ‐ 6" Depth per sq yard $1.74 $2.45
Mobilization Fee $1,500.00 $800.00
Reclaimer Per Hour
#12A SEALCOATING INSTALLED
CRS‐2 LIQUID ASPHALT
@.27Gal/SqYd 1/8” Trap
rock@25#/SqYd
0 ‐ 25,000 sq yds $1.61 $2.07
25‐50,000 sq yds $1.61 $1.95
50‐75,000 sq yds $1.61 $1.90
75‐100,000 sq yds $1.61 $1.87
#12B SEALCOATING INSTALLED CRS‐
2 LIQUID ASPHALT @.30 Gal/SqYd
FA2 Granite @28#/SqYd
0 ‐ 25,000 sq yds $1.61 $2.05
25‐50,000 sq yds $1.61 $1.93
50‐75,000 sq yds $1.61 $1.89
75‐100,000 sq yds $1.61 $1.86
#13 FOG SEAL INSTALLED CSS‐
1hD50 CATIONIC EMULSION @.10
GAL/SqYd
0 ‐ 25,000 sq yds $0.40 $0.75
25‐50,000 sq yds $0.40 $0.69
50‐75,000 sq yds $0.40 $0.64
75‐100,000 sq yds $0.40 $0.60
#14 CURB INSTALLATION MN‐
D.O.T. D424
R/R (w/bit patch) Lin Ft
R&R (no bit patch) Lin Ft $45.00
New Installation Lin Ft $39.00
City of Medina Road Materials and Equipment Bid Tabulation ‐ 2023 ‐ Exhibit A blue = notations yellow = lowest or sole bid
Company Name Designing
Nature
Kraemer
Mining &
Materials
Pearson
Bros
KD & Co
Recycling Fehn Martin Marietta Hassan Sand & Gravel Bryan Rock
Products DMJ Asphalt GMH Asphalt Omann Schmidt
Curb
Allied
Blacktop
Material/Bid
#15 CURB INSTALLATION MN‐
D.O.T. B618
R/R (w/bit patch) Lin Ft
R&R (no bit patch) Lin Ft $45.00
New Installation Lin Ft $39.00
#16 CURB INSTALLATION ‐ RIBBON
CURB MnDOT 2531
12"w X 5' depth Lin Ft $25.00
18"w X 5' depth Lin Ft $35.00
24"w X 5' depth Lin Ft $45.00
#17 NON REINFORCED CONCRETE
FLAT WORK
4" Thick per sq. foot $9.00
6" Thick per sq. foot $12.00
8" Thick per sq. foot $15.00
#18 ¾ “ MINUS CRUSHED
LIMESTONE
Delivered to site per ton $18.80 $20.05
#19 1” MINUS (MN‐D.O.T. 3138,
CLASS 5) CRUSHED LIMESTONE
Delivered to site per ton $17.40 $26.91 $19.65
#20 1 ½” MINUS CRUSHED
LIMESTONE
Delivered to site per ton $17.80 $26.91 $19.65
#21 1 ½” CLEAN CRUSHED
LIMESTONE
Delivered to site per ton $27.80 $37.29 $29.95
#22 CLASS 5 CRUSHED RECYCLED
MAT‐ BITUMINOUS P/U Maple Grove
Picked up per ton $12.50 $12.75 $15.00 $8.00
Delivered to site per ton $17.75 $21.00 $16.00
#23 CLASS 5 GRAVEL
Delivered to site per ton $19.59
#24 FA‐1 (WINTER SAND)
Delivered to site per ton $16.00
#25 5/16” CLEAN CRUSHED
LIMESTONE CHIPS
Delivered to site per ton
#26 3/16” CLEAN F.A. 3 GRANITE
OR TRAP ROCK
Delivered to site per ton $48.10
#27 CLASS 3 RIP RAP
Delivered to site per ton $43.00
City of Medina Road Materials and Equipment Bid Tabulation ‐ 2023 ‐ Exhibit A blue = notations yellow = lowest or sole bid
Company Name Designing
Nature
Kraemer
Mining &
Materials
Pearson
Bros
KD & Co
Recycling Fehn Martin Marietta Hassan Sand & Gravel Bryan Rock
Products DMJ Asphalt GMH Asphalt Omann Schmidt
Curb
Allied
Blacktop
Material/Bid
#28 ‐ TANDEM AXLE DUMP TRUCK
WITH OPERATOR
Quad (18‐18.25T) Quads, Quints
Box Size ‐ Cubic yards 12 14‐15 13 10
Per Hour Rate $110.00 $125.00 $165.00 $110.00
Mobilization Fee $450.00
City of Medina Road Materials and Equipment Bid Tabulation ‐ 2023 ‐ Exhibit A blue = notations yellow = lowest or sole bid
Company Name Designing
Nature
Kraemer
Mining &
Materials
Pearson
Bros
KD & Co
Recycling Fehn Martin Marietta Hassan Sand & Gravel Bryan Rock
Products DMJ Asphalt GMH Asphalt Omann Schmidt
Curb
Allied
Blacktop
Material/Bid
#29 ‐ CRAWLER DOZER WITH
OPERATOR
Size of Machine D5 cat DK5 LGP D6 cat
Per Hour Rate $150.00 $160.00 $165.00
Mobilization Fee $120.00 $450.00 $450.00
#30 ‐ CRAWLER LOADER WITH
OPERATOR
Skid Loader
Size of Machine ‐ Cubic yards 1/4CY
Per Hour Rate $185.00
Mobilization Fee $400.00
#31 ‐ CRAWLER BACKHOE WITH
OPERATOR
Bucket Size ‐ Cubic yards 3 1.75
Per Hour Rate $150.00 $180.00
Mobilization Fee $120.00 $450.00
ADDITIONAL REMARKS P/U Maple Grove
PLANT=10000 81st Av N
PIT=8000 Zachary Ln
*Delivered $ = end dump trac/trail full loads (24‐24.5T)
*Delivered $ subject to fuel surcharges per curr fuel $
*2% discount avail if invoices PIF by 15th
End dump semis 24‐25ton
loads & less than 23ton are
subject to addt'l charge
Pickup Broom (dirt,
bit millings, etc)
$170/hr
see fee schedule for
eqpt rentals
1
TO: Honorable Mayor and City Council Members
FROM: Steve Scherer, Public Works Director
DATE: February 2, 2023
MEETING: February 7, 2023
SUBJECT: Safety Manual Revision
The safety program was developed to assure compliance with all state, federal and OSHA
regulations. The City remains dedicated to the protection of our employees from
occupational injuries and illnesses.
After discovery of discrepancies in our safety program, a consultant from the Minnesota
Safety Council was engaged to review our existing policy. The result yielded a useful,
albeit generic, recommendation.
The Safety Committee agreed that any revisions to the safety program should include
specific content for the processes employees deal with during their workday.
Lisa came to us with many years of experience working in government compliance, as a
certified auditor for quality management systems, and was responsible to develop work
instructions in her previous job. She offered to initiate the review and revision process of
our program.
The discrepancies discovered were found within the existing safety manual, safety
handbook, and personnel policy. Documents were merged, where possible, and
ultimately evaluated for compliancy to OSHA standards.
All sections of the required safety manual, as well as necessary forms, were reviewed,
revised, and presented to the Safety Committee (sections specific to Public Works were
presented to P.W. Staff). Due to the size of the safety manual, a link will be provided to
Council for review.
Staff Recommendation
Approve the Safety Manual for distribution to all employees.
MEMORANDUM
Agenda Item #5H
SAFETY MANUAL
TABLE OF CONTENTS
Safety Manual Table of Contents 02.07.2023
Page 1 of 2
1. Table of Contents
2. Change History Page
3. Statement of Safety Policy
SECTION 1: PERSONAL PROTECTION POLICIES –
ALL EMPLOYEES
4. Mn AWAIR (A Workplace Accident and Injury Reduction) § 182.653, subd 8
5. Safety Committee
6. Safety Rules and Work Inspections
7. Emergency Evacuation § 1910.38 (e) § 1926.35 (e)
8. Hazard Communication § 1910.1200 (h) (1), RTK/GHS Chapter 5206, with
flammable and Combustible Liquids
9. Fire Prevention and Protection § 1910.39, 1910.157 (g)
10. Violence Prevention
11. Medical Services and First Aid § 1910.151
12. Bloodborne Pathogens § 1910.1030 (g)
13. City Vehicle Operation
14. Personal Clothing and Hygiene
15. Slip, Trip and Fall Prevention
16. Lockout/Tagout § 1910.147 (c)
17. Ergonomics
18. Safety Housekeeping and Accident Prevention
SECTION 2: PERSONAL PROTECTION POLICIES –
PUBLIC WORKS EMPLOYEES
19. Stairway and Ladder § 1926.1060
20. Respiratory Protection § 1910.134
21. Confined Space Entry § 1910.146 (g) (k), Minnesota Rules § 5207.0300-0304
22. Chain Saw and Tree Trimming Safety § 1910.266
23. Electrical Safety Related Work Practices w/Arc Flash § 1910.332-335
24. Trenching and Shoring § 1926.650-652 and Excavation
25. Occupational Noise Exposure § 1910.95 (k) (l)
26. Fall Protection § 1926.503
27. Personal Protection Equipment § 1910.132
28. Emergency Eye Wash and Shower § 1910.151
29. Welding and Cutting § 1910.252
SAFETY MANUAL
TABLE OF CONTENTS
Safety Manual Table of Contents 02.07.2023
Page 2 of 2
SECTION 3: FORMS
F001 - Safety Acknowledgement Form
F002 - Job Hazard Assessment Form
F003 - Supervisors Accident Report Form
F004 - Safety Committee Accident Report
F005 - Ergonomic Report For Job Task Form
F006 - Safety Violation Form
F007 - Respirator Training and Issuance Form
F008 - Emergency Response Personnel – CPR-AED-First Aid List
F009 - Fire Drill Report Form
F010 - Lockout Tagout Form
F011 - Lockout Tagout Device Use Log
F012 - Lockout Tagout Energy Source Log
F013 - Lockout Tagout Specific Energy Control Procedure Form
F014 - Lockout Tagout Lock Assignment Log
F015 - Emergency Eyewash and Shower Inspection Checklist
F016 - HAZMAT Label Template Form
F017 - Safety Inspection Form
F018 - Hepatitis B Consent Form
F019 - Sharps Injury Log
F020 - Bloodborne Exposure Incident Form
F021 - Post Exposure Evaluation Report for BBP Accident
F022 - Workstation Ergonomics Request for Assessment Form
F023 - Confined Space Entry Permit
F024 - Ladder Inspection Checklist
F025 - Training Sign-In Record
F026 – Hot Work Permit
4078 - Respirator Fit Test Form
MNFR01 - First Report of Injury Form Example
OSHA Respirator Medical Evaluation Questionnaire Form
OSHA300 Log of Work-Related Injuries and Illnesses Form
Safety Manual
Safety Manual
Safety Director Copy
SAFETY MANUAL CHANGE HISTORY
CHANGE
NO. DESCRIPTION OF CHANGE NAME TITLE DATE
1
Updated Title from “Safety Manual”
to “Safety Handbook”; revised
format, added change history.
DeMars Public Works Asst 07/05/22
2
Phase out “Safety Handbook”,
overhaul Safety Manual, submit to
council.
DeMars Public Works Asst 02/07/23
3
4
5
6
7
8
9
10
SAFETY MANUAL CHANGE HISTORY
CHANGE
NO. DESCRIPTION OF CHANGE NAME TITLE DATE
11
12
13
14
15
16
17
18
19
20
STATEMENT OF SAFETY POLICY
The City of Medina is dedicated to the protection of our employees from occupational injuries
and illnesses. This safety program has been developed to assure compliance with all State and
Federal OSHA regulations.
Providing a safe place to work, the proper protective equipment and training, and a work
environment conducive to safe work practices and policies is the responsibility of the
Administration.
Employees have and must assume the responsibility for working safely. Compliance with our
written Safety Manual is a condition of employment. To ensure cooperation, please complete the
Safety Acknowledgment Form in Section 3.
The joint cooperation of employees and administration in observance of this policy will help
provide safe working conditions, help reduce work related accidents, and will be to the mutual
advantage of all.
By ______________________________
Scott T. Johnson, City Administrator
MINNESOTA AWAIR
02.07.2023
MN AWAIR Page 1 of 6
1.00 POLICY
A Workplace Accident Injury Reduction (AWAIR) policy has been developed to promote safe
and healthful working conditions. OSHA compels employers to furnish a place of employment
free from recognized hazards that are causing or likely to cause death or serious injury or harm to
its employees. This policy applies to all employees and meets the requirements of Minnesota
Statute § 182.653, subd 8.
1.05 SAFETY PROGRAM OBJECTIVES
The objective of the AWAIR program is to provide a safe and healthful workplace, to comply
with State and Federal OSHA regulations and insurance requirements, and to reduce the
frequency and severity of Workers' Compensation accidents. These objectives can be achieved
by recognizing and managing our workplace hazards and by increasing the safety awareness of
all our employees.
To assure the success of the City of Medina AWAIR program and to promote a safe and
healthful working environment; managers, supervisors, and employees must accept
responsibility for implementing the AWAIR program.
Each employee is required to read the safety manual and is responsible to work and act in the
manner set forth in the manual. All new employees must sign the Safety Acknowledgement
Form1 verifying that they have read and understand our safety policy.
1.10 RESPONSIBILITIES
Administration:
1. Delegate safety responsibilities to all employees.
2. Allocate resources for safety-money, personnel, and materials.
3. Establish the safety committee and a safety director.
4. Support safety efforts by setting a safe example and participating visibly in safety
activities.
Human Resources:
1. Notify Safety Committee members of new hires so training roster(s) are updated.
2. File the Workers Compensation First Report of Injury Form1 and complete the OSHA
300 Log1 as required by the workers compensation law.
Safety Director:
1. Chair Safety Committee meetings.
2. Assure safety equipment and personal protective equipment is available and used.
MINNESOTA AWAIR
02.07.2023
MN AWAIR Page 2 of 6
3. Evaluate hazards in the workplace by making periodic safety inspections and analyzing
hazards of high-risk jobs and document on the Safety Inspection Form1.
4. Determine safety training for employees.
5. Conduct Accident Investigations promptly.
a. Review accident reports to confirm a root cause was identified.
b. Decide whether the suggested corrective action is appropriate and that it was
implemented.
Safety Committee:
1. Hold regular safety meetings.
2. Review accident reports for consensus of cause of accident and recommendation for
prevention of similar accident/injury.
3. Maintain a ‘hazard list’. This list will not be inclusive of all hazards and must be updated on
a regular basis.
4. Complete the Safety Committee Accident Report Form1 (and Ergonomic Report for Job Task
Form1, if applicable.)
Supervisor:
1. Be familiar with and enforce all general and department safety regulations.
2. Motivate employees by recognizing safe work practices and correcting unsafe practices.
3. Assure all injuries are reported and treated promptly.
4. Participate in the accident investigation procedure and complete the Supervisor’s
Accident Report1 and Workers Compensation First Report of Injury Form1.
a. Gather and analyze all factual information from the accident investigation and
determine a cause-and-effect relationship.
b. Provide tools, equipment, training, or process changes to prevent accident
recurrence.
c. Arrange for appropriate medical care if an employee requires medical treatment.
Employee:
1. Know all general safety rules and comply with them.
2. Know all safety rules that directly pertain to your job and comply with them.
3. Use all required safety devices and protective equipment, where applicable.
4. Report accidents and injuries to supervisor immediately.
a. Notify Human Resources if medical attention is required after leaving work.
b. Keep the City informed of your situation by calling daily.
c. Participate in the accident investigation procedure.
5. Notify the Safety Director of any unsafe acts or conditions immediately.
6. Utilize the suggestion box located in the breakroom(s) to report safety concerns.
7. Participate in safety training and safety inspections.
a. Talk to your supervisor if unable to attend training, or with any questions.
MINNESOTA AWAIR
02.07.2023
MN AWAIR Page 3 of 6
1.15 MANAGEMENT CONTINUED PARTICIPATION
Manager’s continued participation in the AWAIR program is demonstrated by the following
activities:
1. Implementation of the AWAIR program and other safety policies.
2. Evaluating the safety program on an annual basis by conducting an audit of safety
activities in the areas of:
a. Training, safety committee activities, accident investigations, hazard notification,
and accident recordkeeping.
b. Goals and objectives for the program will be evaluated annually to see if program
direction must be changed.
3. Managers will demonstrate commitment to safety by:
a. Listening and responding to safety concerns of employees and correcting safety
hazards in a timely manner,
b. Evaluating work areas to identify high hazard jobs, conducting hazard assessment
on these high hazard jobs, participating in safety activities, and providing safety
training.
1.20 JOB SAFETY ASSESSMENT PROCEDURE
Identification, analysis, assessment, and control of workplace hazards and potential hazards are
critical to success of the safety program. Job Safety Assessment (JSA) is a review of job
methods and hazards that might affect employee safety. These hazards may have developed after
the task has started or after changes in tasks or may have been overlooked in the design of the
tools or machinery, workstation, or work area. Once understood, solutions can be developed to
eliminate the hazards.
The City looks to develop an assessment for all tasks. A JSA shall be performed by:
1. Selecting a task.
2. Breaking the task into performance steps.
3. Identifying tools and materials for that step.
4. Identifying hazard potential for each step.
5. Developing procedures to eliminate any hazards.
Employees are required to cooperate during the safety assessment.
1.25 JOB HAZARD ASSESSMENT AND CONTROL
A survey of work areas will be made to identify routine hazards that could be encountered by
employees. This list will identify work area or activity, hazards, and controls for the hazard.
Additionally, workplace hazards will be identified through a periodic review of accident records;
first reports of injury, OSHA 300 log, safety inspections, and employee suggestions. Workplace
MINNESOTA AWAIR
02.07.2023
MN AWAIR Page 4 of 6
hazards will be documented on the Job Hazard Assessment Form1. Completed forms make up
the ’Hazard List’ and will be retained in the Safety Director copy of the Safety Manual.
Job Hazard Assessment could be performed on those jobs which present high hazard, high
frequency or accidents, or high severity of accidents.
Each process shall be broken down into three steps:
1. Sequence of job processes and materials.
2. Potential hazards which could lead to accidents.
3. Procedures or protection which could be used to control hazards.
Hazards will be eliminated or controlled by correcting hazards found through safety inspections
and hazard notices, providing proper personal protective equipment, supervisor enforcement of
safety policies and procedures, and training programs developed to address specific safety
concerns.
Preventative maintenance inspections should be conducted on equipment by Public Works.
Appropriate PPE should be provided along with instituted programs for fitting, use, cleaning,
maintenance, and replacement of equipment.
Ongoing inspections and monitoring programs should be conducted to identify and control
changing job hazards.
1.30 COMMUNICATION AND TRAINING
The AWAIR program will be communicated to all affected employees by a variety of
techniques:
1. Safety information will be communicated through one-to-one safety contacts, safety
meetings, posters, bulletin boards, video training, and safety orientation.
2. All training meetings will be documented. The date of meeting, name of instructor,
subject discussed, and names of employees attending the meeting will be documented.
1.35 ACCIDENT INVESTIGATION
The purpose of accident investigation is prevention of similar accidents – not to fix blame for the
accident. The cause of accidents must be determined, corrective action identified and
implemented. Accident investigation is a team effort to identify the cause of accidents and
eliminate or control the hazards by engineering or administrative procedures. All investigations
will conclude with the implementation of a corrective action.
MINNESOTA AWAIR
02.07.2023
MN AWAIR Page 5 of 6
1.40 ACCIDENT INVESTIGATION PROCEDURE
Accidents and incidents should be investigated as soon as circumstances permit. Medical
treatment must never be delayed because of an investigation. Investigation shall begin
immediately after the accident.
The manager and safety director shall be in charge of the investigation team. Supervisors are
responsible for their personnel, work area, and specific work. The supervisor deals with the
employees on a regular basis. The supervisor is held accountable for the employees’ productivity
and should be responsible for their safety practices and procedures. They must know how to
obtain the investigative information needed and will give corrective suggestions. The accident
investigation should include the following information:
1. A description of the injury(ies), including a description of what injury(ies) were sustained
by the employee.
2. A description of any property damage.
3. A description of the employee’s actions before the accident, including all tools and
machinery used.
4. A description of the accident (e.g., unsafe act, condition, or defective equipment).
5. A description of what corrective action will prevent the accident from reoccurring.
1.45 ACCIDENT RECORDS AND ASSESSMENT
Accident records are essential to efficient and successful safety work, just as records of
production, costs, sales, and profits and losses are essential to efficient and successful operation
of a business. Records are the foundation of a scientific approach to safety. Accident records are
prepared to direct attention to hazardous conditions and unsafe acts so that recurrence of the
accident can be prevented, judge the effectiveness of the safety program, and to create interest in
safety among workers and supervisors concerning the safety record of the workplace.
There are three important steps in developing adequate information about an employee’s
accident experience:
1. Obtain a report on every injury including first aid cases.
2. Classify and record each injury.
3. Prepare a quarterly summary of report of circumstances and causes of accidents and
correction action.
1.50 ENFORCEMENT
The enforcement of the AWAIR program is critical if an effective program is to be achieved.
Safety violations will be handled by a progressive disciplinary procedure. Union employees
MINNESOTA AWAIR
02.07.2023
MN AWAIR Page 6 of 6
will follow disciplinary procedures identified in union contract.
Managers and supervisors shall have primary responsibility of communicating and enforcing the
safety policy with all employees working under them. Supervisors are responsible for the safety
of persons within their area, regardless of whether the employee reports to him/her or to another
supervisor.
A sample enforcement procedure is listed below:
1. The Safety Violation Form1 will be completed when there is concern over any
misunderstanding of safety policies or procedures; this form must be signed by both
supervisor and employee.
a. First Offense – verbal warning.
b. Second Offense – verbal and written warning with a copy of the written warning
becoming a part of the employee’s file.
c. Third Offense – one day off work with no pay.
d. Fourth Offense – possible employment termination.
2. NOTE: Serious offenses may result in immediate termination.
The purpose of holding employees accountable is to help employees conform to City policy and
to help them work safely. It is not designed to end employment and, therefore, employees may
be given the opportunity to start over with a first offense after one year of no violations at the
discretion of the City Administrator.
1.55 FORMS
1Refer to the Safety Manual Appendix for all forms.
F001 - Safety Acknowledgement Form
F002 – Job Hazard Assessment Form
F003 - Supervisor’s Accident Report
F004 - Safety Committee Accident Report
F005 - Ergonomic Report For Job Task
F006 - Safety Violation Form
F017 – Safety Inspection Form
MNFR01 - Workers Compensation First Report of Injury Form (example)
OSHA300 – Log of Work Related Injuries and Illnesses
SAFETY COMMITTEE
Safety Committee 02.07.2023
Page 1 of 2
The Safety Committee is appointed by the City Administrator and headed by a Safety Director.
1.00 COMMITTEE MEMBERS
1. Greg Leuer (Safety Director)
2. Lisa DeMars
3. Anne Klaers
4. Caitlyn Walker
The Safety Committee shall meet quarterly and discuss:
1. All employee safety suggestions from the suggestion box.
2. Report on safety tour(s) performed by committee member(s) before the meeting.
3. Any employee injury investigations.
4. Safety Calendar of Tasks2.
1.05 RESPONSIBILITIES
Safety Committee:
1. Maintain the safety manual in an up-to-date condition.
2. Review accident reports and complete the Safety Committee Accident Report Form1 (and
Ergonomic Report for Job Task Form1, if applicable), for consensus of cause of accident
and recommendation for prevention of similar accident/injury.
3. Serve as the Threat Assessment Team and address any violent act that has been reported
since the next meeting and give training recommendations to employees.
4. Post minutes of the Safety Committee Meetings on the employee bulletin board.
5. Maintain and complete tasks on the Safety Calendar of Tasks1 list.
Safety Director:
1. Notify personnel of upcoming training.
2. Keeping an up-to-date list of facility personnel and all training records such as training
roster, quizzes, and manuals.
3. Maintain all Safety Data Sheets (SDS).
4. Advise the City Administrator of all safety compliance issues.
5. Chair the Safety Committee.
6. Head Accident Investigation Teams.
7. Perform walkthroughs of City owned facilities, document on Safety Inspection Form1.
8. Review accident reports to conclude a root cause was identified and decide whether the
suggested corrective action is appropriate.
9. Serve as the Violence Response Coordinator.
SAFETY COMMITTEE
Safety Committee 02.07.2023
Page 2 of 2
1.10 APPENDIX REFERENCES
2Appendix A - Safety Calendar of Tasks
1.15 FORMS
1Refer to the Safety Manual Appendix for all forms.
F004 - Safety Committee Accident Report
F005 - Ergonomic Report For Job Task
F017 - Safety Inspection Form
F024 - Safety Calendar of Tasks
Safety Calendar of Tasks - Appendix A 02.07.2023
Page 1 of 3
Safety Calendar of Tasks
Task Quarter
Due Owner
Safety
Manual
Section
Notes Date
Complete
On-board new employee hires: MN AWAIR/Emergency
Response/Fire Prevention, Hazcom & GHS, BBP,
Accident Prevention ALL Safety Director
H.R. ALL
ascertain signed manual acknowledgment, add
employee to training distribution lists (internal, LMC,
Mn Safety Council, etc.), send Respect in the
Workplace annual training email, City apparel email,
safety training MSC viewer access email
Review Safety Manual to assure it remains up-to-date
ALL Safety
Committee ALL
Safety Committee to handle ongoingly, via email
correspondence and/or in quarterly meetings. NOTE:
any safety committee member changes will
necessitate update to the "Safety Committee" Section
of the safety manual.
Maintain Job Hazard List ALL Safety
Committee MN Awair First, review existing list, make modifications, retain
master list in Safety Director's manual
Hold Regular Safety Meetings ALL Safety
Committee ALL
Review Fire Drill Report Forms ALL Safety
Committee
Fire
Prevention
Safety Director performs fire drills, Safety
Committee reviews reports for support measure.
Address any violent act reported since last meeting ALL Safety
Committee
Violence
Prevention
See section 1.25 in Violence Prevention Section for
guidance
Monthly Elevator Phase I & Phase II checks
ALL Safety Director Elevator
Outside service provides quarterly checks,
department of labor mandates monthly checks. The
City was cited in 2022, adding to task list as a group
reminder.
Review Evacuation Maps Annually
1 Safety Director Emergency
Evacuation
make sure posted maps have a "YOU ARE HERE"
sticker. Any emergency tele# must also be updated in
PW ERP and forwarded to POL for their ERP
Safety Calendar of Tasks - Appendix A 02.07.2023
Page 2 of 3
Safety Calendar of Tasks
Task Quarter
Due Owner
Safety
Manual
Section
Notes Date
Complete
Conduct annual checks of facilities to ensure that the
labels and other forms of hazardous warnings are up to
date and not defaced or removed and document on the
Safety Inspection Form
1 Safety Director HazCom /
RTK
the standard reads it must be performed annually,
added to the facility inspection form.
Order annual fire extinguisher and fire sprinkler
suppression inspections 1 Safety Director Fire
Prevention
Standard reads annual inspections must be
performed by outside service. (fire sprinkler
inspections are a requirement of building/fire code
vs OSHA)
Offer 1st Aid Training Classes for employees 2x year
2 Safety Director 1st Aid /
CPR
Current employee lists expire Nov 2024 and Feb
2023. NOTE: all first responders (POL & PW)
must maintain certifications
Ensure eyewash/shower have current inspection tag for
the year 2 Safety Director
Emergency
Eyewash &
Shower
Safety Director performs monthly, Safety
Committee supports review.
Conduct annual violence survey review
3 Safety
Committee
Violence
Prevention
H.R. performs employee survey, Safety Committee
reviews results. Per section 1.20, provide training
for employees and supervisors - safety committee
agreed to utilize video training courses.
Annual Evaluation of the Safety Program 3 Safety
Committee
MN Awair
Management
Forward/share with management staff so section
1.15 is completed.
Review specific LOTO Procedures and document on
form F012, Energy Source Log 3 Safety Director Lockout
Tagout
Safety Director performs annually, Safety
Committee supports review.
Conduct Risk assessments that identify locations and
tasks that require fall protection 3 Safety Director Fall
Protection
Safety Director performs ongoingly, Safety
Committee supports review.
Ensure that mobile elevating work platform(s) (MEWP)
are inspected on an annual basis. 3 Safety Director Fall
Protection
Safety Director performs annually, Safety
Committee supports review.
Safety Calendar of Tasks - Appendix A 02.07.2023
Page 3 of 3
Safety Calendar of Tasks
Task Quarter
Due Owner
Safety
Manual
Section
Notes Date
Complete
Confirm building(s) cleaning schedule
4 Safety
Committee
BBP & Slip
Trip Fall
City Clerk administers cleaning contract, Safety
Committee confirms compliancy with BBP section 5.
Housekeeping and Slip, Trip, Fall Section 1.15 Floor
Maint Procedures
Review Exposure Control Plan annually 4 Safety Director BBP Safety Director reviews policy, Safety Committee
supports review.
Review Electrical Safety Plan annually 4 Safety Director Electrical
Safety
Safety Director reviews policy, Safety Committee
supports review.
Conduct an annual review, that may include employee
surveys, of the Ergonomic program. 4
Safety Director
Human
Resources
Ergonomics
SAFETY RULES AND WORK INSPECTIONS
02.07.2023
Safety Rules Page 1 of 2
1.00 BASIC SAFETY RULES
Through several years of investigating accidents and research in the field of accident
reconstruction, leaders in the field of occupational accident prevention have concluded that there
are specific reasons why accidents occur. They found that work safety is dependent on worker
behavior and human factors. For the protection of everyone, all employees shall abide by the
following basic safety rules:
1. Report all accidents immediately to your supervisor, no matter how slight.
2. Never attempt to clean-up a chemical spill.
a. If you find a chemical spill, guard the area to prevent accidental contact by another. Send
a fellow employee to notify a supervisor and get personnel trained in clean-up procedures
and proper safety spill controls, continue to guard the area until the spill is cleaned up.
b. If you are responsible to clean-up chemical spills, follow the Safety Data Sheet (SDS)
procedure for clean-up and disposal of the spilled chemical.
c. Refer to Section 1, Chapter 5, for a thorough explanation of Safety Data Sheets, the
Hazard Communication Standard, the Globally Harmonized System, and the Worker
Right-To-Know Program.
3. No employee shall transfer any chemical to a secondary bottle without first checking the SDS
sheet, properly labeling the secondary bottle and placing a SDS sticker on that bottle. They
shall then place their initials on that secondary label.
4. Wear goggles, face shield and gloves whenever pouring or handling solvents or chemicals.
a. Upon contact with a chemical, an employee shall go to an eyewash area or sink and rinse
the affected eye(s) for a full fifteen (15) minutes with water. If there is eye or lung
contamination, seek immediate professional advice.
5. Wear safety glasses where indicated and assure any visitor you take into any signed area
wears safety glasses as indicated.
6. No running will be allowed in any part of the building(s).
7. All horseplay must be avoided to prevent serious injury.
8. Use all guards and machine safeguards that are provided on any equipment. Removal of any
guards from any machine or area will result in disciplinary action. Machines must not be
modified in any way without a supervisor’s approval.
9. Report any machine, fan, or ventilation that appears not to be working or working
incorrectly.
10. Report all hazards or potential hazards to your supervisor or the safety director immediately.
11. Use the suggestion box to suggest possible improvements to employee health and safety.
12. Store waste, oil rags, and flammables only in the receptacle designed and provided for that
purpose. DO NOT hang rags on machinery. Rags must be disposed of regularly.
13. Respirators shall be worn where indicated and clean and stores properly after each shift.
SAFETY RULES AND WORK INSPECTIONS
02.07.2023
Safety Rules Page 2 of 2
14. No material will be stacked higher than six (6) feet from the floor without a supervisor’s
approval.
15. No boxes, carts, or equipment will be left in aisle that could cause blockage of the aisle or a
tripping hazard to others.
16. No cords shall be strung across walkways, even temporarily.
17. Compressed air shall never be used to clean off your clothing or another’s clothing. Gloves
shall be worn when pointing compressed air at one’s hands while cleaning off a piece of
product or equipment.
18. No employee shall drive any heavy equipment unless they are trained to do so, nor shall any
drivers give a ride to another. Driver shall obey all driving rules.
19. All hand tools shall be unplugged when not in use.
20. All employees shall wear protective gloves if assisting another in first aid. All blood spills
should be reported to a supervisor so they can be cleaned properly. Any contaminated
machinery shall be locked and tagged out, and properly sanitized before reuse.
21. Obey all WARNING, DANGER, and informational signs. DO NOT cover or remove them.
22. The use of intoxicating beverages or the use of drugs in any amount during work hours on
the premises, or reporting to work under the influence of intoxicants, is cause for termination.
23. Supervisors must okay the use of any radios or recorders. Any combination of noise exposure
may not exceed recommended levels.
24. Do not attempt to repair or adjust any machine, electrical equipment, or tools unless you are qualified
to do so. Notify your supervisor if machinery is not working properly.
25. Shut off any equipment when left unattended.
26. Never block access to electrical panels or switches, first aid cabinet, fire extinguishers, exits,
aisles, or stairways.
1.05 WORK INSPECTIONS
All employees shall have regular supervision and work inspections. These inspections shall be at
a minimum annually. These inspections shall ensure that all employees are complying with all
safety requirements of the City of Medina. Employees shall be retrained if:
1. Inspection shows that the employee is not complying with City safety regulations.
2. New technology or types of equipment or changes or procedures are introduced by the
City.
3. Safety practices not normally used are required for a specific job.
EMERGENCY EVACUATION PLAN
02.07.2023
Emergency Evacuation Page 1 of 5
1.00 POLICY
The Emergency Evacuation policy has been developed to prepare personnel for an evacuation
situation so they can vacate in a safe and effective manner. This plan covers two types of
emergency situations: fire and severe weather. This policy applies to all employees and meets
the requirements of OSHA Standard 29 CFR § 1910.38 (e) and § 1926.35 (e).
1.05 CRISIS MANAGEMENT TEAM
A Crisis Management Team has been established and trained to take charge of the evacuation
command center and give direction to employees during an emergency. The following personnel
make up the Crisis Management Team:
1. City Administrator and Public Information Lead 763-473-4643/612-290-9791
2. Police Chief 763-473-9209/612-290-5592
3. Public Works Director 763-473-8842/612-290-2220
4. Safety Director 763-473-4643/612-290-1746
5. Public Works Foreman 612-685-6827
6. Planning Director 763-473-8846
1.10 EMERGENCY RESPONSE PERSONNEL
Emergency Response Personnel1 are trained for general First Aid, CPR, AED, and Bloodborne
Pathogen procedures. A list of trained personnel is provided in the safety manual and in First
Aid Cabinets.
1.15 EMERGENCY EVACUATION FLOORPLANS
Emergency evacuation floorplans2 are posted near exits and in hallways of each building.
Evacuation floorplans are to be reviewed by the Safety Director annually or whenever a change
occurs.
EMERGENCY EVACUATION PLAN
02.07.2023
Emergency Evacuation Page 2 of 5
1.20 EMERGENCY EVACUATION AND SEVERE WEATHER PLAN
City Hall Building:
Evacuation Command Center Locations:
Weather: Lower Level Hallway (nearest restrooms)
Fire: Primary Location - Log Cabin
Secondary Location - Storage Shed (Old Public Works Shop)
Communication Equipment:
Severe weather alerts
Supplies:
Emergency Response Personnel
Crisis Management Team
Means of Informing Employees:
Shoutout/yell (i.e. FIRE) and/or call on phone if time permits
Equipment List:
Water: Well – shut off is in furnace room
Gas: CenterPoint – shut off is on west side of building
Electrical WHE – shut off is on west side of building
Fire Extinguishers: several locations within City Hall
First Aid Cabinets: Council Chambers and Planning
Public Works / Police Building:
Evacuation Command Center Locations:
Weather: Police – lunchroom
Public Works - Lower-Level Hallway (nearest restrooms)
Fire: Primary Location – West Berm
Communication Equipment:
Mobile units and severe weather alerts
Supplies:
Emergency Response Personnel
Crisis Management Team
Public Works Safety Cabinet
Means of Informing Employees:
Shoutout/yell (i.e. FIRE) and/or call on phone if time permits
Alarm System:
Fire alarm system
Equipment List:
Water: PIV – shut off is on west side of building in center
Gas: CenterPoint – shut off is on southeast side of building on corner
Electrical Xcel - shut off is on southeast side of building on corner
Fire Extinguishers: several locations within PW/Police and in mobile units
First Aid Cabinets: Public Works and Police
PPE / Health Eqpt: Emergency Personnel
Public Works Safety Cabinet
EMERGENCY EVACUATION PLAN
02.07.2023
Emergency Evacuation Page 3 of 5
1.25 FIRE EVACUATION INSTRUCTIONS
In case of a large fire, immediately stop what you are doing and follow the following procedure:
1. Notify others by yelling “FIRE”.
2. Call 911.
3. If able to do so safely, turn off your equipment and lights, close doors and evacuate to the
evacuation command center location (see evacuation floorplan).
a. At City Hall, the primary evacuation command center is the LOG CABIN. If
smoke is blowing in the direction of the log cabin, evacuate to secondary
evacuation command center which is the storage shed/old public works building.
b. At Public Works / Police, the evacuation command center is on the west berm, out
of the direction of any smoke.
4. A member of the Crisis Team will take charge of evacuation command center, promote
order, and assure employees safety.
5. Stay there until you have been accounted for. Do not leave until your supervisor
releases you.
If you find an incipient fire (one that you believe you can put out with a fire extinguisher), follow
the below procedure:
1. Shoutout/yell “FIRE” and notify your supervisor.
2. Make sure there is not accelerant of flammable chemicals in the area.
3. Be sure your back is to an escape route.
4. Take a fire extinguisher from the wall, check its classification, pull the pin, and aim at the
base of the fire from a distance of eight (8) feet away and sweep back and forth at the
base of the fire.
5. Report the fire to the Safety Director.
If the fire increases in size:
1. Shoutout/yell “FIRE”.
2. Evacuate immediately to the evacuation command center location (see evacuation
floorplan).
3. A member of the Crisis Team will take charge of evacuation command center, promote
order, and assure employees safety.
4. Stay there until you have been accounted for. Do not leave until your supervisor
releases you.
1.30 SEVERE WEATHER EVACUATION INSTRUCTIONS
All employees are responsible for monitoring weather conditions when a potential for a weather
emergency exists. To do so, you are also encouraged to listen for weather alerts on your mobile
phone.
EMERGENCY EVACUATION PLAN
02.07.2023
Emergency Evacuation Page 4 of 5
You will be notified by your supervisor if you need to move to safety. In case of an emergency
(i.e. tornado) proceed to the evacuation command center location as marked on the evacuation
floorplan.
1. Proceed to the evacuation command center location (see evacuation floorplan).
2. Stay away from windows.
3. Remain quiet and await instructions from your supervisor.
4. A member of the Crisis Team will take charge of evacuation command center, promote
order, and assure employees safety.
5. Stay there until you have been accounted for. Do not leave until your supervisor
releases you.
1.35 SUPERVISOR EVACUATION RESPONSIBILITIES
Supervisors shall be trained to assist in evacuations. Supervisors shall review this plan with the
employee at orientation, when his or her designated actions under the plan change, or if this plan
is changed. Supervisors shall also inform employees of the location of this plan throughout the
building. In the event of an emergency where evacuation is necessary:
1. Supervisors shall instruct employees to evacuate immediately to the evacuation command
center location (LOG CABIN at City Hall or WEST BERM at PW/POL).
2. If able to do so safely, supervisors will shut down any equipment that may feed a fire,
shut off well, electric and gas, and report any toxic chemicals released.
3. Supervisors will take roll call of all employees within your department and report to the
Safety Director or Crisis Team Lead on site the total number of people.
4. Supervisors shall provide for first aid and CPR for employees in their care by contacting
emergency services.
EMERGENCY EVACUATION PLAN
02.07.2023
Emergency Evacuation Page 5 of 5
1.40 OTHER EMERGENCY PERSONNEL
1. Utilities:
CenterPoint 612-372-4900
W/H Electric 763-477-3000 or 763-477-3100
Xcel Energy 800-641-4400 or 800-895-1999
2. Fire Chief(s): 911 (Hamel, Loretto, Long Lake, Maple Plain)
3. Medical Facility: 911
763-577-7000 (West Health Urgent Care)
952-993-8900 (Park Nicollet Urgent Care)
763-520-5200 (North Memorial Hospital)
952-993-5000 (Methodist Hospital, St Louis Park)
952-993-7672 (Methodist Hospital, Maple Grove)
4. Police Department: 763-473-9209 (Medina)
952-258-5321 (Henn Co Dispatch)
5. Mayor: 612-385-1342 (Kathleen Martin – EMERGENCY USE ONLY)
6. Public Works: 612-290-2220 (Steve Scherer, Director)
612-282-7020 (P.W. on-call)
7. Public Information Officer: 612-290-9791 (Scott Johnson, City Administrator)
1.45 APPENDIX
2Emergency Evacuation Floorplans are posted near exits and in hallways of each building.
1.50 FORMS
1Refer to the Safety Manual Appendix for all forms.
F008 – Emergency Response Personnel List
Medina City Hall Upper Level
Evacuation Plan
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Evacuation Plan
DESIGNATED EVACUATION MEETING AREA:
At the Berm on the West side of building (out of the direction of smoke)
STORM SHELTER:
In the stairwell outside of the Public Works Break Room
HAZARD COMMUNICATION
Hazard Communication 02.07.2023
Page 1 of 6
1.00 POLICY
The Hazard Communication policy has been developed to ensure that information on the use,
handling, and storage of hazardous chemical substances is made available to all employees who
might be affected by exposure to those materials under normal working conditions of use, or in an
emergency situation, so they are better able to control and protect themselves against those hazards.
This policy applies to all employees and meets the requirements of OSHA Standard 29 CFR §
1910.1200 (h) (1) and statue Minn Statute § 5206.
1.05 DEFINITIONS
Acute health hazard: a hazard that usually occurs rapidly following a brief exposure, such as a
skin rash or eye irritation.
Article: a manufactured item which:
1. is formed to a specific shape and design during manufacture
2. has end use functions dependent upon its shape or design during end use, and
3. under normal use conditions, does not release more than trace amounts of a hazardous
chemical and does not pose a physical hazard or health risk to employees
Chemical: any element, chemical compound or mixture of elements and/or compounds.
Chemical Inventory: a list of hazardous substances located in the workplace.
Chemical manufacturer: an employer with a workplace where chemicals are produced for use
or distribution.
Chemical name: a name that will clearly identify the chemical for the purpose of hazard
evaluation
Chemical manufacturer: an employer with a workplace where chemicals are produced for use
or distribution.
Chemical name: a name that will clearly identify the chemical for the purpose of hazard
evaluation.
Chronic health hazard: a hazard that is continuous and follows repeated long term exposure -
such as lung cancer or kidney disease.
Common name: a brand name used to identify a chemical by other than its chemical name.
Container: a bag, barrel, bottle, box, can, cylinder, drum, reaction vessel, storage tank, or the
like that contains a hazardous chemical.
Exposure: the subjection, or potential of subjection, in the course of employment, to a chemical
that is a physical or health hazard.
HAZARD COMMUNICATION
Hazard Communication 02.07.2023
Page 2 of 6
Foreseeable emergency: any potential occurrence that could result in an uncontrollable release
of a hazardous chemical in the workplace.
Global Harmonized System (GHS): the internationally agreed upon hazard classification and
labeling standard managed by the United Nations.
Hazardous chemical: any chemical that is a physical hazard or a health hazard.
Hazard warning: any words, pictures, symbols or combination or words, pictures, or symbols
appearing on a label or other appropriate form of warning which convey the specific physical or
health hazards.
Hazard Material Identification (Hazmat) Label: a numerical hazard rating compliance aid
that provides information about potential sources of injury.
Health hazard: a chemical for which there is statistically significant evidence based on a least
one study conducted in accordance with established scientific principles that acute or chronic
health effects may occur to exposed employees.
Label: any written, printed, or graphic material displayed on or affixed to containers of
hazardous chemicals.
Non-routine Task: an event or activity that occurs infrequently, therefore, details of the
hazard(s) and protective measures may not be fully developed or known by persons who will
perform the task.
Safety Data Sheet (SDS): a fact sheet that provides workers with specific information on
chemicals that pose a physical, health, or environmental hazard in the workplace.
Physical Hazards: a chemical that acts outside the body to produce a dangerous situation.
Flammable or explosive chemicals pose physical hazards.
Responsible party: someone who can provide additional information on the hazardous chemical
and appropriate emergency procedures, if necessary.
Use: to package, handle, react, emit, extract, generate a byproduct, or transfer.
Worker Right to Know (RTK): a workers rights and entitlement to a safe workplace, free of
known health and safety hazards, and the right to speak up about hazards without fear of
retaliation.
1.10 RESPONSIBILITIES
Safety Director:
1. Issue and administer this program and review it for update, as necessary.
2. Train new employees and employees changing job assignments on this policy before they
begin work.
HAZARD COMMUNICATION
Hazard Communication 02.07.2023
Page 3 of 6
3. Clear the purchase of new chemicals and ensure all containers are labeled in accordance
with this policy.
4. Maintain all Safety Data Sheets (SDS) and ensuring they remain current.
5. Provide, upon request, copies of this written program, including further information about
applicable SDSs, and the Chemical Inventory list.
6. Instruct employees in the use of site or task specific work practices, engineering controls,
and procedures for prevention of, and response to, incidents and exposures involving
hazardous chemicals.
7. Provide hazardous Chemical Inventory list and SDS to supervisors for their work area.
8. Conduct periodic facility audits to assure compliance with this policy and document on
the Safety Inspection Form1.
9. Conduct annual checks of facilities to ensure that the labels and other forms of hazardous
warnings are up to date and not defaced or removed and document on the Safety
Inspection Form1.
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Supervisor:
1. Maintain the hazardous Chemical Inventory list and SDS for their work area, as provided
by the Safety Director.
2. Clear the purchase of any new chemical through the Safety Director and obtain and
forward SDS to the Safety Director
Employee:
1. Read and understand the safety data sheet prior to use of a chemical.
2. Practice safe behavior while working with a chemical.
3. Use applicable PPE as called-out on the SDS.
4. Clear the purchase of any new chemical through the Safety Director and obtain and
forward SDS to the Safety Director
1.15 CHEMICAL INVENTORY
The hazardous substances identified on the Chemical Inventory list can cover a variety of
physical forms including liquids, solids, gases, vapors, fumes, and mists.
The Safety Director is responsible for maintaining the Chemical Inventory3 list which is kept in
the Safety Director copy of the safety manual (located at Public Works) and electronically in
LaserFiche. The list will show the name of the chemical and where in the workplace the
chemical is found. Workers have the right to request copies of the list and the Safety Director is
responsible to ensure that all requests for copies are honored within five (5) business days.
1.20 SAFETY DATA SHEET (SDS)
HAZARD COMMUNICATION
Hazard Communication 02.07.2023
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The Safety Director is responsible for obtaining and maintaining current SDSs at City facilities.
All new chemical procurements must be cleared by the Safety Director.
SDSs will be readily accessible to affected workers and are located at Public Works, Police, City
Hall, community center, well houses, the water treatment plant, and electronically on Laserfiche.
Supervisors shall inform all employees who work with, or who are exposed to chemicals, of the
locations of the safety data sheets within their department or building.
Workers have the right to request copies of SDS. The Safety Director is responsible to ensure
that all requests for copies of the SDS are honored.
Appendix B – OSHA Brief: Hazard Communication Standard: Safety Data Sheets3 describes all
sixteen (16) sections of the SDS, along with their contents.
1.25 HAZMAT LABELING
The Safety Director is responsible for labeling hazardous chemical containers and ensuring that
containers from manufacturers and distributors have the correct, required labels. These labels
should not be removed or defaced unless they are replaced immediately with in-house hazmat
labels1. Each container should be labeled, tagged, or marked in English, and include:
1. Product identifier (name of chemical),
2. A signal word such as "CAUTION," "DANGER," or "WARNING,"
3. A statement or a description of the hazard,
4. Pictogram(s),
5. Instruction for necessary precautions, and
6. Name, address and telephone number of the chemical manufacturer, importer, or other
responsible party.
Label information for a chemical should agree with the chemical’s safety data sheet and workers
should be aware that label information can be verified by referring to the corresponding SDS.
The Safety Director is responsible for ensuring that all hazardous chemicals in containers at the
workplace have proper labels or other forms of warning that are legible, in English and other
languages if applicable, and displayed clearly on the container.
All labels for all hazardous materials shall be checked annually to ensure that the labels and other
forms of hazardous warnings are up to date and not defaced or removed.
1.30 TRAINING
Employees who work with or are potentially exposed to hazardous chemicals on the job will
receive initial training and annual training on the Hazard Communication Standard and the safe
use of hazardous chemicals before starting work. The Safety Director will provide training
whenever a new chemical hazard is introduced or an old hazard changes.
Training may include classroom lecture, video, overhead projections, charts, training materials,
and handouts.
HAZARD COMMUNICATION
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The City strives for clear understanding, safe behavior, and involvement in the Hazard
Communication program. Workers are encouraged to share feedback, suggestions, or questions
with the Safety Director, the Safety Committee, or in the suggestion box located in each
breakroom.
Training Content:
Training may include classroom lecture, video, overhead projections, charts, training materials,
and handouts. Employees will receive training with job changes as well as annual Hazard
Communication training. The training program emphasizes these elements:
1. Summary of the Hazard Communication Standard/GHS 1910.1200
2. What hazardous chemicals are present in operations in employee work areas
3. Chemical and physical properties of hazardous chemicals and how to detect the presence
or release of these chemicals
4. Physical hazards of chemicals
5. Health hazards, including signs and symptoms of overexposure, associated with exposure
to chemicals and any medical condition known to be aggravated by exposure to them.
6. Steps the company has taken to reduce or prevent exposure to hazardous chemicals, such
as engineering controls.
7. Procedures to protect against hazards and exposure, work practices or methods to assure
proper use and handling of chemicals and any required personal protective equipment and
its proper use and maintenance).
8. Procedures for reporting and responding to chemical emergencies.
9. How to read and use both the workplace labeling system and labels received on shipped
containers.
10. The order of information found on SDSs and how to read the information
11. How to access SDSs and the written Hazard Communication Program, including the
Chemical Inventory list.
12. The procedure to train new employees at the time of their initial assignment and when a
new hazard is introduced.
13. Training logs are signed by employees upon completion of their training and are retained
electronically on SharePoint.
14. The Safety Director arranges for appropriate medical attention for any incident which
results in potential overexposure or injury from a hazardous chemical.
Workers are required to cooperate in training activities, develop a working knowledge of the
chemical hazards in their work area, and inform the Safety Director of possible over-exposure.
To protect their own safety and health, workers must use PPE equipment defined in the SDS and
other provided controls.
1.35 NON-ROUTINE TASK HAZARD
In the event of non-routine tasks (i.e. spill cleanup or disposal of outdated products), the Safety
Director must ensure that the affected employee(s) has been properly briefed regarding the
chemical hazards associated with the operation and proper, safe use of all chemicals used before
asking an employee to perform a non-routine task involving hazardous chemicals.
HAZARD COMMUNICATION
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Workers have a conditional right to refuse to work if they believe it will place them in imminent
danger, or if the required information and training has not been provided.
1.40 PURCHSING PROCEDURE
All new and updated chemical material purchases must be reviewed by the Safety Director for
the possible development of personal protection, engineering controls, employee training, and
hazardous Chemical Inventory list / SDS book revision updates.
After the Safety Director clears the chemical purchase, it is the responsibility of the buyer to
follow any procurement instruction (i.e. obtain the SDS).
1.45 OUTSIDE CONTRACTORS
Outside contractors will be informed of any potential hazards they or their employees may face
while working in areas where hazardous chemicals are used. The information shall include
copies of relevant SDS sheets and any additional relevant information. They will also have
access to all SDS sheets of any chemical they could come in contact with.
No employee of the City will, under any circumstances, train directly or indirectly another
employer’s workers.
All contractors working in City facilities will be required to provide copies of SDS sheets for any
hazardous chemicals brought onto premises. This requirement shall be included in the contract
for their services.
1.50 APPENDIX REFERENCES
2Appendix A – Chemical Inventory List
2Appendix B – OSHA Brief: Hazard Communication Standard: SDS
1.55 FORMS
1Refer to the Safety Manual Appendix for all forms.
F016 – In House HAZMAT Label Template Form
F017 – Safety Inspection Form
HAZCOM Appendix A 02.07.2023
Chemical Inventory List
CHEMICAL
NAME LOCATION HAZARD
WARNING
(if applicable)
MSDS OBTAINED
(Yes/No)
BRIEFBRIEF
The Hazard Communication Standard (HCS)
(29 CFR 1910.1200(g)), revised in 2012, requires
that the chemical manufacturer, distributor,
or importer provide Safety Data Sheets
(SDSs) (formerly MSDSs or Material Safety
Data Sheets) for each hazardous chemical
to downstream users to communicate
information on these hazards. The information
contained in the SDS is largely the same as
the MSDS, except now the SDSs are required
to be presented in a consistent user-friendly,
16-section format. This brief provides guidance
to help workers who handle hazardous
chemicals to become familiar with the format
and understand the contents of the SDSs.
The SDS includes information such as the
properties of each chemical; the physical,
health, and environmental health hazards;
protective measures; and safety precautions
for handling, storing, and transporting the
chemical. The information contained in the SDS
must be in English (although it may be in other
languages as well). In addition, OSHA requires
that SDS preparers provide specific minimum
information as detailed in Appendix D of
29 CFR 1910.1200. The SDS preparers may
also include additional information in various
section(s).
Hazard Communication Standard: Safety Data Sheets
Sections 1 through 8 contain general
information about the chemical, identification,
hazards, composition, safe handling practices,
and emergency control measures (e.g., fire
fighting). This information should be helpful to
those that need to get the information quickly.
Sections 9 through 11 and 16 contain other
technical and scientific information, such as
physical and chemical properties, stability
and reactivity information, toxicological
information, exposure control information,
and other information including the date of
preparation or last revision. The SDS must
also state that no applicable information was
found when the preparer does not find relevant
information for any required element.
The SDS must also contain Sections 12
through 15, to be consistent with the UN
Globally Harmonized System of Classification
and Labeling of Chemicals (GHS), but OSHA
will not enforce the content of these sections
because they concern matters handled by other
agencies.
A description of all 16 sections of the SDS,
along with their contents, is presented below:
Section 1: Identification
This section identifies the chemical on the SDS as well as the recommended uses. It also provides
the essential contact information of the supplier. The required information consists of:
• Product identifier used on the label and any other common names or synonyms by which the
substance is known.
• Name, address, phone number of the manufacturer, importer, or other responsible party, and
emergency phone number.
• Recommended use of the chemical (e.g., a brief description of what it actually does, such
as flame retardant) and any restrictions on use (including recommendations given by the
supplier).
1
Section 2: Hazard(s) Identification
This section identifies the hazards of the chemical presented on the SDS and the appropriate
warning information associated with those hazards. The required information consists of:
• The hazard classification of the chemical (e.g., flammable liquid, category1).
• Signal word.
• Hazard statement(s).
• Pictograms (the pictograms or hazard symbols may be presented as graphical reproductions
of the symbols in black and white or be a description of the name of the symbol (e.g., skull
and crossbones, flame).
• Precautionary statement(s).
• Description of any hazards not otherwise classified.
• For a mixture that contains an ingredient(s) with unknown toxicity, a statement describing how
much (percentage) of the mixture consists of ingredient(s) with unknown acute toxicity. Please
note that this is a total percentage of the mixture and not tied to the individual ingredient(s).
Section 3: Composition/Information on Ingredients
This section identifies the ingredient(s) contained in the product indicated on the SDS, including
impurities and stabilizing additives. This section includes information on substances, mixtures,
and all chemicals where a trade secret is claimed. The required information consists of:
Substances
• Chemical name.
• Common name and synonyms.
• Chemical Abstracts Service (CAS) number and other unique identifiers.
• Impurities and stabilizing additives, which are themselves classified and which contribute to
the classification of the chemical.
Mixtures
• Same information required for substances.
• The chemical name and concentration (i.e., exact percentage) of all ingredients which are
classified as health hazards and are:
° Present above their cut-off/concentration limits or
° Present a health risk below the cut-off/concentration limits.
• The concentration (exact percentages) of each ingredient must be specified except
concentration ranges may be used in the following situations:
° A trade secret claim is made,
° There is batch-to-batch variation, or
° The SDS is used for a group of substantially similar mixtures.
Chemicals where a trade secret is claimed
• A statement that the specific chemical identity and/or exact percentage (concentration) of
composition has been withheld as a trade secret is required.
1 Chemical, as defined in the HCS, is any substance, or mixture of substances.
2
Section 4: First-Aid Measures
This section describes the initial care that should be given by untrained responders to an
individual who has been exposed to the chemical. The required information consists of:
• Necessary first-aid instructions by relevant routes of exposure (inhalation, skin and eye contact,
and ingestion).
• Description of the most important symptoms or effects, and any symptoms that are acute or
delayed.
• Recommendations for immediate medical care and special treatment needed, when necessary.
Section 5: Fire-Fighting Measures
This section provides recommendations for fighting a fire caused by the chemical. The required
information consists of:
• Recommendations of suitable extinguishing equipment, and information about extinguishing
equipment that is not appropriate for a particular situation.
• Advice on specific hazards that develop from the chemical during the fire, such as any
hazardous combustion products created when the chemical burns.
• Recommendations on special protective equipment or precautions for firefighters.
Section 6: Accidental Release Measures
This section provides recommendations on the appropriate response to spills, leaks, or releases,
including containment and cleanup practices to prevent or minimize exposure to people,
properties, or the environment. It may also include recommendations distinguishing between
responses for large and small spills where the spill volume has a significant impact on the
hazard. The required information may consist of recommendations for:
• Use of personal precautions (such as removal of ignition sources or providing sufficient
ventilation) and protective equipment to prevent the contamination of skin, eyes, and clothing.
• Emergency procedures, including instructions for evacuations, consulting experts when
needed, and appropriate protective clothing.
• Methods and materials used for containment (e.g., covering the drains and capping
procedures).
• Cleanup procedures (e.g., appropriate techniques for neutralization, decontamination, cleaning
or vacuuming; adsorbent materials; and/or equipment required for containment/clean up).
Section 7: Handling and Storage
This section provides guidance on the safe handling practices and conditions for safe storage
of chemicals. The required information consists of:
• Precautions for safe handling, including recommendations for handling incompatible
chemicals, minimizing the release of the chemical into the environment, and providing advice
on general hygiene practices (e.g., eating, drinking, and smoking in work areas is prohibited).
• Recommendations on the conditions for safe storage, including any incompatibilities. Provide
advice on specific storage requirements (e.g., ventilation requirements).
3
Section 8: Exposure Controls/Personal Protection
This section indicates the exposure limits, engineering controls, and personal protective
measures that can be used to minimize worker exposure. The required information consists of:
• OSHA Permissible Exposure Limits (PELs), American Conference of Governmental Industrial
Hygienists (ACGIH) Threshold Limit Values (TLVs), and any other exposure limit used or
recommended by the chemical manufacturer, importer, or employer preparing the safety data
sheet, where available.
• Appropriate engineering controls (e.g., use local exhaust ventilation, or use only in an enclosed
system).
• Recommendations for personal protective measures to prevent illness or injury from exposure
to chemicals, such as personal protective equipment (PPE) (e.g., appropriate types of eye, face,
skin or respiratory protection needed based on hazards and potential exposure).
• Any special requirements for PPE, protective clothing or respirators (e.g., type of glove material,
such as PVC or nitrile rubber gloves; and breakthrough time of the glove material).
Section 9: Physical and Chemical Properties
This section identifies physical and chemical properties associated with the substance or mixture.
The minimum required information consists of:
• Appearance (physical state, color, etc.); • Upper/lower flammability or explosive limits;
• Odor; • Vapor pressure;
• Odor threshold; • Vapor density;
• pH; • Relative density;
• Melting point/freezing point; • Solubility(ies);
• Initial boiling point and boiling range; • Partition coefficient: n-octanol/water;
• Flash point; • Auto-ignition temperature;
• Evaporation rate; • Decomposition temperature; and
• Flammability (solid, gas); • Viscosity.
The SDS may not contain every item on the above list because information may not be relevant
or is not available. When this occurs, a notation to that effect must be made for that chemical
property. Manufacturers may also add other relevant properties, such as the dust deflagration
index (Kst) for combustible dust, used to evaluate a dust’s explosive potential.
4
Section 10: Stability and Reactivity
This section describes the reactivity hazards of the chemical and the chemical stability
information. This section is broken into three parts: reactivity, chemical stability, and other.
The required information consists of:
Reactivity
• Description of the specific test data for the chemical(s). This data can be for a class or family
of the chemical if such data adequately represent the anticipated hazard of the chemical(s),
where available.
Chemical stability
• Indication of whether the chemical is stable or unstable under normal ambient temperature
and conditions while in storage and being handled.
• Description of any stabilizers that may be needed to maintain chemical stability.
• Indication of any safety issues that may arise should the product change in physical
appearance.
Other
• Indication of the possibility of hazardous reactions, including a statement whether the chemical
will react or polymerize, which could release excess pressure or heat, or create other hazardous
conditions. Also, a description of the conditions under which hazardous reactions may occur.
• List of all conditions that should be avoided (e.g., static discharge, shock, vibrations, or
environmental conditions that may lead to hazardous conditions).
• List of all classes of incompatible materials (e.g., classes of chemicals or specific substances)
with which the chemical could react to produce a hazardous situation.
• List of any known or anticipated hazardous decomposition products that could be produced
because of use, storage, or heating. (Hazardous combustion products should also be included
in Section 5 (Fire-Fighting Measures) of the SDS.)
Section 11: Toxicological Information
This section identifies toxicological and health effects information or indicates that such data
are not available. The required information consists of:
• Information on the likely routes of exposure (inhalation, ingestion, skin and eye contact).
The SDS should indicate if the information is unknown.
• Description of the delayed, immediate, or chronic effects from short- and long-term exposure.
• The numerical measures of toxicity (e.g., acute toxicity estimates such as the LD50 (median
lethal dose)) - the estimated amount [of a substance] expected to kill 50% of test animals in a
single dose.
• Description of the symptoms. This description includes the symptoms associated with
exposure to the chemical including symptoms from the lowest to the most severe exposure.
• Indication of whether the chemical is listed in the National Toxicology Program (NTP)
Report on Carcinogens (latest edition) or has been found to be a potential carcinogen in the
International Agency for Research on Cancer (IARC) Monographs (latest editions) or found
to be a potential carcinogen by OSHA.
5
Section 12: Ecological Information (non-mandatory)
This section provides information to evaluate the environmental impact of the chemical(s) if it
were released to the environment. The information may include:
• Data from toxicity tests performed on aquatic and/or terrestrial organisms, where available
(e.g., acute or chronic aquatic toxicity data for fish, algae, crustaceans, and other plants; toxicity
data on birds, bees, plants).
• Whether there is a potential for the chemical to persist and degrade in the environment either
through biodegradation or other processes, such as oxidation or hydrolysis.
• Results of tests of bioaccumulation potential, making reference to the octanol-water partition
coefficient (Kow) and the bioconcentration factor (BCF), where available.
• The potential for a substance to move from the soil to the groundwater (indicate results from
adsorption studies or leaching studies).
• Other adverse effects (e.g., environmental fate, ozone layer depletion potential, photochemical
ozone creation potential, endocrine disrupting potential, and/or global warming potential).
Section 13: Disposal Considerations (non-mandatory)
This section provides guidance on proper disposal practices, recycling or reclamation of the
chemical(s) or its container, and safe handling practices. To minimize exposure, this section
should also refer the reader to Section 8 (Exposure Controls/Personal Protection) of the SDS.
The information may include:
• Description of appropriate disposal containers to use.
• Recommendations of appropriate disposal methods to employ.
• Description of the physical and chemical properties that may affect disposal activities.
• Language discouraging sewage disposal.
• Any special precautions for landfills or incineration activities.
Section 14: Transport Information (non-mandatory)
This section provides guidance on classification information for shipping and transporting of
hazardous chemical(s) by road, air, rail, or sea. The information may include:
• UN number (i.e., four-figure identification number of the substance)2.
• UN proper shipping name2.
• Transport hazard class(es)2.
• Packing group number, if applicable, based on the degree of hazard2.
• Environmental hazards (e.g., identify if it is a marine pollutant according to the International
Maritime Dangerous Goods Code (IMDG Code)).
• Guidance on transport in bulk (according to Annex II of MARPOL 73/783 and the International
Code for the Construction and Equipment of Ships Carrying Dangerous Chemicals in Bulk
(International Bulk Chemical Code (IBC Code)).
• Any special precautions which an employee should be aware of or needs to comply with, in
connection with transport or conveyance either within or outside their premises (indicate
when information is not available).
2 Found in the most recent edition of the United Nations Recommendations on the Transport of
Dangerous Goods.
3 MARPOL 73/78 means the International Convention for the Prevention of Pollution from Ships,
1973, as modified by the Protocol of 1978 relating thereto, as amended.
6
Section 15: Regulatory Information (non-mandatory)
This section identifies the safety, health, and environmental regulations specific for the product
that is not indicated anywhere else on the SDS. The information may include:
• Any national and/or regional regulatory information of the chemical or mixtures (including any
OSHA, Department of Transportation, Environmental Protection Agency, or Consumer Product
Safety Commission regulations).
Section 16: Other Information
This section indicates when the SDS was prepared or when the last known revision was made.
The SDS may also state where the changes have been made to the previous version. You may
wish to contact the supplier for an explanation of the changes. Other useful information also may
be included here.
Employer Responsibilities
Employers must ensure that the SDSs
are readily accessible to employees for all
hazardous chemicals in their workplace. This
may be done in many ways. For example,
employers may keep the SDSs in a binder or
on computers as long as the employees have
immediate access to the information without
leaving their work area when needed and a
back-up is available for rapid access to the
SDS in the case of a power outage or other
emergency. Furthermore, employers may
want to designate a person(s) responsible for
obtaining and maintaining the SDSs. If the
employer does not have an SDS, the employer
or designated person(s) should contact the
manufacturer to obtain one.
References
OSHA, 29 CFR 1910.1200(g) and Appendix D.
United Nations Globally Harmonized System of
Classification and Labelling of Chemicals (GHS),
third revised edition, United Nations, 2009.
These references and other information
related to the revised Hazard Communication
Standard can be found on OSHA’s Hazard
Communication Safety and Health Topics
page, located at:
http://www.osha.gov/dsg/hazcom/index.html.
Disclaimer: This brief provides a general
overview of the safety data sheet
requirements in the Hazard Communication
Standard (see 29 CFR 1910.1200(g) and
Appendix D of 29 CFR 1910.1200). It does not
alter or determine compliance responsibilities
in the standard or the Occupational Safety
and Health Act of 1970. Since interpretations
and enforcement policy may change over
time, the reader should consult current
OSHA interpretations and decisions by the
Occupational Safety and Health Review
Commission and the courts for additional
guidance on OSHA compliance requirements.
Please note that states with OSHA-approved
state plans may have additional requirements
for chemical safety data sheets, outside of
those outlined above. For more information
on those standards, please visit:
http://www.osha.gov/dcsp/osp/statestandards.html.
This is one in a series of informational briefs highlighting OSHA programs, policies or standards. It does
not impose any new compliance requirements. For a comprehensive list of compliance requirements
of OSHA standards or regulations, refer to Title 29 of the Code of Federal Regulations. This information
will be made available to sensory-impaired individuals upon request. The voice phone is (202) 693-1999;
teletypewriter (TTY) number: (877) 889-5627.
DSG BR-3514 2/2012
www.osha.gov • (800) 321 OSHA (6742)
FIRE PREVENTION
Fire Prevention 02.07.2023
Page 1 of 4
1.00 POLICY
The Fire Prevention policy has been developed to minimize any potential of injury to personnel
or property damage from fire. All flammable and combustible liquids used in any operation
should be used, handled, stored, and transported according to applicable OSHA and
Governmental regulations and standards. Portable fire extinguishers shall be provided for
employee use and selected and distributed based on the classes of anticipated workplace fires and
on the size and degree of hazard which would affect their use. It is important that all fire
prevention methods must be practiced at all times. This policy applies to all employees and
meets the requirements of OSHA Standard 29 CFR § 1910.39 and § 1910.157 (g).
1.05 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Supervisor:
1. Perform regular inspections of the premises to assure there is no accumulation of
flammable and/or combustible materials or residues.
Employee:
1. Work safely and report all dangerous situations or potential fire hazards to supervisor.
Safety Director:
1. Ensure the proper placement of fire extinguishers on City property.
2. Ensure fire drills are regularly performed and documented on the Fire Drill Report Form1.
3. Ensure fire extinguisher inspections are performed internally on a monthly* basis.
*Monthly Fire Extinguisher Inspection Responsibility By Location:
Public Works and HCB: Safety Director
City Hall: **City Clerk / Assistant to City Administrator
Police: **Police Administrative Assistant
**Responsible to notify Safety Director of maintenance needed
4. Ensure fire extinguisher and fire sprinkler suppression inspections are performed by an
outside service on an annual basis.
1.10 GENERAL RULES
1. Smoking is prohibited on City owned property.
2. All incoming containers of flammable or combustible material are to be stored in the safety
cabinet.
FIRE PREVENTION
Fire Prevention 02.07.2023
Page 2 of 4
3. All metal containers of flammable or combustible material in the chemical storage area are to
be grounded.
4. Use approved safety cans for handling or transferring flammable or combustible liquids.
5. Flammable or combustible containers are to be clearly labeled.
6. Upon receipt of flammable or combustible liquids, they should promptly deliver to the safety
cabinet. These liquids should not be left on the receiving dock or in the aisles.
7. Rags and other absorbent materials that become contaminated with flammable or
combustible material should be disposed of in cans with self-closing lids.
8. Fire extinguishers and fire hoses are to be in their proper places. Access to this equipment
must not be obstructed.
1.15 GENERAL FIRE RESPONSE INSTRUCTIONS
Refer to the Emergency Evacuation Policy in this Safety Manual if fire or smoke is detected:
If you find large fire, immediately stop what you are doing and follow the following procedure:
1. Notify others by yelling “FIRE”.
2. Call 911.
3. If able to do so safely, turn off your equipment and lights, close doors and evacuate to the
evacuation command center location (see evacuation floorplan2).
a. At City Hall, the primary evacuation command center is the LOG CABIN. If
smoke is blowing in the direction of the log cabin, evacuate to secondary
evacuation command center which is the storage shed/old public works building.
b. At Public Works / Police, the evacuation command center is on the west berm, out
of the direction of any smoke.
4. A member of the Crisis Team will take charge of evacuation command center, promote
order, and assure employees safety.
5. Stay there until you have been accounted for. Do not leave until your supervisor
releases you
If you find an incipient fire (one that you believe you can put out with a fire extinguisher), follow
the following procedure:
1. Shoutout/yell “FIRE” and notify your supervisor.
2. Make sure there is not accelerant of flammable chemicals in the area.
3. Be sure your back is to an escape route.
4. Take a fire extinguisher from the wall, check its classification, pull the pin, and aim at the
base of the fire from a distance of eight (8) feet away and sweep back and forth at the
base of the fire.
5. Report the fire to the Safety Director.
If the fire increases in size:
1. Shoutout/yell “FIRE”.
FIRE PREVENTION
Fire Prevention 02.07.2023
Page 3 of 4
2. Evacuate immediately to the evacuation command center location (see evacuation
floorplan2).
3. A member of the Crisis Team will take charge of evacuation command center, promote
order, and assure employees safety.
4. Stay there until you have been accounted for. Do not leave until your supervisor
releases you.
1.20 PORTABLE FIRE EXTINGUISHER GENERAL REQUIREMENTS
1. The City of Medina will re-train all employees annually as to the proper use of all classes of
fire extinguishers used at our facility to ensure employees are familiar with the types and
uses of extinguishers.
2. The Safety Director is responsible for placement (no more than 75 feet apart), selection and
maintenance of all fire extinguishers in the City.
3. The Safety Director will ensure all fire extinguishers are to be inspected monthly, as well as
inspected and maintained once per year by an outside service.
4. Employees should notify the Safety Director if they think the amount or the types of fire
extinguishers in their area are inadequate.
1.25 FIRE EXTINGUISHER RATINGS
All fire extinguishers are marked with their gallon and pound capacities. Each fire extinguisher
has an Underwriters Laboratories rating in numerical and alpha form. The numerical rating tells
how many square feet the fire extinguisher can control. The alpha rating indicates which class of
fire it extinguishes. For example, an ABC rated fire extinguisher can be used on Class A, B, and
C fires. Class D fires must be extinguished with Class D fire extinguishers.
1.30 FIRE CATEGORIES
The 5 main classes of fires are categorized by what caused the fire or what the fire uses as fuel,
and are as follows:
1. Class A: Solid materials such as wood or paper, fabric, and some plastics
2. Class B: Liquids or gas such as alcohol, ether, gasoline, or grease
3. Class C: Electrical failure from appliances, electronic equipment, and wiring
**All fire extinguishers classified as “ABC” can be used on ABC class fires
4. Class D: Metallic substances such as sodium, titanium, zirconium, or magnesium
**Class D fires must be extinguished with Class D extinguishers
5. Class K: Grease or oil fires specifically from cooking
**Class K fires must be extinguished with Class K extinguishers
FIRE PREVENTION
Fire Prevention 02.07.2023
Page 4 of 4
When a fire extinguisher is discharged, it loses its ability to put out fires. Therefore, notify the
Safety Director immediately when a fire extinguisher is used so it can be replaced with a charged
one.
1.35 LIST OF MAJOR WORKPLACE FIRE HAZARDS
HAZARD LOCATION
Fuel Tanks Public Works / Police Building
Aerosol Cans Safety Cabinets
Electrical Connections City Hall and Public Works/Police Building
Welding Public Works Shop
1.40 EMPLOYEES RESPONSIBLE FOR CONTROL OF FUEL SOURCES
Those who use fuel tanks.
1.45 APPENDIX EVACUATION FLOORPLAN
2Emergency evacuation floorplans are posted near exits and in hallways of each building.
1.50 FORMS
1Refer to the Safety Manual Appendix for all forms.
F009 Fire Drill Report Form1
VIOLENCE PREVENTION
Violence Prevention 02.07.2023
Page 1 of 3
1.00 POLICY
This policy has been developed to prevent violence in the workplace. The City believes it is of
the utmost importance that all employees feel safe in the workplace and will enforce a “no
tolerance” policy towards any type of violence in the workplace, whether the threat is oral,
gestured, e-mail, phone, on or off the premises. This policy applies to all employees.
1.05 WEAPONS POLICY
Except for licensed peace officers, no employee will possess a weapon while acting in the course
and scope of employment at the City of Medina.
1.10 RISK FACTORS
Factors identified by the National Institution of Occupational Safety and Health may increase a
worker’s risk of being a victim of violence in the City include:
1. Contact with the public
2. Exchange of money
3. Mobile workplace – such as police cruisers
4. Working at night – such as police and fire department
1.15 RESPONSIBILITIES
Administration:
1. Respond promptly to all threats made to its employees. All perceived threats will be
taken seriously, and careful records will be made documenting the investigation.
2. Work with the police department to ensure all acts of violence are reported immediately.
Human Resources:
1. Carefully screen all potential employees for gaps of employment, job hopping and
abandonment of careers to screen for potentially violent persons.
2. Perform credit checks, drug testing, reference checks, employment verification and
criminal background checks, where appropriate, for potential employees.
3. Issue an annual Employee Violence Survey to encourage employees to report any area of
concern they may have regarding safety issues.
4. Review all Employee Violence Surveys each year and respond appropriately to their
content.
5. Identify and record risk levels of jobs and high-risk factors in the workplace.
6. Keep all records of violent acts or threats within our facilities and will give a report to the
safety committee of any report of violence that may appear on OSHA 300 logs, incident
reports, grievance reports, medical, workers comp and insurance records within 30 days.
VIOLENCE PREVENTION
Violence Prevention 02.07.2023
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Employee:
1. Report immediately any act they feel is a threat to their safety or the safety of any other
employee.
2. Report any area within the facility that they feel encourages unsafe acts because of
lighting or remoteness, etc.
3. Fill out and hand in the Employee Violence Survey that they are given each year.
Employees will never be sanctioned for reporting acts they perceive are threatening. There will
be no discrimination allowed by other employees or supervisors for reporting perceived violent
acts.
1.20 TRAINING
All employees will be trained on non-violent response and conflict resolution, the types of
violence, coping with stress at work, the procedure to report violent acts, how to react during a
violent encounter, and City policy regarding threats or violence of any kind. Training records
will be retained with safety training records.
1. Employees will be trained to the correct response and reporting of violence.
2. Supervisors will be trained to recognize violent employee acts and respond quickly to
reports of violence.
3. Supervisors will be trained to potentially defuse violence in their area and report such
acts immediately.
Any report of violence will be forwarded to human resources within four (4) hours of the act
occurring.
1.25 PROCEDURE WHEN THREATENED
If you are threatened in any way, administration requests you:
1. Stay calm.
2. Call 911 if you feel the threat is immediate and/or serious, but not in the presence of the
offender.
3. Look the person in the eye.
4. Keep the offender talking - never use “I” sentences.
5. Do not try to disarm the offender or play the hero.
6. Once the act is over, write down all information as soon as possible after the incident
(time, witnesses, type of threat, if weapons were threatened or present).
7. If the threat was by phone, record any sounds or background noises, the tone of the
offender’s voice, age, gender, etc.
8. Report threat immediately to supervisor or human resources personnel.
VIOLENCE PREVENTION
Violence Prevention 02.07.2023
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1.30 THREAT ASSESSMENT TEAM
The Safety Committee will act as the Threat Assessment Team. The Safety Director will act as
the Violence Response Coordinator. This team will:
1. Address any violent act that has been reported since the last meeting.
2. Give training recommendations to employees.
3. Implement plans for response to violence and communicate these plans to employees.
4. Audit the reports of violent acts each year to see if improvements could be made in
employee security.
5. Do violence assessments regularly of City facilities.
6. Develop a response plan to handle any threat to City buildings or personnel.
7. Suggest security measures or engineering controls that would increase employee safety.
MEDICAL SERVICES AND FIRST AID
First Aid/CPR 02.07.2023
Page 1 of 1
1.00 POLICY
The Medical Services and First Aid policy has been developed to ensure the ready availability of
medical personnel for advice and consultation, and to render first aid. This policy applies to all
employees and meets the requirements of OSHA Standard 29 CFR § 1910.151 (b).
1.05 EMERGENCY RESPONSE PERSONNEL
First Aid / CPR / AED training provides correct knowledge and skills to the trainees for handling
emergency situations and helps them react appropriately without feeling nervous, afraid, or
confused.
Emergency Response Personnel1 are trained for general First Aid, CPR, AED, and Bloodborne
Pathogen procedures. A list of trained personnel is provided in the safety manual and in first aid
cabinets.
First Aid/CPR classes are offered twice each year. If you would like to attend these classes,
please advise the Safety Director.
1.10 MEDICAL EMERGENCY INSTRUCTIONS
The first procedure in an emergency is to call 911, then notify your supervisor of the
pending danger. Do not move the injured or ill person. Enlist the assistance of Emergency
Response Personnel
1.15 FIRST AID CABINETS
First aid cabinets are located in each building and are disinfected on an (at least) monthly basis
and inventoried on a quarterly basis. If supplies are needed, contact the Safety Director.
1.20 EMERGENCY EYE WASH AND SAFETY SHOWER STATIONS
Emergency eye wash and safety shower stations for flushing and quick drenching of the eyes and
body are provided near areas where corrosive materials are used. This equipment is designed to
treat those who have been exposed to corrosive or other injurious chemicals/materials in an effort
to reduce serious or permanent damage to skin or eyes.
1.25 FORMS
1Refer to the Safety Manual Appendix for all forms.
F008 – Emergency Response Personnel List
BLOODBORNE PATHOGENS
Bloodborne Pathogens 02.07.2023
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1.00 POLICY
The Bloodborne Pathogen (BBP) policy has been developed to eliminate or minimize employee
exposure to blood or other potentially infectious materials. This program applies to all
employees who face a reasonably anticipated risk of exposure to BBP in the course and scope of
their work. This policy applies to all employees and meets the requirements of OSHA Standard
29 CFR § 1910.1030 (g).
1.05 DEFINITIONS
Bloodborne Pathogens: pathogenic microorganisms that are present in human blood and can
cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus
(HBV) and human immunodeficiency virus (HIV).
Contaminated: the presence or the reasonably anticipated presence of blood or other potentially
infectious materials on an item or surface.
Contaminated Sharps: any contaminated object that can penetrate the skin including, but not
limited to, needles, scalpels, and broken glass.
Decontamination: the use of physical or chemical means to remove, inactivate, or destroy
bloodborne pathogens on a surface or item to the point where they are no longer capable of
transmitting infectious particles and the surface or item is rendered safe for handling, use, or
disposal.
Exposure Incident: a specific eye, mouth, other mucous membrane, non-intact skin, or
parenteral contact with blood or other potentially infectious materials that results from the
performance of an employee's duties.
Hepatitis B virus (HBV): The most common form of hepatitis; a liver disease that initially
causes inflammation of the liver and frequently leads to more serious conditions, including
cirrhosis and liver cancer. HBV is usually transmitted through mucous membranes or breaks in
the skin. After exposure, it can take two to six months for HBV to develop. The initial symptoms
of HBV infection are like those of a mild case of the flu: fatigue, stomach pain, loss of appetite
and nausea. As the disease progresses, jaundice (yellowing of the skin) and darkened urine will
occur. Although there is no cure, vaccination directly after contact (well before symptoms
appear) can prevent infection.
Human Immunodeficiency Virus (HIV): A bloodborne pathogen that attacks the immune
system. Symptoms of HIV can include weakness, fever, sore throat, nausea, headaches, diarrhea
and some forms of cancer. Many people can go years before showing any symptoms. HIV
eventually may lead to Acquired Immune Deficiency Syndrome (AIDS) and the breakdown of
the immune system. Currently, there is no vaccination against HIV and no proven cure.
However, there have been some major breakthroughs in recent years in controlling HIV and
significantly delaying the onset of AIDS.
BLOODBORNE PATHOGENS
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Occupational Exposure: any reasonably anticipated skin, eye, mucous membrane, or parenteral
contact with blood or other potentially infectious materials that may result from the performance
of an employee's duties.
Other Potentially Infectious Materials:
1. The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial
fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental
procedures, any body fluid that is visibly contaminated with blood, and all body fluids in
situations where it is difficult or impossible to differentiate between body fluids;
2. Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and
3. HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture
medium or other solutions; and blood, organs, or other tissues from experimental animals
infected with HIV or HBV.
Parenteral: piercing mucous membranes or the skin barrier through such events as needlesticks,
human bites, cuts, and abrasions.
Personal Protective Equipment (PPE): specialized clothing or equipment worn for protection
against a hazard.
Sterilize: the use of a physical or chemical procedure to destroy all microbial life including
highly resistant bacterial endospores.
Universal Precautions: an approach to infection control whereas all human blood and certain
human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne
pathogens.
Work Practice Controls: controls that reduce the likelihood of exposure by altering the manner
in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique).
1.10 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Human Resources:
1. Complete all Hepatitis B vaccination processes outlined in this policy.
2. Complete all post-exposure evaluation and follow-up processes outlined in this policy.
3. Maintain all records outlined in this policy and make available, upon request, in
accordance with all OSHA and applicable federal, state, local and HIPPA laws.
4. Implement housekeeping schedule and method of decontamination in City facilities.
BLOODBORNE PATHOGENS
Bloodborne Pathogens 02.07.2023
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Safety Director:
1. Identify job classifications that have a higher risk of exposure to infectious materials.
2. Review and update this policy at least annually and/or whenever necessary.
3. Determine safety training for employees.
4. Complete the Sharps Injury Log, Bloodborne Exposure Incident Form, and Post-
Exposure Evaluation Report for Bloodborne Pathogen Accident Form
Employee:
1. Observe universal precautions, including the use of PPE, to prevent contact with blood or
other potentially infectious materials.
2. Immediately report exposure incidents to the Safety Director and Human Resources.
1.15 OCCUPATIONAL EXPOSURE DETERMINATION
OSHA compels employers to perform an exposure determination to identify workers who have
occupational exposure to blood or other potentially infectious materials.
The following job classifications may have a higher risk of exposure to bloodborne pathogens in
their work:
JOB CLASSIFICATION TASKS / PROCEDURES
First Aid Attendant First aid situations involving blood or body fluids
CPR or rescue
Burn treatment
De-contamination of equipment or accident scene
Cleanup of body fluids
Janitorial Services De-contamination of equipment or accident scene
Cleanup of body fluids
Cleaning and disinfecting restrooms and hand-washing
facilities
Maintenance Services Emptying garbage receptacles
Repairs of equipment or restroom and hand-washing facilities
Emptying public garbage receptacles
Working within storm drains or sewers
Potential occupational exposure to bloodborne pathogens is identified in the Police, Public
Works, and Janitorial departments. Any employee may volunteer to assist co-workers in an
accidental First Aid situation.
The Safety Director is responsible for reviewing and updating this exposure control plan at least
annually and whenever necessary to reflect new or modified tasks and procedures which affect
occupational exposure and to reflect new or revised employee positions with occupational
exposure. The review and update of the plan will:
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Bloodborne Pathogens 02.07.2023
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1. Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens;
2. Consider and implement appropriate commercially available and effective safer medical
devices designed to eliminate or minimize occupational exposure;
3. Include input from employee(s) working within the job classification listed in the
Occupational Exposure Determination.
1.20 UNIVERSAL PRECAUTIONS
Employees shall observe universal precautions to prevent contact with blood or other potentially
infectious materials. Under circumstances in which differentiation between body fluid types is
difficult or impossible, all body fluids shall be considered potentially infectious materials.
1. Personal Protective Equipment:
Employees are responsible to use appropriate PPE such as gloves, face masks and eye protection
whenever an occupational exposure can be reasonably anticipated. The PPE will be considered
appropriate only if it does not permit blood or other potentially infectious materials to pass
through or reach the employee’s clothing, skin, eyes, mouth, or other mucous membranes under
normal conditions of use and for the duration of time which the protective equipment will be
used.
a. Gloves: Gloves are provided in the first aid cabinets and must be worn when it can be
reasonably anticipated that the employee may have hand contact with blood, other potentially
infectious materials, mucous membranes, and non-intact skin; and when handling or touching
contaminated items or surfaces.
i. Employees shall wash their hands and any other skin with soap and water, or flush
mucous membranes with water immediately or as soon as feasible after removal of
gloves or other PPE and following contact of such body areas with blood or other
potentially infectious materials.
ii. If a sink is not available, use antiseptic cleaners or towelettes until washing with soap
and water is possible.
b. Masks and Eye Protection: Masks in combination with eye protection devices, such as
goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever
splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be
generated and eye, nose, or mouth contamination can be reasonably anticipated.
Any PPE will be discarded if it is cracked, peeling, torn, punctured, or exhibits other signs of
deterioration, or when its ability to function as a barrier is compromised. All contaminated PPE
to be disposed of is to be placed in a biohazard bag and disposed of through one of the local fire
departments.
1.25 HEPATITIS B VACCINATION
The City makes available to employees with occupational exposure to bloodborne pathogens
Hepatitis B vaccination. The vaccination consists of a series of three (3) injections over a six (6)
month period of time:
BLOODBORNE PATHOGENS
Bloodborne Pathogens 02.07.2023
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a. Employees working within the job classification listed in the Occupational Exposure
Determination are required to complete and sign the Hepatitis B Consent Form1 to accept or
decline hepatitis B vaccination offered by the City.
i. If the employee initially declines hepatitis B vaccination but at a later date while still
covered under this policy decides to accept the vaccination, the City shall make
available, at no cost, hepatitis B vaccination at that time.
b. If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public Health
Service at a future date, such booster dose(s) shall be made available, at no cost, to
employees covered under this policy.
1.30 POST-EXPOSURE EVALUATION AND FOLLOW-UP
When an employee incurs an exposure, it must be reported immediately to the Safety Director,
so to maintain the Sharps Injury Log1, Bloodborne Exposure Incident Form1, and Post-Exposure
Evaluation Report for Bloodborne Pathogen Accident Form1.
Following a report of an exposure incident, the City shall make immediately available to the
exposed employee a confidential medical evaluation and follow-up, including at least the
following elements:
a. Documentation of the route(s) of exposure, and the circumstances under which the exposure
incident occurred;
b. Identification and documentation of the source individual, unless the City can establish that
identification is infeasible or prohibited by state or local law;
i. The source individual's blood shall be tested as soon as feasible and after consent is
obtained in order to determine HBV and HIV infectivity.
ii. If consent is not obtained, the City shall establish that legally required consent cannot
be obtained.
iii. When the source individual's consent is not required by law, the source individual's
blood, if available, shall be tested and the results documented.
iv. When the source individual is already known to be infected with HBV or HIV, testing
for the source individual's known HBV or HIV status need not be repeated.
v. Results of the source individual's testing shall be made available to the exposed
employee, and the employee shall be informed of applicable laws and regulations
concerning disclosure of the identity and infectious status of the source individual.
c. Collection and testing of blood for HBV and HIV serological status;
i. The exposed employee's blood shall be collected as soon as feasible and tested after
consent is obtained.
ii. If the employee consents to baseline blood collection, but does not give consent at that
time for HIV serologic testing, the sample shall be preserved for at least 90 days. If,
within 90 days of the exposure incident, the employee elects to have the baseline
sample tested, such testing shall be done as soon as feasible.
d. Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public
Health Service;
e. Counseling;
f. Evaluation of reported illnesses.
BLOODBORNE PATHOGENS
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1.35 INFORMATION PROVIDED TO THE HEALTHCARE PROFESSIONAL
1. The City shall ensure that the healthcare professional responsible for the employee's
Hepatitis B vaccination is provided a copy of this regulation.
2. The City shall ensure that the healthcare professional evaluating an employee after an
exposure incident is provided the following information:
3. A copy of this regulation;
4. A description of the exposed employee's duties as they relate to the exposure incident;
5. Documentation of the route(s) of exposure and circumstances under which exposure
occurred;
6. Results of the source individual's blood testing, if available;
7. All medical records relevant to the appropriate treatment of the employee including
vaccination status which are the City’s responsibility to maintain.
1.40 HEALTHCARE PROFESSIONALS’S WRITTEN OPINION
1. The City shall obtain and provide the employee with a copy of the evaluating healthcare
professional's written opinion within 15 days of the completion of the evaluation.
2. The healthcare professional's written opinion for Hepatitis B vaccination shall be limited to
whether Hepatitis B vaccination is indicated for an employee, and if the employee has
received such vaccination.
3. The healthcare professional's written opinion for post-exposure evaluation and follow-up
shall be limited to the following information:
4. That the employee has been informed of the results of the evaluation;
5. That the employee has been told about any medical conditions resulting from exposure to
blood or other potentially infectious materials which require further evaluation or treatment.
6. All other findings or diagnoses shall remain confidential and shall not be included in the
written report.
1.45 HOUSEKEEPING
The City has implemented an appropriate schedule for cleaning and method of decontamination
to ensure that facilities are maintained in a clean and sanitary condition.
Restrooms will be cleaned and disinfected:
1. Bi-weekly;
2. Any time blood or other body fluids have been washed into, poured into, or by any other
means discharged into a wash basin or sink;
3. Whenever it is suspected that a wash basin or sink has been contaminated or contaminants
appear to be present.
Cleaning of restroom facilities will be performed by the following personnel only:
1. A qualified and trained employee.
2. An outside cleaning contractor hired to perform such services.
3. Cleaning of restroom facilities shall be performed by using the following procedures:
BLOODBORNE PATHOGENS
Bloodborne Pathogens 02.07.2023
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a. Personnel will wear necessary PPE such as rubber and disposable gloves, face shields,
safety glasses, aprons, etc.
b. Soap and water, followed by a 10:1 water/bleach solution, will be used to thoroughly
clean wash basins, sinks, toilets, urinals, floors, soap dispensers, towel cabinets,
feminine napkin disposal containers, counter tops, etc.
c. All disposable cleaning materials will be placed in a separate plastic bag, sealed, and
placed in a trash container for removal.
d. All contaminated PPE to be disposed of is to be placed in a biohazard bag and disposed
of through one of the local fire departments.
e. Upon completion of cleaning, personnel will immediately wash hands thoroughly with
soap and water.
The following laundry procedures will be followed:
1. Laundry and clothing contaminated with blood or other potentially infectious materials will
be handled as little as possible;
2. An employees clothing which has become contaminated with another individuals blood or
body fluids will be placed in a biohazard bag, sealed, and sent to a uniform rental service
for decontamination and laundering.
First Aid Kits will be cleaned and disinfected:
4. Monthly;
5. Whenever it is suspected that a kit has been contaminated or contaminants appear to be
present.
1.50 SHARPS INJURY LOG
The City shall establish and maintain a Sharps Injury Log1 for the recording of percutaneous
injuries from contaminated sharps. The information in the sharps injury log shall be recorded and
maintained in such manner as to protect the confidentiality of the injured employee; and for the
period required by 29 CFR 1904.33. The sharps injury log shall contain, at a minimum:
a. The type and brand of device involved in the incident,
b. The department or work area where the exposure incident occurred, and
c. An explanation of how the incident occurred.
1.55 TRAINING
The City utilizes work practice controls to eliminate or minimize occupational exposure to
employees. Where exposure remains after institution of these controls, PPE shall also be
utilized.
The City shall train each employee with occupational exposure at no cost to the employee and
during working hours. Employees will receive certified First Aid, CPR and AED training as
well as Bloodborne Pathogen training in accordance with this standard.
BLOODBORNE PATHOGENS
Bloodborne Pathogens 02.07.2023
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The Safety Director shall examine and maintain work practice controls on an annual (at
minimum) schedule, in accordance with the standard.
1.60 RECORDKEEPING
The City shall maintain a record for each employee with occupational exposure. The City shall
ensure that all medical records required by this standard shall be maintained in accordance with
this standard and made available, or transferred, upon request for examination and copying, to
employees and to employee representatives in accordance with all OSHA and applicable federal,
state, local and HIPPA laws.
1.65 FORMS
1Refer to the Safety Manual Appendix for all forms.
F018 Hepatitis B Consent Form
F019 Sharps Injury Log
F020 Bloodborne Exposure Incident Form
F021 Post-Exposure Evaluation Report for Bloodborne Pathogen Accident
CITY VEHICLE USE POLICY
City Vehicle Use 02.07.2023
Page 1 of 2
1.00 POLICY
The City Vehicle Use policy has been developed to maintain a safe vehicle fleet, with concern
for the safety of people and the protection of property. This policy applies to all employees who
operate motor vehicles owned or operated by the City.
1.05 RESPONSIBILITY
Supervision
1) Assure all vehicles are in good repair and maintained in accordance with all OSHA and
DOT regulations.
2) Adequately train all personnel that will be driving City vehicles before they are allowed
to operate each vehicle.
3) Supervise drivers in such a way that their driving is continuously inspected.
Employee
1) Possess a valid Minnesota Driver’s license.
2) Obey all state traffic rules and regulations.
3) Perform daily visual inspections of lights, brakes, horns, turn signals, and tires before the
vehicle is operated and report all unsafe and defective equipment to Public Works.
4) Comply with this policy and follow all Driving Regulations.
1.10 PROCEDURE
Vehicles owned, leased, or rented by the City shall be used only in the discharge and transaction
of City business. It is the responsibility of the employee to follow all city regulations regarding
the driving of city vehicles and report any driving abuses they may see during working hours.
Employees are also responsible to perform visual inspections of lights, brakes, horns, turn signals
and tires before the vehicle is operated. Any deficiencies will be reported to the Public Works
Department to arrange for maintenance or repair.
1.15 DRIVING REGULATIONS
a) Only authorized personnel shall operate city vehicles. All drivers and passengers must
wear seatbelts any time the vehicle is in motion.
b) No vehicle shall be operated that is signed UNSAFE or found to be unsafe.
c) City vehicles shall be refueled only when the engine is off.
d) City vehicles must be off and the key must be removed if the vehicle is left unattended or
parked.
e) All slow-moving vehicles shall use safety flashers when driving on public streets.
f) No more than three persons shall ride in the front seat of any city vehicle.
g) Passengers and drivers of city vehicles must sit in only approved seatbelt locations.
CITY VEHICLE USE POLICY
City Vehicle Use 02.07.2023
Page 2 of 2
h) No person shall ride on any portion of a motor grater, tractor, forklift or similar
equipment except the authorized operator.
i) Drivers shall never permit any city vehicle to be loaded beyond the recommended
capacity of the manufacturer. The driver’s vision shall not be obscured by the load.
j) All tools and equipment shall be securely stored in compartments or fastened down when
the vehicle is in operation.
k) Drivers shall be very cautious when driving near children.
l) Children shall be kept from playing in or around city owned vehicles.
m) Extra caution shall be taken when driving into or near buildings. When near any
building, the driver shall drive slowly.
n) The vehicle must be stopped and parked with engine off before city personnel gets out of
the vehicle.
o) All required PPE shall be worn as recommended by the safety manual.
1.20 BACKING OPERATIONS
a) Backing shall be avoided unless absolutely necessary.
b) Backing shall be done only after the driver has made certain his/her vehicle has adequate
clearance on all sides.
c) Backing shall be done very slowly and with extreme caution.
d) Both sides of the vehicle shall be observed during backing operations.
e) All possible backing shall be done with the use of a signal person.
f) Back up alarms shall be used on all one-ton vehicles.
1.25 MOWERS
The City requires that the following regulations are followed at all times when operating any city
mower. This paragraph includes tractor, self-propelled and push type mowers. Operators shall
inspect each mower before it leaves the shop for:
a) Sparkplug wires, mower blades, housing (for cracks and loose mounting flanges), gears,
pulleys, wheels, handles and bolts (for tightness), etc. to determine their condition.
b) Employee shall report any mower that is in need of repair to supervisor.
c) Before operating a mower, employee shall check that all guards are in place.
d) The gas tank shall be filled before leaving the shop.
e) Any area to be mowed shall be checked for wires, sticks, and miscellaneous objects. Before
mowing they shall be removed.
f) Any bystanders shall be warned of the danger of flying objects before mowing commences.
g) Mowers shall not be left unattended with the engine running.
h) Loose fitting clothing shall not be worn while operating or working around mowers.
i) Safety Glasses, safety shoes, shirts, and full-length pants shall be worn while operating
mowers.
j) Mowers shall be refueled only with the engine off and after the engine has cooled.
PERSONAL CLOTHING AND HYGIENE
Personal Clothing and Hygiene 02.27.2023
Page 1 of 1
1.00 POLICY
The Personal Clothing and Hygiene policy has been developed to prevent the spread of hygiene-
related diseases. This policy applies to all employees.
1.05 PROCEDURE
Personal hygiene is important when working with others. Some body odor, colognes, deodorants,
hairsprays, etc. may be offensive or cause an allergic reaction. Cooperation is required.
Many diseases and conditions can be prevented or controlled through appropriate personal
hygiene and by regularly washing parts of the body and hair with soap and water*. Employees
shall observe the following practices:
1) Wear safe clean clothing that is appropriate for your job.
2) When operating equipment such as drill presses, lathes, milling machines, or electronic
equipment, do not wear loose fitting clothes, gloves or jewelry, as they can be a hazard.
3) Long hair past shoulder length must be tied back to prevent injury when using machinery
or performing tasks where hair could get caught.
4) Wash hands well before eating or touching your mouth or eyes.
5) Cover coughs and sneezes and immediately wash hands.
*CONTENT SOURCE: Centers for Disease Control and Prevention,
https://www.cdc.gov/hygiene/disease/index
SLIP, TRIP AND FALL PREVENTION
Slip, Trip, Fall Prevention 02.27.2023
Page 1 of 5
1.00 POLICY
The Slip, Trip and Fall Prevention policy has been developed to help employees understand the
simple things they can do on a daily basis to help keep themselves and their coworkers safe. It
also explains how a worker’s individual behavior is their best protection against injury. This
policy applies to all employees.
1.05 RESPONSIBILITIES
Administration:
1) Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1) Eliminate or mark fall hazards where feasible.
2) Provide technical assistance to departments regarding slip, trip and fall hazards.
3) Investigate complaints involving slips, trip and fall hazards.
4) Investigate accidents that involve a fall and where there may have been a contributing
environmental factor such as missing handrail, slippery walking surface.
5) Review and update this policy periodically.
6) Inspect facilities to identify fall hazards inside the building on at minimum an annual
basis.
Supervisor:
1) Identify work locations that are “Higher Risk Areas.”
2) Properly address slip, trip and fall hazards promptly and consulting with the Safety
Director if a slip, trip and/or fall hazard cannot be abated.
3) Ensure appropriate training is provided for all employees who will be working in higher
risk areas where slip, trip and fall hazards are prevalent.
4) Evaluate employees’ compliance with safe work practices.
5) Eliminate slip, trip and fall hazards that fall under their control and have been reported.
Employee:
1) Wear proper footwear based on the work environment.
2) Use prescribed exterior walkways and not take short cuts (i.e. down banks).
3) Report any slip, trip or fall hazards to their immediate supervisor or Safety Director.
4) Eliminate slip, trip and fall hazards where feasible. Examples include, moving a power
cord that crosses a walkway, cleaning up spills, removing clutter, etc.
1.10 PROCEDURES
Slips, trips and falls are the 2nd leading cause of accidental death (behind motor vehicle
accidents). Over 17% of all disabling occupational injuries that occur in the U.S. result from
SLIP, TRIP AND FALL PREVENTION
Slip, Trip, Fall Prevention 02.27.2023
Page 2 of 5
falls. Factors, such as the ones listed below, all contribute to an increased risk of slip, trip and
fall injury:
1) Failing eyesight &/or visual perception
2) Age
3) Physical condition & fatigue
4) Stress or illness
5) Medications, alcohol & drug effects
6) Carrying or moving cumbersome objects or simply too many objects at one time
7) Not paying attention to surroundings or walking distracted
8) Taking unapproved shortcuts
9) Being in a hurry and rushing
Common Slip, Trip and Fall Hazards Result From:
1) Uneven walking surfaces, holes, changes in level, broken or loose floor tiles, defective or
wrinkled carpet or uneven steps/thresholds.
2) Mats or rugs not lying flat on the floor.
3) Obstructions and accumulation of objects in walkways (i.e. hoses, cords, cables, debris,
etc.).
4) Unguarded platforms, walkways, and work areas 30 inches above ground.
5) Inadequate illumination
6) Wet or contaminated floors (i.e. grease, liquids, ice, oil, dust fine powders, etc.):
Contaminant Source(s)
Rainwater Transmitted internally from open external doors or from the feet, coats
or umbrellas of pedestrians.
Building leaks.
Water, other fluids From spills, plumbing leaks, cleaning, ice machines
Floor cleaning
products
Resulting from failure to follow appropriate cleaning protocol
Body fluids Blood, vomit
Condensation Variations in temperature
Dusts Natural or from stored materials
Debris Bags, paper, food residues, soil, cardboard boxes
Higher Risk Areas:
For purposes of this policy, an area where slip, trip, or fall hazards may likely arise during a
typical work shift, is considered a “higher risk area”. Examples of higher risk areas include:
1) Kitchens – wet floor
2) Locker rooms – wet floor
3) Loading docks – elevated locations
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Inspections:
The Safety Director performs regular inspections to identify slip, trip and fall hazards that
include evaluation of the following:
1) Condition of floors, carpets, and steps
2) Floor maintenance protocol
3) Housekeeping practices
4) Lighting levels
5) Presence and condition of guardrails/ handrails at elevated work surfaces.
1.15 HAZARD CONTROL MEASURES
General Housekeeping Procedures / Safe Work Practices:
The following housekeeping procedures and safe work practices must be followed to prevent
accidents associated with slip, trip and fall hazards:
General Safety:
1) Avoid running or walking too fast, especially in higher risk areas.
2) Avoid carrying items that will obstruct one’s view of their walking pathway.
3) Avoid walking through potential slip, trip and fall hazards.
4) Use extra caution when traveling both outdoors and indoors during/ following wet
weather.
General Housekeeping Procedures:
1) Clean up spills immediately. For greasy liquids, use suitable cleaning agent.
2) Do not leave floors wet after cleaning – clean them to a completely dry finish if possible.
a. If “clean-to-dry” is not possible, then use barriers and “wet floor” warning signs
to keep people off the wet area.
3) Use cleaning methods that do not spread the problem. Small spills are often better dealt
with using a paper towel instead of a mop that wets a larger area of floor.
4) Do not use cardboard to soak up spills.
Slip Hazards:
1) Floors, platforms, and walkways shall be maintained in good repair, and reasonably free
of oil, grease, or water.
2) Mats, grates, or other methods that provide equivalent protection shall be used on areas
where operation requires walking on slippery surfaces.
3) Slip-resistant floor coatings should be used in areas that are likely to be wet or subject to
frequent spills.
4) Slip hazards must be identified and removed promptly.
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5) Warning signs or other equally effective means (barricades) should be used as a warning
system in areas where a slip hazard is present.
Trip Hazards:
1) Platforms and walkways shall be free of obstructions and dangerous projections (i.e.
extension cords, power cables, hoses, carts, boxes, debris).
2) Position equipment to avoid cables crossing pedestrian routes; use cable covers securely
affixed to surfaces or consider use of cordless tools.
3) Surfaces in poor repair (i.e. holes, surface upheaval, and broken tiles) shall be repaired or
guarded by readily visible barricades, rails or other equally effective means.
4) Ensure floor mats and rugs lay flat and do not have curling edges.
Floor Mats and Other Floor Treatments:
Where work processes are expected to create wet floor surfaces, such surfaces shall be protected
against slipping by using mats, grates, cleats, or other methods that provide equivalent
protection.
Where wet processes take place, drainage shall be maintained and false floors, platforms, mats,
or other dry standing places provided.
Floor Mats:
1) Floor mats shall be placed at building entrances and higher risk areas where walking-
working surfaces may be wet. Examples of these areas include:
a. Areas adjacent to food counters and food preparation areas
b. Dishwashing areas
c. Car washing areas
2) The design of floor mats should have the following features:
a. Slip resistant surface on both top and bottom sides.
b. Beveled edges, flat edges or similar design to help reduce the likelihood of
workers tripping on the mat’s edges.
c. Slots or similar design to help promote drainage and prevent accumulation of
water & grease.
d. Antibacterial treatment or similar design to help prevent the growth of mold and
mildew.
3) Floor mats should not be installed and used in a way where the mat itself becomes a slip
or trip hazard.
4) Other floor treatments may be used to reduce slip hazards associated with wet floors.
SLIP, TRIP AND FALL PREVENTION
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Slip-Resistant Footwear:
Employees who work in potentially slippery higher risk areas should consider slip-resistant
footwear. When selecting slip-resistant footwear, the following should be considered:
1) Level of slip-resistance (i.e. polyurethane and microcellular urethane soles are more slip-
resistant compared to nitrite and styrene rubber).
2) Tread design, tread hardness, and shape of sole and heel. (i.e. high elastic soles with
raised-tread and cross-hatch patterns are more slip-resistant compared to rough and flat
soles. Tread patterns should cover the whole sole and heel area.)
3) Proper support and comfort.
NOTE: The use of slip-resistant footwear alone is not adequate in preventing slip-related
accidents. General housekeeping procedures, safe work practices, and matting/ floor treatments
(as necessary) must be used.
Floor Maintenance Procedures:
Professional (subcontracted) floor cleaning is performed on a routine basis in all facilities.
1.20 TRAINING
Employees working in higher risk areas receive training to ensure safe work practices. Training
includes the following:
1) Recognition of potential hazards associated with working in a higher risk area.
2) The use of control measures to prevent slip, trip and fall related accidents.
The frequency of training provided to the employees is to be determined by the supervisor and
Safety Director. Department-specific training may be arranged upon request by contacting the
Safety Director.
1.25 RECORDKEEPING
The City maintains accident reports and investigations and complaints involving fall hazards
based on OSHA requirements, as outlined in the MN AWAIR policy.
LOCKOUT / TAGOUT PROCEDURE
LOTO 02.07.2023
Page 1 of 5
1.00 POLICY
The Lockout/Tagout (LOTO) policy has been developed to safeguard workers from hazardous
energy releases. The program consists of energy control procedures, employee training and
periodic inspections to ensure stored energy is rendered inoperative prior to servicing or
maintenance on a machine or equipment. This policy applies to all employees and meets the
requirements of OSHA Standard 29 CFR § 1910.147 (c).
All employees, including office staff, will be trained to understand when a LOTO tag is
attached to a machine or piece of equipment, it may be removed ONLY BY THE
AUTHORIZED PERSON RESPONSIBLE FOR IT, and it is NEVER to be BYPASSED,
IGNORED, or OTHERWISE DEFEATED.
1.05 DEFINITIONS
Authorized Employee: Employees trained to implement LOTO and notify affected employees
Affected Employee: Employees in the area where LOTO will be used or those who work with
the machines that may need LOTO)
1.10 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Train all employees on this policy before they begin work.
2. Develop procedures and maintenance.
3. Enforce the LOTO procedures.
4. Complete periodic inspections, at a minimum annually, for compliance and procedures.
5. Recognize when re-training is needed.
Public Works Director:
1. Participate in the development of specific job procedures.
Authorized Employee:
1. Understand the purpose of LOTO.
2. Understand the hazards of unexpected energization of equipment.
3. Have the ability to perform LOTO procedures correctly.
4. Keep all proper documentation (forms1) of LOTO.
LOCKOUT / TAGOUT PROCEDURE
LOTO 02.07.2023
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Affected Employee:
1. Be careful to avoid area of LOTO.
2. Understand the importance of LOTO and the importance of NOT ATTEMPTING to
remove a LOTO device.
1.10 EXAMPLES OF STORED ENERGY
1. Electric
2. Mechanical
3. Chemical (acids and caustics)
4. Explosives (natural gas)
5. Fly wheels
6. Spring
7. Capacitors
8. Pressure Systems (pneumatic, hydraulic, gas, steam and water)
1.15 APPROVED LOCKOUT/TAGOUT DEVICE RULES
1. Specific Lockout locks will be issued only to AUTHORIZED employees.
2. Locks will be standardized, approved, and supplied by the Safety Director.
3. Only one key will be given with each lock.
a. The making of duplicate keys is strictly prohibited.
4. A Lock Assignment Log1 identifying all locks assigned is kept at the Public Works shop.
5. Locks will not be used for any other purpose than LOGO.
6. Multiple lock adapters will be available for all jobs requiring more than one safety lock.
7. Tags will NOT be used alone unless locks cannot be physically installed to isolation
devices. These instances will be brought to the attention of the Safety Director who will
make efforts to make engineering changes to allow locks to be utilized.
1.20 TRAINING
Training will be provided to ensure all employees understand the purpose and function of an
energy control program. Employees will be divided into two (2) groups:
Authorized:
1. Employees who will be trained to implement LOTO and notify affected employees.
2. Authorized employees will be trained in the recognition of hazardous energy sources, the
type of magnitude of the energy available, and the procedure for energy isolation and
control.
3. Authorized employees will be trained during job orientation and before a new job
assignment.
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LOTO 02.07.2023
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Affected:
1. Employees in the area where LOTO will be used or those who work with the machines
that may need LOTO.
2. Affected employees will be trained as to the purpose and use of energy control
procedures.
3. Affected employees will understand machines or equipment marked with a LOTO tag are
never to be bypassed, ignored, or otherwise defeated.
4. Affected employees will understand they are never to remove a LOTO tag from a
machine or piece of equipment.
1.25 RE-TRAINING
All employees shall be re-trained:
1. When procedure inspection reveals non-compliance.
2. An accident occurs due to non-compliance of procedures.
3. Changes occur in LOTO program.
4. Changes of equipment or machines are made.
Re-training will also take place as needed or when a supervisor sees a need for re-training. At a
minimum, authorized employees will be evaluated for re-training annually.
1.30 INSPECTIONS
The Safety Director is responsible to complete and record inspections periodically or at
minimum, on an annual basis, and records maintained. If inspections reveal improper or lack of
LOTO procedures, re-training of employees will be conducted.
The Safety Director will conduct regular inspections as work is done to assure proper LOTO
procedures are performed in the shop area, when applicable.
1.35 SPECIFIC LOCKOUT/TAGOUT PROCEDURES
All hardwired power equipment requires specific LOTO procedures. Each machine in this
category shall have its own specific procedure that identifies:
1. Machine;
2. Locations;
3. Energy Controls.
4. Type(s) of energy used;
5. Isolation devices;
6. Shut down procedure(s); and
7. Release procedures
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LOTO 02.07.2023
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These specific procedures should be reviewed for update annually, and if modifications are made
to the machine or energy system.
1.40 GENERAL LOCKOUT/TAGOUT PROCEDURE
A. TURN OFF EQUIPMENT AND DISCONNECT THE ENERGY SOURCE
1. Notify all affected employees that a LOTO procedure is beginning and why.
2. Locate and identify all switches, valves, and other devices that will have to be
locked and/or tagged. More than one energy source may be involved.
3. Shut the machine down by normal stopping procedure.
4. Disconnect the energy source to neutralize stored energy by pulling the plug, flipping
the power switch, breaking the circuit, or pulling the fuse and closing a valve.
5. Bleed residual energy (release residual energy by discharging capacitors, grounding
circuits, or release built-up pressure).
6. Test the “on” switch and turn it back to “off”. (after the first four (4) steps have been
completed, turn on the switch or push the start button to make sure all power is off.)
B. LOCKOUT ENERGY SOURCE(S)
1. Use a lock to prevent the flow of energy from being restored.
2. Snap your lock on the control level or on the multiple-lock adapter. The multiple-
lock adapter is used when more than one person is going to be working on the
equipment.
3. Test the disconnect to be sure it cannot be moved to the “on” position.
C. TAGOUT AT THE DISCONNECT POINT
1. Attach the LOGO tag at the disconnect point with the lock.
2. A LOGO tag should state a warning such as “DO NOT START”, or “DO NOT
OPEN” or “DO NOT ENERGIZE”
3. A lockout tag should also provide the following information:
a. The name or names of the people performing maintenance;
b. The time and date the work began; and
c. The type of work being done.
WARNING: It is important that proper personal protection equipment is worn while
maintaining or repairing the machinery. The “buddy” system should be used, as the situation
requires.
D. TO RESTORE ENERGY SAFELY
When the work has been completed, check to make sure:
1. Affected employees have been notified.
2. All tools have been removed, the machine has been completely re-assembled, and all
guards have been replaced.
LOCKOUT / TAGOUT PROCEDURE
LOTO 02.07.2023
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3. Other workers are safely out of the way before removing your lock and tag and
turning the machine one.
4. All locks are removed.
1.45 OUTSIDE CONTRACTORS
The City will communicate with all outside contractors and assure that all personnel understand
and comply with all prohibitions and restrictions of the employer’s lockout program.
1.50 FORMS
1Refer to the Safety Manual Appendix for all forms.
F010 LOTO Tag Examples
F011 LOTO Device Use Log
F012 Energy Source Log
F013 Specific Energy Control Procedure
F014 Lock Assignment Log
ERGONOMIC PROTECTION POLICY
Ergonomic Protection 02.07.2023
Page 1 of 8
1.00 POLICY
The Ergonomic Protection policy has been developed to optimize employee health and safety by
preventing musculoskeletal disorders caused by exposure to risk factors and ensure early
intervention once a musculoskeletal injury has been reported. This policy applies to all jobs that
require more than four (4) hours per day of the following:
1) Repetitive hand, arm or shoulder motions
2) Fixed or awkward position (working with wrists bent, kneeling, twisted or bent back,
overhead work, stooping)
3) Poor sitting/standing posture
4) Excessive reaching
5) Use of vibrating or impact equipment
6) Manual handling of 25 pounds or more
7) Use of excessive force
8) Contact stress (resting wrist/forearm against a sharp edge)
9) Improper workstation or chair adjustments
1.05 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director and Human Resources:
1. Coordinate an assessment upon receipt of a Workstation Ergonomics Request for
Assessment Form1 and maintain records.
2. Conduct an annual review, that may include employee surveys, of the program.
Supervisor:
1. Ensure appropriate work methods. When considering an employee's regular job
assignment, both pace of work and job flow should be reviewed to avoid excessively-
repetitive work for any one employee and their specific position.
2. Encourage employees to promptly report signs and symptoms of ergonomic-related
discomfort to the Safety Director and Human Resources by completing the Workstation
Ergonomics Request for Assessment Form1, and follow up for compliance.
3. Accommodate employee work restrictions established by their health care provider.
4. Oversee implementation of work site corrections and improvements recommended by the
Safety Director and Human Resources. Upon completion of the workstation assessment,
you will receive a copy of the recommendations for changes to your employee's
workstation.
ERGONOMIC PROTECTION POLICY
Ergonomic Protection 02.07.2023
Page 2 of 8
Employee:
1. Immediately inform the Safety Director and Human Resources, of any ergonomic-related
discomfort. Early reporting is important to prevent injuries from occurring or becoming
worse.
2. Complete a Workstation Ergonomics Request for Assessment Form1 to report
deficiencies and to schedule an assessment.
3. Be responsible for correct use of the equipment provided by the City.
4. Participate in required ergonomic safety training.
5. Perform simple stretches or exercises throughout the day, according to ability, to
reduce stress.
6. Comply with this ergonomic policy and follow recommended work practices to prevent
repetitive strain injuries and discomfort.
1.10 WORK RELATED ERGONOMIC RISK FACTORS
Physical stressors and workplace conditions that may pose a risk of injury to the musculoskeletal
system of an employee. The following activities are recognized as important risk factors,
especially when performed frequently and/or in combination with each other:
A. Repetitive Motions:
Performing the same constant actions can result in fatigue and strain of muscles and tendons,
especially when performed frequently over a prolonged period of time. Overused, tired muscles
and tendons cannot recover from the effects of repeated actions if sufficient recovery time is not
allotted between exertions. For most repetitive strain injuries, the disease progresses through
three injury/disease stages. The effects of performing repetitive actions are increased when
combined with awkward postures and forceful exertions. Examples include:
a. Intensive data entry requiring rapid, repeated keying actions
b. Manual material-handling activities
B. Awkward Posture/Position:
Working in stressful or non-neutral body postures can fatigue or stress affected parts of the body
due to the amount of force or stress which occurs. Examples include:
a. Working with bent or flexed wrists
b. Performing tasks with outstretched arms
c. Prolonged holding of a single posture or position
d. Lifting, lowering, or handling objects when the back is bent or twisted
e. Sudden, jerking movements made during the work process
f. Frequent or prolonged extended reaching for materials, especially above the shoulders
g. Frequent stooping or squatting
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C. Forceful Exertions:
Placing excessive loads on the muscles, tendons, ligaments, and joints increases demands on
the body necessary to sustain an increased effort, such as greater muscle exertion and
physiological changes. This includes lifting, pushing, and pulling motions. Examples include:
a. Using small or narrow tool handles that lessen grip capacity
b. Using the index finger and thumb in a pinch grip to forcefully grip objects
c. Twisting, bending or stooping at the waist to lift and lower loads
d. Lifting, loading or lowering objects that do not have adequate hand-holds
D. Contact Stresses:
Placing the forearms, wrists or fingers in repeated or continual contact with hard or sharp
objects/surfaces or with unpadded, narrow tool handles can interfere with proper nerve function
and blood flow. Examples include:
a. Pressing forearms or wrists against sharp/hard desk edges when keying or writing
b. Using tools that press into the base of the palm
c. Using the palm of the hand as a hammer
E. Vibration:
Localized vibration exposure is produced by contact between the hands and a vibrating object,
such as a power tool. Whole-body vibration exposure occurs while standing or sitting in
vibrating environments such as in trucks or heavy machinery, or while using heavy equipment
such as jackhammers.
1.15 INJURY/DISEASE STAGES
For most repetitive strain injuries, the disease progresses through three stages:
A. First Stage:
Mild pain or tiredness that clears up after rest and generally does not affect the worker's lifestyle
away from work, to any great extent. This stage can last for weeks or months, but is generally
reversible if the cause is identified and removed.
B. Second Stage:
More severe pain, aching, tingling, numbness or tiredness that develops early in the working day,
persists longer at night, and affects activities even at home.
C. Third Stage:
Symptoms become continuous, even during complete rest. Often, the worker can no longer carry
out ordinary light tasks at work or at home. At this stage, recovery may take years if it occurs at
all.
ERGONOMIC PROTECTION POLICY
Ergonomic Protection 02.07.2023
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1.20 WORKSTATION SETUP
An individual workstation should provide the operator with a comfortable sitting position
sufficiently flexible to reach, use and observe the screen, keyboard and any paper document
referred to while keying. Some general guidelines to minimize fatigue include:
A. Posture Support:
The seat and backrest of the chair should support a comfortable posture permitting occasional
variations in the sitting position. Chair height and backrest angle should be easily adjustable. A
footrest may be necessary.
B. Arms:
When using the keyboard, the upper arm and forearm should form a right angle. The hands
should be in a reasonably straight line with the forearm, using a wrist rest. Long or
unnaturally high reaches should be avoided. Armrests should also be avoided while keying.
ERGONOMIC PROTECTION POLICY
Ergonomic Protection 02.07.2023
Page 5 of 8
C. Legs and Feet:
The chair height is correct when the entire sole of the foot can rest on the floor or on a footrest
and the knee is level with or slightly higher than the hip. This allows blood to circulate freely in
the legs and feet.
D. Monitor Position:
Monitors that adjust vertically enable the operator to select the optimum viewing position. Eyes
should be level or slightly below the top of the screen. The monitor should be centered and
approximately one arm's length away (or closer for better vision).
ERGONOMIC PROTECTION POLICY
Ergonomic Protection 02.07.2023
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E. Workstation Surface:
The table or workstation should suit the task to be done. It should be large enough for reference
materials, files, telephone, calculator or other necessary items and also permit different positions
of the screen and keyboard. An adjustable surface height is an advantage.
ERGONOMIC PROTECTION POLICY
Ergonomic Protection 02.07.2023
Page 7 of 8
F. Adjustment Guidelines:
1) Top of monitor screen should be at eye level and 20-30" away
2) Arms should hang comfortably from shoulders, close to body with forearms in a 90-
degree alignment (neutral posture)
3) Wrists should be flat. Place keyboard here
4) Adjust chair so that hips and legs achieve a 90-degree angle with feet flat on floor. Sit
all the way back and straight
5) Use a copyholder for documents
6) Take small breaks every hour
G. Adjustments:
Invariably, individuals twist or strain to reach the keyboard or sit in odd contortions, which result
in neck, back, or wrist pain. Some simple workstation modifications, posture awareness, and
chair consciousness can prevent problems.
1) Lower the height of the chair so that your back touches the back of the chair and you are
comfortable
2) Your feet should rest firmly on the floor slightly in front of you
3) Center your keyboard in front of your monitor. Your eyes should be at the same level as
the tool bar
4) Keep the keyboard and mouse close to the edge of the desk
5) Keyboard and mouse should be positioned so your arms fall naturally at your sides, with
wrists straight out in front while typing/mousing
6) Support your wrist and forearms with a gel pad or wrist support
7) Avoid repetitive gripping of the mouse
ERGONOMIC PROTECTION POLICY
Ergonomic Protection 02.07.2023
Page 8 of 8
8) Keep frequently used items close - avoid reaching for anything
9) Perform wrist, finger, and hand exercises
1.25 WORKSTATION ASSESSMENT
Any employee who is concerned there may be a problem with their workstation, or is already
experiencing ergonomic-related discomfort shall request an assessment of their work area by
completing the Workstation Ergonomics Request for Assessment Form1.
Once you complete the Workstation Ergonomics Request for Assessment Form1, the Safety
Director and Human Resources will schedule an assessment of your work area. Once completed,
a report will be written listing any problem areas and the recommendations for improvement. A
copy of this report will be made available to your supervisor. The Safety Director and Human
Resources will assist with any modifications that need to be made to your workstation.
1.30 BODY MECHANICS
Being aware of your posture during all of your daily activities is the best way to ensure you are
using good body mechanics. Follow these additional guidelines to avoid injury and muscle
fatigue:
1) Wear shoes with low heels, closed backs, and nonslip soles. This will help prevent falling
and improve your body alignment.
2) Push rather than pull objects. It is easier to push than to pull.
3) Do not sit in the same position for long periods. Get up from time to time and stretch.
4) Use a firm mattress when lying down. Avoid sleeping on your stomach.
5) Use lightweight purses and/or shoulder bags. Carry heavy loads in a backpack, rather
than a briefcase.
6) Exercise on a regular basis. Keep in shape.
1.35 FORMS
1Refer to the Safety Manual Appendix for all forms.
F022 – Workstation Ergonomics Request for Assessment Form1
SAFETY HOUSEKEEPING
AND ACCIDENT PREVENTION
Safety Housekeeping & Accident Prevention 02.07.2023
Page 1 of 2
1.00 POLICY
The Safety Housekeeping and Accident Prevention program has been designed to present the
basics of good safety housekeeping as a means of accident prevention. This policy applies to all
employees.
1.05 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Develop and administer the Safety Housekeeping and Accident Prevention program.
2. Conduct periodic facility walkthroughs to identify potential housekeeping risk factors.
3. Ensure employees are trained on the policy and procedures included in this section.
Supervisors:
1. Assure that safe work practices are utilized and prohibit the use of poor of forbidden
practices.
2. Encourage employees to inform you immediately of any potential safety hazards,
implement corrective measures immediately.
Employees:
1. Comply with this policy and follow recommended work practices to prevent injuries and
accidents.
2. Institute a routine cleaning schedule.
3. Keep walkways free of debris, cords, cables and storage items.
4. Clean up oil, water and grease on floors immediately.
1.10 PROCEDURE
Some workplace hazards are obvious, and some may be harder to recognize, but they all can
cause accidents that decrease production and may result in painful injuries and even death for
employees. These risks can often be reduced significantly when workers follow good
housekeeping procedures and other accident prevention practices.
Employees first need to understand the importance of having a “good safety attitude”. They also
need to know how to maintain their workplace to prevent accidents and how to avoid exposure to
on-the-job hazards by choosing and using the appropriate personal protective equipment. This
combination of good housekeeping and accident prevention knowledge and skills help workers
SAFETY HOUSEKEEPING
AND ACCIDENT PREVENTION
Safety Housekeeping & Accident Prevention 02.07.2023
Page 2 of 2
recognize workplace hazards ahead of time and take action to prevent them, before accidents and
injuries occur.
Housekeeping at work is as important as it is at home, especially if you want a safe workplace.
Studies show people who must function every day in a messy, disorderly work environment have
lower morale, although they may not be aware of the cause. But the safety ramifications of poor
housekeeping in the workplace are even more important.
Poor housekeeping practices can result in:
1. Injuries when employees trip over, strike or are struck by out-of-place objects.
2. Injuries from using improper tools because the correct tool can’t be found.
3. Lowered production because of the time spent maneuvering over and around someone
else’s mess and time spent looking for proper tools and materials.
Remember: If you are complacent about safe housekeeping, employees may become desensitized
to poor practices and become unable to identify hazards, putting them at risk of injury.
General housekeeping rules to remember:
1. Housekeeping is everyone’s responsibility!
2. Clean up after yourself. Pick up trash and debris and dispose of it properly. Keep your
work area clean throughout the day, minimizing the time needed to clean a larger mess at
the end of the day.
3. Dispose of combustibles and flammables properly. If improperly discarded, they will
increase the potential for a fire.
4. Remove protruding nails and other sharp objects or hammer them flat to prevent someone
from being injured by them.
5. Stack materials and supplies in an orderly manner and secure them so they won’t topple.
6. Remove any cords or cables in walking areas.
7. Organize cables under desks.
A well-kept workplace shows respect for those who work there. Help keep it that way!
Results of poor housekeeping practices at work include:
1. Time spent investigating and reporting accidents that could have been avoided.
2. Fires due to improper storage and disposal of flammable or combustible materials and
wastes.
3. Substandard quality of finished products because of production schedule delays, damaged
or defective finishes, ill-equipped employees, etc.
4. “Wall-to-wall” OSHA inspections due to the “first impression” of the compliance officer.
STAIRWAY AND LADDER SAFETY
Stairway and Ladder Safety 02.07.2023
Page 1 of 3
1.00 POLICY
The Ladder and Stairway Safety policy has been developed to ensure no employee is exposed to
hazards caused by improper or unsafe use of ladders and/or stairways. This policy applies to
Public Works employees and meets the requirements of OSHA Standard 29 CFR § 1926.1060.
1.05 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Develop and administer the Ladder and Stairway Safety Program.
2. Utilize the Ladder Inspection Checklist1 to periodically perform ladder inspections.
3. Ensure employees are trained on the policy and procedures included in this section.
Supervisors:
1. Purchase work equipment and tools that meets current recognized standards.
2. Assure that safe work practices are utilized and prohibit the use of poor of forbidden
practices.
Employees:
1. Follow supervisory direction and abide by the prescribed work practices
2. Inspect ladders before and after use, report issues to supervisor.
3. Participate in safety training.
1.10 PROCEDURE
A. Stairway Safety:
1) All parts of stairways will be free of hazardous projections, such as protruding nails.
2) Slippery conditions on stairways will be eliminated before the stairways are used to reach
other levels.
3) Stair rail systems and handrails will be so surfaced as to prevent injury to employees
from punctures or lacerations, and to prevent snagging of clothing.
4) Handrails will provide an adequate handhold for employees grasping them to avoid
falling.
STAIRWAY AND LADDER SAFETY
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B. Ladder Safety:
1) When portable ladders are used for access to an upper landing surface, the ladder side
rails will extend at least 3 feet above the upper landing surface to which the ladder is used
to gain access; or, when such an extension is not possible because of the ladder’s length,
then the ladder will be secured at its top to a rigid support that will not deflect, and a
grasping device, such as a grab rail, will provided to assist employees in mounting and
dismounting the ladder. In no case will the extension be such that ladder deflection under
a load would, by itself, cause the ladder to slip off its support.
2) Ladders will be maintained free of oil, grease, and other slipping hazards.
3) Ladder rungs, cleats, and steps will be parallel, level, and uniformly spaced when the
ladder is in position for use.
4) Ladders will not be loaded beyond the maximum intended for which they were built or
beyond their manufacturer’s rated capacity.
5) Ladders will be used only for the purpose for which they were designed.
6) Non-self-supporting ladders will be used at an angle such that the horizontal distance
from the top support to the foot of the ladder is approximately one-quarter of the working
length of the ladder (the distance along the ladder between the foot and the top support).
7) Fixed ladders will be used at a pitch no greater than 90 degrees from the horizontal, as
measured to the back side of the ladder.
8) Ladders will be used only on stable and level surfaces unless secured to prevent
accidental displacement.
9) Ladders will not be used on slippery surfaces unless secured or provided with slip-
resistant feet to prevent accidental displacement. Slip-resistant feet will not be used as a
substitute for care in placing, lashing, or holding a ladder that is used upon slippery
surfaces, including flat metal or concrete surfaces that are constructed so they cannot be
prevented from becoming slippery.
10) Ladders placed in any location where they can be displaced by workplace activities or
traffic, such as in passageways, doorways, or driveways will be secured to prevent
accidental displacement, or a barricade will be used to keep the activities or traffic away
from the ladder.
11) The area around the top and bottom of ladders will be kept clear.
12) The top of a non-self-supporting ladder will be placed with the two rails supported
equally unless it is equipped with a single support attachment.
13) Ladders will not be moved, shifted, or extended while occupied.
14) Ladders will have nonconductive side-rails if they are used where the employee or the
ladder could contact exposed energized electrical equipment.
15) The top or top step of a stepladders will not be used as a step.
16) Cross-bracing on the rear section of stepladders will not be used for climbing unless the
ladders are designed and provided with steps for climbing on both front and rear sections.
17) Ladders will be inspected by the Safety Director for visible defects on a periodic basis
and after any occurrence that could affect their safe use.
18) Portable ladders with structural defects, such as broken or missing rungs, cleats, or steps,
broken or split rails, corroded components, or other faulty or defective components, will
either be immediately marked in a manner that readily identifies them as defective, or to
STAIRWAY AND LADDER SAFETY
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be tagged with “DO NOT USE” or similar language, and will be withdrawn from service
until repaired.
19) Fixed ladders with structural defects, such as broken or missing rungs, cleats, or steps,
broken or split rails, or corroded components, will be withdrawn from service until
repaired. The defective ladder will be withdrawn from service in the following manner:
a. Immediately tagged with “DO NOT USE” or similar language.
b. Marked in a method that readily identifies it as defective.
c. Blocked from further use, such as with a plywood attachment that spans several
rungs.
20) Before damaged or defective ladders may be returned to service, repairs will be made that
restore the ladder to its original design specifications.
21) Single-rail ladders will not be used.
22) When ascending or descending a ladder, the user will face the ladder.
23) Each employee will use at least one hand to grasp the ladder when progressing up and/or
down the ladder.
24) An employee will not carry any object or load that could cause the employee to lose
balance and fall.
1.15 TRAINING
Training shall enable each employee to recognize hazards related to ladders and stairways and
shall train each employee in the procedures to be followed to minimize these hazards. Training
includes the following:
1) The nature of fall hazards in the work area.
2) The correct procedures for erecting, maintaining, and disassembling the fall protection
systems to be used.
3) The proper construction, use, placement, and care in handling of all stairways and
ladders.
4) The maximum intended load-carrying capacities of ladders.
Retraining shall be provided for each employee as necessary so that the employee maintains the
understanding and knowledge acquired through compliance with this policy.
1.20 FORMS
1Refer to the Safety Manual Appendix for all forms.
F024 Ladder Inspection Checklist Form
RESPIRATOR PROTECTION
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1.00 POLICY
The Respirator Protection policy has been developed to protect employees from breathing air
contaminated with harmful dusts, sprays, or vapors and to establish standard operating
procedures to ensure the protection of all employees from respiratory hazards through proper
selection and use of respirators. This policy applies to Public Works employees and meets the
requirements of OSHA Standard 29 CFR § 1910.134.
1.05 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Program Administrator:
The City has designated the Safety Director as the Program Administrator to oversee the
respiratory protection program. Duties of the Program Administrator include:
1. Identifying work areas, processes or tasks that require workers to wear respirators, and
evaluating hazards
2. Selection of respiratory protection options
3. Monitoring respirator use to ensure that respirators are used in accordance with their
certifications
4. Ensure employee training is conducted annually
5. Conducting or arranging for fit testing
6. Administering the medical surveillance program
7. Maintaining records required by the program
8. Evaluating the program
9. Updating written program as needed
Supervisor:
Supervisors are responsible for ensuring that the respiratory protection program is implemented
in their particular areas. In addition to being knowledgeable about the program requirements for
their own protection, supervisors must also ensure that the program is understood and followed
by the employees under their charge. Duties of the supervisor include:
1. Ensuring that employees under their supervision (including new hires) have received
appropriate training, fit testing, and medical evaluation
2. Ensuring the availability of appropriate respirators and accessories
3. Being aware of tasks requiring the use of respiratory protection
4. Enforcing the proper use of respiratory protection when necessary
5. Ensuring proper storage and maintenance of respiratory protection equipment
RESPIRATOR PROTECTION
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6. Ensuring that respirators are properly cleaned, maintained, and stored according to the
respiratory protection plan
7. Ensuring that respirators fit well and do not cause discomfort
8. Continually monitoring work areas and operations to identify respiratory hazards
9. Coordinating with the program administrator on how to address respiratory hazards or
other concerns regarding the program
Employee:
Each employee has the responsibility to wear his or her respirator when and where required and
in the manner in which they were trained. Employees must also:
1. Care for and maintain their respirators as instructed and store them in a clean sanitary
location
2. Inform their supervisor if the respirator no longer fits well, and request a new one that fits
properly
3. Perform a seal check before entering any area a respirator is required
4. Inform their supervisor of any respiratory hazards that they feel may not be adequately
addressed in the workplace and of any other concerns that they have regarding the
program
5. Attend all safety classes, follow all safety signage, wear all required PPE and work safely
in all areas of the City
1.10 PROGRAM ELEMENTS
Respirator Selection:
Respirators are selected on the basis of the hazards to which the employees are exposed and in
accordance with OSHA requirements. Only NIOSH certified respirators will be selected and
used.
The Safety Director will conduct a hazard evaluation for each operation process, or work area
where airborne contaminants may be present in routine operations or during an emergency.
Hazard Evaluation:
The Safety Director will perform hazard evaluations. The hazard evaluation will include:
1. Identification of the hazardous substances used in the workplace, department or work
process;
2. Review of work processes to determine where potential exposures to these hazardous
substances may occur; and
3. Exposure monitoring to quantify potential hazardous exposures.
RESPIRATOR PROTECTION
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Hazard Assessment:
The Safety Director will revise and update the hazard assessment as needed (i.e., any time work
process changes which may potentially affect exposure).
RESPIRATOR HAZARD ASSESSMENT
VOLUNTARY AND REQUIRED RESPIRATOR USE
RESPIRATOR TYPE DEPARTMENT/PROCESS
Required:
Half-face air purifying respirator with organic
vapor cartridge
Paint Department:
• cleaning still bottom from waste
recycling
• cleaning spray paint equipment
General Requirements:
1. Workplace and user factors that affect respirator performance and reliability will be
considered.
2. Where the exposures cannot be identified or reasonably estimated, the employer shall
consider the atmosphere to be IDLH.
3. The employer shall select respirators from a sufficient number of respirator models and
sizes so that the respirator is acceptable to, and correctly fits, the user.
Voluntary Respirator Usage:
The City of Medina will provide (or allow employee-owned) respirators to employees for
voluntary usage upon employee request following a hazard evaluation.
The Safety Director will provide all employees who voluntarily choose to wear respirators with a
copy of Appendix D2 of the standard. (Appendix D details the requirements for voluntary use of
respirators by employees)
Respirator Filter & Canister Replacement/Change Schedule:
Each filter and canister shall be equipped with an expiration date certified by NIOSH for the
contaminant.
NOTE: Cartridges/Filters shall be changed based on the most limiting factor below:
1. After each use
2. Prior to expiration date
3. Manufacturer’s recommendations for use and environment
4. When requested by employee
5. When restriction to air flow has occurred as evidenced by increased effort by user to
breathe normally
RESPIRATOR PROTECTION
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Medical Evaluation:
A licensed health care professional will provide medical evaluations to employees, if requested.
They will provide medical questionnaires to the employee at the time of the appointment.
Medical evaluation procedures are as follows:
1. The medical evaluation will be conducted, if requested, using the medical questionnaire
provided in Appendix C2 of 29 CFR 1910.134 Respiratory Protection Standard.
2. Follow up medical exams will be provided to employees as required by the OSHA
standard, and/or as deemed necessary by the health care professional.
3. All employees will be allowed the opportunity to speak with the health care professional
about their medical evaluation, if they so request.
4. The Safety Director will provide the health care professional with a copy of this program.
For each employee requiring evaluation, the health care professional will be provided
with information regarding the employee’s work area or job title, proposed respirator
type and weight, length of time required to wear the respirator, expected physical work
load (light, moderate, or heavy), potential temperature and humidity extremes, and any
additional protective clothing required.
After an employee has received clearance to wear a respirator, additional medical evaluations
will be provided under any of the following circumstances:
a. The employee reports signs and/or symptoms related to their ability to use a
respirator, such as shortness of breath, dizziness, chest pains, or wheezing;
b. The health care professional or supervisor informs the Safety Director that the
employees needs to be reevaluated;
c. Information from this program, including observations made during fit testing and
program evaluation, indicates a need for reevaluation; and
d. A change occurs in workplace conditions that may result in an increased
physiological burden on the employee.
NOTE: All examinations and questionnaires are to remain confidential between the employee
and the physician.
The Safety Director will maintain documentation of the OSHA Respirator Medical Evaluation
Questionnaire Form1.
Fit Testing Procedures:
The Safety Director will ensure that fit-test will be administered using an OSHA-accepted
qualitative fit test (QLFT) or quantitative fit test (QNFT) protocol. The OSHA-accepted QLFT
and QNFT protocols are contained in Appendix A2 of the Respiratory Standard (1910.134).
The Safety Director will maintain documentation of the fit tests administered to employees. The
Safety Director will maintain documentation of the fit tests administered to employees on the
Respirator Fit Test Form1.
RESPIRATOR PROTECTION
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1.15 USE OF RESPIRATORS
1. Employees will use their respirators under conditions specified by this program, and in
accordance with the training they receive on the use of each particular model. In
addition, the respirator shall not be used in a manner for which it is not certified by
NIOSH or its manufacturer.
2. All employees shall conduct user seal checks each time that they wear their respirator.
3. All employees shall be permitted to leave the work area in order to maintain their
respirator for the following reasons: to clean their respirator if the respirator is impeding
their ability to work, change filters or cartridges, replace parts, or to inspect respirator if it
stops functioning as intended. Employees should notify their supervisor before leaving
the area.
4. Employees are not permitted to wear tight fitting respirators if they have any condition,
such as facial hair, facial scars, or missing dentures that prevents them from achieving a
good seal. Employees are not permitted to wear headphones, jewelry, or other articles
that may interfere with the facepiece to seal the face.
Respirator Malfunction:
For any malfunction of a respirator (e.g., such as breakthrough, facepiece leakage, or improperly
working valve), the respirator wearer should inform his or her supervisor that the respirator no
longer functions as intended, and then should go to a safe area to maintain the respirator. The
supervisor must ensure that the employee receives the needed parts to repair the respirator, or is
provided with a new respirator.
1.20 MAINTENANCE AND CARE PROCEDURES
In order to ensure continuing protection from the respirators being use, it is necessary to establish
and implement proper maintenance and care procedures and schedules. A lax attitude toward
maintenance and care will negate successful selection and fit because the devices will not deliver
the assumed protection unless they are kept in good working order.
Cleaning & Disinfecting:
The City of Medina provides each respirator user with a respirator that is clean, sanitary, and in
good working order. We ensure that personal respirators are cleaned and disinfected weekly or
as often as necessary to be maintained in a sanitary condition. Respirators are cleaned and
disinfected using the procedures specified in Appendix B-22 of the standard or manufacturer’s
recommendations.
Storage:
Storage of respirators must be done properly to ensure that the equipment is protected and not
subject to environmental conditions that may cause deterioration. We ensure that respirators are
stored to protect them from damage, contamination, dust, sunlight, extreme temperatures,
excessive moisture, and damaging chemicals.
RESPIRATOR PROTECTION
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Respirator Inspection:
All respirators will be inspected before and after each use. Should any defects be noted, the
respirators will be taken to the Safety Director. Damaged respirators will be either repaired or
replaced.
Respirator inspections shall include a check of respirator function, tightness of connections, and
the condition of the various parts including, but not limited to, the half-mask respirators, straps,
and face piece.
1.25 TRAINING
Respirators which are applicable and suitable for the purpose intended shall be provided by the
City when such equipment is necessary to protect the health of the employee. Once trained and
fit tested, employees are expected to comply with all OSHA and city rules as to their safe use.
No employee will be allowed to work without a respirator when the SDS states a respirator is
needed. Failure to comply with this regulation is grounds for dismissal. The respiratory
program is evaluated annually, and the written procedure will be modified as needed.
The Safety Director will ensure that respirator training is provided to respirator users on the
contents of the Respiratory Protection Program and on the OSHA Respiratory Protection
Standard. All employees required to wear respirators shall be trained as to their safe use before
they are allowed to use them and yearly thereafter. Supervisors will also be trained prior to using
a respirator in the workplace or prior to supervision of employees that must wear respirators.
The Safety Director will maintain documentation of all training on the Respirator Training and
Issuance Form1.
Training will cover the following topics:
1. The City of Medina Respiratory Protection Program
2. The OSHA Respiratory Protection Standard
3. Respiratory hazards encountered and their health effects
4. Proper selection and use of respirators
5. Limitations of respirators
6. Respirator donning and user seal (fit) checks
7. Fit testing
8. Emergency use procedures
9. Maintenance and storage
10. Medical signs and symptoms limiting the effective use of respirators
Employees will be retrained annually or as needed (e.g., if they need to use a different
respirator). Employees must demonstrate their understanding of the topics covered in the
training utilizing a hands-on exercise and a written test. Respirator training will be documented
by the Safety Director and the documentation will include the type, model, and size of respirator
for which each employee has been trained and fit tested.
RESPIRATOR PROTECTION
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1.30 PROGRAM EVALUATION
The Safety Director will conduct annual and periodic evaluations of the workplace to ensure the
effectiveness of this program. The evaluation will include regular consultations with employees
who use respirators and their supervisors, site inspections, air monitoring and review of records.
Identified problems will be noted and addressed by the Safety Director. These findings will be
reported to management, and the report will list plans to correct deficiencies in the respirator
program and target dates for the implementations of those corrections.
1.35 DOCUMENTATION AND RECORDKEEPING
Any employee who wishes to review this program and the OSHA standard may contact the
Safety Director for a printed copy.
Training and fit test records are maintained on OneDrive. These records will be updated as new
employees are trained, as existing employees receive refresher training, and as new fit tests are
conducted.
The City will also maintain copies of the medical authorizations for all employees covered under
the respirator program. The completed medical questionnaire and the physician’s documented
findings are confidential and will remain on OneDrive.
The City of Medina will only retain the physician’s written recommendation regarding each
employee’s ability to wear a respirator.
1.40 APPENDIX REFERENCES
2Appendix to § 1910.134 (Mandatory)
2Appendix A - Fit Testing Procedures
2Appendix B-2 - Respirator Cleaning Procedures
2Appendix C - OSHA Respirator Medical Evaluation Questionnaire
2Appendix D - Information for Employees Using Respirators When Not Required Under the Standard
1.45 FORMS
1Refer to the Safety Manual Appendix for all forms.
4078 - Respirator Fit Test Form
F007 – Respirator Training and Issuance Form
By Standard Number (/laws-regs/regulations/standardnumber/1910) / 1910.134 - Respiratory protection.
Part Number:1910
Part Number Title:Occupational Safety and Health Standards
Subpart:1910 Subpart I
Subpart Title:Personal Protective Equipment
Standard Number:1910.134 (/laws-regs/interlinking/standards/1910.134)
Title:Respiratory protection.
Appendix:A (/laws-regs/regulations/standardnumber/1910/1910.134AppA);
B-1 (/laws-regs/regulations/standardnumber/1910/1910.134AppB1);
B-2 (/laws-regs/regulations/standardnumber/1910/1910.134AppB2);
C (/laws-regs/regulations/standardnumber/1910/1910.134AppC);
D (/laws-regs/regulations/standardnumber/1910/1910.134AppD)
GPO Source:e-CFR (https://www.ecfr.gov/cgi-bin/text-idx?
SID=65b279ee2e7530009034c1f152d451e5&tpl=/ecfrbrowse/Title29/29tab_02.tpl)
This section applies to General Industry (part 1910), Shipyards (part 1915), Marine Terminals (part 1917),
Longshoring (part 1918), and Construction (part 1926).
1910.134(a) (/laws-regs/interlinking/standards/1910.134(a))
Permissible practice.
1910.134(a)(1) (/laws-regs/interlinking/standards/1910.134(a)(1))
In the control of those occupational diseases caused by breathing air contaminated with harmful dusts, fogs,
fumes, mists, gases, smokes, sprays, or vapors, the primary objective shall be to prevent atmospheric
contamination. This shall be accomplished as far as feasible by accepted engineering control measures (for
example, enclosure or confinement of the operation, general and local ventilation, and substitution of less toxic
materials). When effective engineering controls are not feasible, or while they are being instituted, appropriate
respirators shall be used pursuant to this section.
1910.134(a)(2) (/laws-regs/interlinking/standards/1910.134(a)(2))
A respirator shall be provided to each employee when such equipment is necessary to protect the health of such
employee. The employer shall provide the respirators which are applicable and suitable for the purpose
intended. The employer shall be responsible for the establishment and maintenance of a respiratory protection
program, which shall include the requirements outlined in paragraph (c) of this section. The program shall cover
each employee required by this section to use a respirator.
1910.134(b) (/laws-regs/interlinking/standards/1910.134(b))
Definitions. The following definitions are important terms used in the respiratory protection standard in this
section.
Air-purifying respirator means a respirator with an air-purifying filter, cartridge, or canister that removes
specific air contaminants by passing ambient air through the air-purifying element.
Assigned protection factor (APF) means the workplace level of respiratory protection that a respirator or class
of respirators is expected to provide to employees when the employer implements a continuing, effective
respiratory protection program as specified by this section.
Atmosphere-supplying respirator means a respirator that supplies the respirator user with breathing air from
a source independent of the ambient atmosphere, and includes supplied-air respirators (SARs) and self-
contained breathing apparatus (SCBA) units.
Canister or cartridge means a container with a filter, sorbent, or catalyst, or combination of these items, which
removes specific contaminants from the air passed through the container.
Demand respirator means an atmosphere-supplying respirator that admits breathing air to the facepiece only
when a negative pressure is created inside the facepiece by inhalation.
Emergency situation means any occurrence such as, but not limited to, equipment failure, rupture of
containers, or failure of control equipment that may or does result in an uncontrolled significant release of an
airborne contaminant.
Employee exposure means exposure to a concentration of an airborne contaminant that would occur if the
employee were not using respiratory protection.
End-of-service-life indicator (ESLI) means a system that warns the respirator user of the approach of the end
of adequate respiratory protection, for example, that the sorbent is approaching saturation or is no longer
effective.
Escape-only respirator means a respirator intended to be used only for emergency exit.
Filter or air purifying element means a component used in respirators to remove solid or liquid aerosols from
the inspired air.
Filtering facepiece (dust mask) means a negative pressure particulate respirator with a filter as an integral part
of the facepiece or with the entire facepiece composed of the filtering medium.
Fit factor means a quantitative estimate of the fit of a particular respirator to a specific individual, and typically
estimates the ratio of the concentration of a substance in ambient air to its concentration inside the respirator
when worn.
Fit test means the use of a protocol to qualitatively or quantitatively evaluate the fit of a respirator on an
individual. (See also Qualitative fit test QLFT and Quantitative fit test QNFT.)
Helmet means a rigid respiratory inlet covering that also provides head protection against impact and
penetration.
High efficiency particulate air (HEPA) filter means a filter that is at least 99.97% efficient in removing
monodisperse particles of 0.3 micrometers in diameter. The equivalent NIOSH 42 CFR 84 particulate filters are
the N100, R100, and P100 filters.
Hood means a respiratory inlet covering that completely covers the head and neck and may also cover portions
of the shoulders and torso.
Immediately dangerous to life or health (IDLH) means an atmosphere that poses an immediate threat to life,
would cause irreversible adverse health effects, or would impair an individual's ability to escape from a
dangerous atmosphere.
Interior structural firefighting means the physical activity of fire suppression, rescue or both, inside of
buildings or enclosed structures which are involved in a fire situation beyond the incipient stage. (See 29 CFR
1910.155)
Loose-fitting facepiece means a respiratory inlet covering that is designed to form a partial seal with the face.
Maximum use concentration (MUC) means the maximum atmospheric concentration of a hazardous
substance from which an employee can be expected to be protected when wearing a respirator, and is
determined by the assigned protection factor of the respirator or class of respirators and the exposure limit of
the hazardous substance. The MUC can be determined mathematically by multiplying the assigned protection
factor specified for a respirator by the required OSHA permissible exposure limit, short-term exposure limit, or
ceiling limit. When no OSHA exposure limit is available for a hazardous substance, an employer must determine
an MUC on the basis of relevant available information and informed professional judgment.
Negative pressure respirator (tight fitting) means a respirator in which the air pressure inside the facepiece is
negative during inhalation with respect to the ambient air pressure outside the respirator.
Oxygen deficient atmosphere means an atmosphere with an oxygen content below 19.5% by volume.
Physician or other licensed health care professional (PLHCP) means an individual whose legally permitted
scope of practice (i.e., license, registration, or certification) allows him or her to independently provide, or be
delegated the responsibility to provide, some or all of the health care services required by paragraph (e) of this
section.
Positive pressure respirator means a respirator in which the pressure inside the respiratory inlet covering
exceeds the ambient air pressure outside the respirator.
Powered air-purifying respirator (PAPR) means an air-purifying respirator that uses a blower to force the
ambient air through air-purifying elements to the inlet covering.
Pressure demand respirator means a positive pressure atmosphere-supplying respirator that admits breathing
air to the facepiece when the positive pressure is reduced inside the facepiece by inhalation.
Qualitative fit test (QLFT) means a pass/fail fit test to assess the adequacy of respirator fit that relies on the
individual's response to the test agent.
Quantitative fit test (QNFT) means an assessment of the adequacy of respirator fit by numerically measuring
the amount of leakage into the respirator.
Respiratory inlet covering means that portion of a respirator that forms the protective barrier between the
user's respiratory tract and an air-purifying device or breathing air source, or both. It may be a facepiece,
helmet, hood, suit, or a mouthpiece respirator with nose clamp.
Self-contained breathing apparatus (SCBA) means an atmosphere-supplying respirator for which the
breathing air source is designed to be carried by the user.
Service life means the period of time that a respirator, filter or sorbent, or other respiratory equipment provides
adequate protection to the wearer.
Supplied-air respirator (SAR) or airline respirator means an atmosphere-supplying respirator for which the
source of breathing air is not designed to be carried by the user.
This section means this respiratory protection standard.
Tight-fitting facepiece means a respiratory inlet covering that forms a complete seal with the face.
User seal check means an action conducted by the respirator user to determine if the respirator is properly
seated to the face.
1910.134(c) (/laws-regs/interlinking/standards/1910.134(c))
Respiratory protection program. This paragraph requires the employer to develop and implement a written
respiratory protection program with required worksite-specific procedures and elements for required respirator
use. The program must be administered by a suitably trained program administrator. In addition, certain program
elements may be required for voluntary use to prevent potential hazards associated with the use of the
respirator. The Small Entity Compliance Guide contains criteria for the selection of a program administrator and
a sample program that meets the requirements of this paragraph. Copies of the Small Entity Compliance Guide
will be available on or about April 8, 1998 from the Occupational Safety and Health Administration's Office of
Publications, Room N 3101, 200 Constitution Avenue, NW, Washington, DC, 20210 (202-219-4667).
1910.134(c)(1) (/laws-regs/interlinking/standards/1910.134(c)(1))
In any workplace where respirators are necessary to protect the health of the employee or whenever respirators
are required by the employer, the employer shall establish and implement a written respiratory protection
program with worksite-specific procedures. The program shall be updated as necessary to reflect those changes
in workplace conditions that affect respirator use. The employer shall include in the program the following
provisions of this section, as applicable:
1910.134(c)(1)(i)
Procedures for selecting respirators for use in the workplace;
1910.134(c)(1)(ii) (/laws-regs/interlinking/standards/1910.134(c)(1)(ii))
Medical evaluations of employees required to use respirators;
1910.134(c)(1)(iii)
Fit testing procedures for tight-fitting respirators;
1910.134(c)(1)(iv)
Procedures for proper use of respirators in routine and reasonably foreseeable emergency situations;
1910.134(c)(1)(v)
Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding, and otherwise
maintaining respirators;
1910.134(c)(1)(vi)
Procedures to ensure adequate air quality, quantity, and flow of breathing air for atmosphere-supplying
respirators;
1910.134(c)(1)(vii)
Training of employees in the respiratory hazards to which they are potentially exposed during routine and
emergency situations;
1910.134(c)(1)(viii)
Training of employees in the proper use of respirators, including putting on and removing them, any limitations
on their use, and their maintenance; and
1910.134(c)(1)(ix)
Procedures for regularly evaluating the effectiveness of the program.
1910.134(c)(2) (/laws-regs/interlinking/standards/1910.134(c)(2))
Where respirator use is not required:
1910.134(c)(2)(i) (/laws-regs/interlinking/standards/1910.134(c)(2)(i))
An employer may provide respirators at the request of employees or permit employees to use their own
respirators, if the employer determines that such respirator use will not in itself create a hazard. If the employer
determines that any voluntary respirator use is permissible, the employer shall provide the respirator users with
the information contained in appendix D to this section ("Information for Employees Using Respirators When Not
Required Under the Standard"); and
1910.134(c)(2)(ii) (/laws-regs/interlinking/standards/1910.134(c)(2)(ii))
In addition, the employer must establish and implement those elements of a written respiratory protection
program necessary to ensure that any employee using a respirator voluntarily is medically able to use that
respirator, and that the respirator is cleaned, stored, and maintained so that its use does not present a health
hazard to the user. Exception: Employers are not required to include in a written respiratory protection program
those employees whose only use of respirators involves the voluntary use of filtering facepieces (dust masks).
1910.134(c)(3)
The employer shall designate a program administrator who is qualified by appropriate training or experience that
is commensurate with the complexity of the program to administer or oversee the respiratory protection program
and conduct the required evaluations of program effectiveness.
1910.134(c)(4) (/laws-regs/interlinking/standards/1910.134(c)(4))
The employer shall provide respirators, training, and medical evaluations at no cost to the employee.
1910.134(d) (/laws-regs/interlinking/standards/1910.134(d))
Selection of respirators. This paragraph requires the employer to evaluate respiratory hazard(s) in the
workplace, identify relevant workplace and user factors, and base respirator selection on these factors. The
paragraph also specifies appropriately protective respirators for use in IDLH atmospheres, and limits the
selection and use of air-purifying respirators.
1910.134(d)(1) (/laws-regs/interlinking/standards/1910.134(d)(1))
General requirements.
1910.134(d)(1)(i) (/laws-regs/interlinking/standards/1910.134(d)(1)(i))
The employer shall select and provide an appropriate respirator based on the respiratory hazard(s) to which the
worker is exposed and workplace and user factors that affect respirator performance and reliability.
1910.134(d)(1)(ii) (/laws-regs/interlinking/standards/1910.134(d)(1)(ii))
The employer shall select a NIOSH-certified respirator. The respirator shall be used in compliance with the
conditions of its certification.
1910.134(d)(1)(iii) (/laws-regs/interlinking/standards/1910.134(d)(1)(iii))
The employer shall identify and evaluate the respiratory hazard(s) in the workplace; this evaluation shall include
a reasonable estimate of employee exposures to respiratory hazard(s) and an identification of the contaminant's
chemical state and physical form. Where the employer cannot identify or reasonably estimate the employee
exposure, the employer shall consider the atmosphere to be IDLH.
1910.134(d)(1)(iv)
The employer shall select respirators from a sufficient number of respirator models and sizes so that the
respirator is acceptable to, and correctly fits, the user.
1910.134(d)(2) (/laws-regs/interlinking/standards/1910.134(d)(2))
Respirators for IDLH atmospheres.
1910.134(d)(2)(i)
The employer shall provide the following respirators for employee use in IDLH atmospheres:
1910.134(d)(2)(i)(A) (/laws-regs/interlinking/standards/1910.134(d)(2)(i)(A))
A full facepiece pressure demand SCBA certified by NIOSH for a minimum service life of thirty minutes, or
1910.134(d)(2)(i)(B) (/laws-regs/interlinking/standards/1910.134(d)(2)(i)(B))
A combination full facepiece pressure demand supplied-air respirator (SAR) with auxiliary self-contained air
supply.
1910.134(d)(2)(ii) (/laws-regs/interlinking/standards/1910.134(d)(2)(ii))
Respirators provided only for escape from IDLH atmospheres shall be NIOSH-certified for escape from the
atmosphere in which they will be used.
1910.134(d)(2)(iii) (/laws-regs/interlinking/standards/1910.134(d)(2)(iii))
All oxygen-deficient atmospheres shall be considered IDLH. Exception: If the employer demonstrates that,
under all foreseeable conditions, the oxygen concentration can be maintained within the ranges specified in
Table II of this section (i.e., for the altitudes set out in the table), then any atmosphere-supplying respirator may
be used.
1910.134(d)(3) (/laws-regs/interlinking/standards/1910.134(d)(3))
Respirators for atmospheres that are not IDLH.
1910.134(d)(3)(i)
The employer shall provide a respirator that is adequate to protect the health of the employee and ensure
compliance with all other OSHA statutory and regulatory requirements, under routine and reasonably
foreseeable emergency situations.
1910.134(d)(3)(i)(A) (/laws-regs/interlinking/standards/1910.134(d)(3)(i)(A))
Assigned Protection Factors (APFs). Employers must use the assigned protection factors listed in Table 1 to
select a respirator that meets or exceeds the required level of employee protection. When using a combination
respirator (e.g., airline respirators with an air-purifying filter), employers must ensure that the assigned
protection factor is appropriate to the mode of operation in which the respirator is being used.
Table 1 - Assigned Protection Factors
Type of respirator
Quarter
mask
Half
mask
Full
facepiece Helmet/hood
Loose-
fitting
facepiece
1. Air-Purifying Respirator 5 10 50
2. Powered Air-Purifying Respirator (PAPR) 50 1,000 25/1,000 25
3. Supplied-Air Respirator (SAR) or Airline
Respirator
• Demand mode 10 50
• Continuous flow mode 50 1,000 25/1,000 25
• Pressure-demand or other positive-pressure
mode
50 1,000
4. Self-Contained Breathing Apparatus (SCBA)
• Demand mode 10 50 50
• Pressure-demand or other positive-pressure
mode (e.g., open/closed circuit)
10,000 10,000
5
1 2
3
4
4
Notes:
Employers may select respirators assigned for use in higher workplace concentrations of a hazardous
substance for use at lower concentrations of that substance, or when required respirator use is independent of
concentration.
The assigned protection factors in Table 1 are only effective when the employer implements a continuing,
effective respirator program as required by this section (29 CFR 1910.134), including training, fit testing,
maintenance, and use requirements.
This APF category includes filtering facepieces, and half masks with elastomeric facepieces.
The employer must have evidence provided by the respirator manufacturer that testing of these respirators
demonstrates performance at a level of protection of 1,000 or greater to receive an APF of 1,000. This level of
performance can best be demonstrated by performing a WPF or SWPF study or equivalent testing. Absent such
testing, all other PAPRs and SARs with helmets/hoods are to be treated as loose-fitting facepiece respirators,
and receive an APF of 25.
These APFs do not apply to respirators used solely for escape. For escape respirators used in association with
specific substances covered by 29 CFR 1910 subpart Z, employers must refer to the appropriate substance-
specific standards in that subpart. Escape respirators for other IDLH atmospheres are specified by 29 CFR
1910.134 (d)(2)(ii).
1910.134(d)(3)(i)(B)
Maximum Use Concentration (MUC).
1910.134(d)(3)(i)(B)(1)
The employer must select a respirator for employee use that maintains the employee's exposure to the
hazardous substance, when measured outside the respirator, at or below the MUC.
1910.134(d)(3)(i)(B)(2)
Employers must not apply MUCs to conditions that are immediately dangerous to life or health (IDLH); instead,
they must use respirators listed for IDLH conditions in paragraph (d)(2) of this standard.
1910.134(d)(3)(i)(B)(3)
When the calculated MUC exceeds the IDLH level for a hazardous substance, or the performance limits of the
cartridge or canister, then employers must set the maximum MUC at that lower limit.
1910.134(d)(3)(ii)
The respirator selected shall be appropriate for the chemical state and physical form of the contaminant.
1910.134(d)(3)(iii) (/laws-regs/interlinking/standards/1910.134(d)(3)(iii))
For protection against gases and vapors, the employer shall provide:
1910.134(d)(3)(iii)(A)
An atmosphere-supplying respirator, or
1910.134(d)(3)(iii)(B)
An air-purifying respirator, provided that:
1
2
3
4
5
1910.134(d)(3)(iii)(B)(1) (/laws-regs/interlinking/standards/1910.134(d)(3)(iii)(B)(1))
The respirator is equipped with an end-of-service-life indicator (ESLI) certified by NIOSH for the contaminant; or
1910.134(d)(3)(iii)(B)(2)
If there is no ESLI appropriate for conditions in the employer's workplace, the employer implements a change
schedule for canisters and cartridges that is based on objective information or data that will ensure that
canisters and cartridges are changed before the end of their service life. The employer shall describe in the
respirator program the information and data relied upon and the basis for the canister and cartridge change
schedule and the basis for reliance on the data.
1910.134(d)(3)(iv)
For protection against particulates, the employer shall provide:
1910.134(d)(3)(iv)(A)
An atmosphere-supplying respirator; or
1910.134(d)(3)(iv)(B) (/laws-regs/interlinking/standards/1910.134(d)(3)(iv)(B))
An air-purifying respirator equipped with a filter certified by NIOSH under 30 CFR part 11 as a high efficiency
particulate air (HEPA) filter, or an air-purifying respirator equipped with a filter certified for particulates by NIOSH
under 42 CFR part 84; or
1910.134(d)(3)(iv)(C)
For contaminants consisting primarily of particles with mass median aerodynamic diameters (MMAD) of at least
2 micrometers, an air-purifying respirator equipped with any filter certified for particulates by NIOSH.
TABLE I. - ASSIGNED PROTECTION FACTORS [RESERVED]
Table II
Altitude (ft.)
Oxygen deficient Atmospheres (% 0 ) for which the employer may rely on atmosphere-
supplying respirators
Less than
3,001
16.0-19.5
3,001-4,000 16.4-19.5
4,001-5,000 17.1-19.5
5,001-6,000 17.8-19.5
6,001-7,000 18.5-19.5
7,001-
8,000
19.3-19.5.
Above 8,000 feet the exception does not apply. Oxygen-enriched breathing air must be supplied above 14,000
feet.
2
1
1
1910.134(e) (/laws-regs/interlinking/standards/1910.134(e))
Medical evaluation. Using a respirator may place a physiological burden on employees that varies with the
type of respirator worn, the job and workplace conditions in which the respirator is used, and the medical status
of the employee. Accordingly, this paragraph specifies the minimum requirements for medical evaluation that
employers must implement to determine the employee's ability to use a respirator.
1910.134(e)(1) (/laws-regs/interlinking/standards/1910.134(e)(1))
General. The employer shall provide a medical evaluation to determine the employee's ability to use a
respirator, before the employee is fit tested or required to use the respirator in the workplace. The employer may
discontinue an employee's medical evaluations when the employee is no longer required to use a respirator.
1910.134(e)(2) (/laws-regs/interlinking/standards/1910.134(e)(2))
Medical evaluation procedures.
1910.134(e)(2)(i) (/laws-regs/interlinking/standards/1910.134(e)(2)(i))
The employer shall identify a physician or other licensed health care professional (PLHCP) to perform medical
evaluations using a medical questionnaire or an initial medical examination that obtains the same information as
the medical questionnaire.
1910.134(e)(2)(ii)
The medical evaluation shall obtain the information requested by the questionnaire in Sections 1 and 2, part A of
appendix C of this section.
1910.134(e)(3) (/laws-regs/interlinking/standards/1910.134(e)(3))
Follow-up medical examination.
1910.134(e)(3)(i)
The employer shall ensure that a follow-up medical examination is provided for an employee who gives a
positive response to any question among questions 1 through 8 in Section 2, part A of appendix C or whose
initial medical examination demonstrates the need for a follow-up medical examination.
1910.134(e)(3)(ii)
The follow-up medical examination shall include any medical tests, consultations, or diagnostic procedures that
the PLHCP deems necessary to make a final determination.
1910.134(e)(4)
Administration of the medical questionnaire and examinations.
1910.134(e)(4)(i)
The medical questionnaire and examinations shall be administered confidentially during the employee's normal
working hours or at a time and place convenient to the employee. The medical questionnaire shall be
administered in a manner that ensures that the employee understands its content.
1910.134(e)(4)(ii)
The employer shall provide the employee with an opportunity to discuss the questionnaire and examination
results with the PLHCP.
1910.134(e)(5) (/laws-regs/interlinking/standards/1910.134(e)(5))
Supplemental information for the PLHCP.
1910.134(e)(5)(i) (/laws-regs/interlinking/standards/1910.134(e)(5)(i))
The following information must be provided to the PLHCP before the PLHCP makes a recommendation
concerning an employee's ability to use a respirator:
1910.134(e)(5)(i)(A)
(A) The type and weight of the respirator to be used by the employee;
1910.134(e)(5)(i)(B)
The duration and frequency of respirator use (including use for rescue and escape);
1910.134(e)(5)(i)(C)
The expected physical work effort;
1910.134(e)(5)(i)(D)
Additional protective clothing and equipment to be worn; and
1910.134(e)(5)(i)(E)
Temperature and humidity extremes that may be encountered.
1910.134(e)(5)(ii)
Any supplemental information provided previously to the PLHCP regarding an employee need not be provided
for a subsequent medical evaluation if the information and the PLHCP remain the same.
1910.134(e)(5)(iii)
The employer shall provide the PLHCP with a copy of the written respiratory protection program and a copy of
this section.
Note to paragraph (e)(5)(iii): When the employer replaces a PLHCP, the employer must ensure that the new
PLHCP obtains this information, either by providing the documents directly to the PLHCP or having the
documents transferred from the former PLHCP to the new PLHCP. However, OSHA does not expect employers
to have employees medically reevaluated solely because a new PLHCP has been selected.
1910.134(e)(6) (/laws-regs/interlinking/standards/1910.134(e)(6))
Medical determination. In determining the employee's ability to use a respirator, the employer shall:
1910.134(e)(6)(i) (/laws-regs/interlinking/standards/1910.134(e)(6)(i))
Obtain a written recommendation regarding the employee's ability to use the respirator from the PLHCP. The
recommendation shall provide only the following information:
1910.134(e)(6)(i)(A)
Any limitations on respirator use related to the medical condition of the employee, or relating to the workplace
conditions in which the respirator will be used, including whether or not the employee is medically able to use
the respirator;
1910.134(e)(6)(i)(B) (/laws-regs/interlinking/standards/1910.134(e)(6)(i)(B))
The need, if any, for follow-up medical evaluations; and
1910.134(e)(6)(i)(C)
A statement that the PLHCP has provided the employee with a copy of the PLHCP's written recommendation.
1910.134(e)(6)(ii) (/laws-regs/interlinking/standards/1910.134(e)(6)(ii))
If the respirator is a negative pressure respirator and the PLHCP finds a medical condition that may place the
employee's health at increased risk if the respirator is used, the employer shall provide a PAPR if the PLHCP's
medical evaluation finds that the employee can use such a respirator; if a subsequent medical evaluation finds
that the employee is medically able to use a negative pressure respirator, then the employer is no longer
required to provide a PAPR.
1910.134(e)(7)
Additional medical evaluations. At a minimum, the employer shall provide additional medical evaluations that
comply with the requirements of this section if:
1910.134(e)(7)(i)
An employee reports medical signs or symptoms that are related to ability to use a respirator;
1910.134(e)(7)(ii)
A PLHCP, supervisor, or the respirator program administrator informs the employer that an employee needs to
be reevaluated;
1910.134(e)(7)(iii)
Information from the respiratory protection program, including observations made during fit testing and program
evaluation, indicates a need for employee reevaluation; or
1910.134(e)(7)(iv)
A change occurs in workplace conditions (e.g., physical work effort, protective clothing, temperature) that may
result in a substantial increase in the physiological burden placed on an employee.
1910.134(f) (/laws-regs/interlinking/standards/1910.134(f))
Fit testing. This paragraph requires that, before an employee may be required to use any respirator with a
negative or positive pressure tight-fitting facepiece, the employee must be fit tested with the same make, model,
style, and size of respirator that will be used. This paragraph specifies the kinds of fit tests allowed, the
procedures for conducting them, and how the results of the fit tests must be used.
1910.134(f)(1)
The employer shall ensure that employees using a tight-fitting facepiece respirator pass an appropriate
qualitative fit test (QLFT) or quantitative fit test (QNFT) as stated in this paragraph.
1910.134(f)(2) (/laws-regs/interlinking/standards/1910.134(f)(2))
The employer shall ensure that an employee using a tight-fitting facepiece respirator is fit tested prior to initial
use of the respirator, whenever a different respirator facepiece (size, style, model or make) is used, and at least
annually thereafter.
1910.134(f)(3) (/laws-regs/interlinking/standards/1910.134(f)(3))
The employer shall conduct an additional fit test whenever the employee reports, or the employer, PLHCP,
supervisor, or program administrator makes visual observations of, changes in the employee's physical
condition that could affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental
changes, cosmetic surgery, or an obvious change in body weight.
1910.134(f)(4) (/laws-regs/interlinking/standards/1910.134(f)(4))
If after passing a QLFT or QNFT, the employee subsequently notifies the employer, program administrator,
supervisor, or PLHCP that the fit of the respirator is unacceptable, the employee shall be given a reasonable
opportunity to select a different respirator facepiece and to be retested.
1910.134(f)(5)
The fit test shall be administered using an OSHA-accepted QLFT or QNFT protocol. The OSHA-accepted QLFT
and QNFT protocols and procedures are contained in appendix A of this section.
1910.134(f)(6) (/laws-regs/interlinking/standards/1910.134(f)(6))
QLFT may only be used to fit test negative pressure air-purifying respirators that must achieve a fit factor of 100
or less.
1910.134(f)(7) (/laws-regs/interlinking/standards/1910.134(f)(7))
If the fit factor, as determined through an OSHA-accepted QNFT protocol, is equal to or greater than 100 for
tight-fitting half facepieces, or equal to or greater than 500 for tight-fitting full facepieces, the QNFT has been
passed with that respirator.
1910.134(f)(8) (/laws-regs/interlinking/standards/1910.134(f)(8))
Fit testing of tight-fitting atmosphere-supplying respirators and tight-fitting powered air-purifying respirators shall
be accomplished by performing quantitative or qualitative fit testing in the negative pressure mode, regardless of
the mode of operation (negative or positive pressure) that is used for respiratory protection.
1910.134(f)(8)(i)
Qualitative fit testing of these respirators shall be accomplished by temporarily converting the respirator user's
actual facepiece into a negative pressure respirator with appropriate filters, or by using an identical negative
pressure air-purifying respirator facepiece with the same sealing surfaces as a surrogate for the atmosphere-
supplying or powered air-purifying respirator facepiece.
1910.134(f)(8)(ii)
Quantitative fit testing of these respirators shall be accomplished by modifying the facepiece to allow sampling
inside the facepiece in the breathing zone of the user, midway between the nose and mouth. This requirement
shall be accomplished by installing a permanent sampling probe onto a surrogate facepiece, or by using a
sampling adapter designed to temporarily provide a means of sampling air from inside the facepiece.
1910.134(f)(8)(iii)
Any modifications to the respirator facepiece for fit testing shall be completely removed, and the facepiece
restored to NIOSH-approved configuration, before that facepiece can be used in the workplace.
1910.134(g) (/laws-regs/interlinking/standards/1910.134(g))
Use of respirators. This paragraph requires employers to establish and implement procedures for the proper
use of respirators. These requirements include prohibiting conditions that may result in facepiece seal leakage,
preventing employees from removing respirators in hazardous environments, taking actions to ensure continued
effective respirator operation throughout the work shift, and establishing procedures for the use of respirators in
IDLH atmospheres or in interior structural firefighting situations.
1910.134(g)(1) (/laws-regs/interlinking/standards/1910.134(g)(1))
Facepiece seal protection.
1910.134(g)(1)(i) (/laws-regs/interlinking/standards/1910.134(g)(1)(i))
The employer shall not permit respirators with tight-fitting facepieces to be worn by employees who have:
1910.134(g)(1)(i)(A) (/laws-regs/interlinking/standards/1910.134(g)(1)(i)(A))
Facial hair that comes between the sealing surface of the facepiece and the face or that interferes with valve
function; or
1910.134(g)(1)(i)(B) (/laws-regs/interlinking/standards/1910.134(g)(1)(i)(B))
Any condition that interferes with the face-to-facepiece seal or valve function.
1910.134(g)(1)(ii) (/laws-regs/interlinking/standards/1910.134(g)(1)(ii))
If an employee wears corrective glasses or goggles or other personal protective equipment, the employer shall
ensure that such equipment is worn in a manner that does not interfere with the seal of the facepiece to the face
of the user.
1910.134(g)(1)(iii) (/laws-regs/interlinking/standards/1910.134(g)(1)(iii))
For all tight-fitting respirators, the employer shall ensure that employees perform a user seal check each time
they put on the respirator using the procedures in appendix B-1 or procedures recommended by the respirator
manufacturer that the employer demonstrates are as effective as those in appendix B-1 of this section.
1910.134(g)(2)
Continuing respirator effectiveness.
1910.134(g)(2)(i)
Appropriate surveillance shall be maintained of work area conditions and degree of employee exposure or
stress. When there is a change in work area conditions or degree of employee exposure or stress that may
affect respirator effectiveness, the employer shall reevaluate the continued effectiveness of the respirator.
1910.134(g)(2)(ii)
The employer shall ensure that employees leave the respirator use area:
1910.134(g)(2)(ii)(A)
To wash their faces and respirator facepieces as necessary to prevent eye or skin irritation associated with
respirator use; or
1910.134(g)(2)(ii)(B)
If they detect vapor or gas breakthrough, changes in breathing resistance, or leakage of the facepiece; or
1910.134(g)(2)(ii)(C)
To replace the respirator or the filter, cartridge, or canister elements.
1910.134(g)(2)(iii)
If the employee detects vapor or gas breakthrough, changes in breathing resistance, or leakage of the
facepiece, the employer must replace or repair the respirator before allowing the employee to return to the work
area.
1910.134(g)(3) (/laws-regs/interlinking/standards/1910.134(g)(3))
Procedures for IDLH atmospheres. For all IDLH atmospheres, the employer shall ensure that:
1910.134(g)(3)(i)
One employee or, when needed, more than one employee is located outside the IDLH atmosphere;
1910.134(g)(3)(ii)
Visual, voice, or signal line communication is maintained between the employee(s) in the IDLH atmosphere and
the employee(s) located outside the IDLH atmosphere;
1910.134(g)(3)(iii)
The employee(s) located outside the IDLH atmosphere are trained and equipped to provide effective emergency
rescue;
1910.134(g)(3)(iv)
The employer or designee is notified before the employee(s) located outside the IDLH atmosphere enter the
IDLH atmosphere to provide emergency rescue;
1910.134(g)(3)(v)
The employer or designee authorized to do so by the employer, once notified, provides necessary assistance
appropriate to the situation;
1910.134(g)(3)(vi)
Employee(s) located outside the IDLH atmospheres are equipped with:
1910.134(g)(3)(vi)(A)
Pressure demand or other positive pressure SCBAs, or a pressure demand or other positive pressure supplied-
air respirator with auxiliary SCBA; and either
1910.134(g)(3)(vi)(B)
Appropriate retrieval equipment for removing the employee(s) who enter(s) these hazardous atmospheres
where retrieval equipment would contribute to the rescue of the employee(s) and would not increase the overall
risk resulting from entry; or
1910.134(g)(3)(vi)(C)
Equivalent means for rescue where retrieval equipment is not required under paragraph (g)(3)(vi)(B).
1910.134(g)(4) (/laws-regs/interlinking/standards/1910.134(g)(4))
Procedures for interior structural firefighting. In addition to the requirements set forth under paragraph (g)
(3), in interior structural fires, the employer shall ensure that:
1910.134(g)(4)(i)
At least two employees enter the IDLH atmosphere and remain in visual or voice contact with one another at all
times;
1910.134(g)(4)(ii)
At least two employees are located outside the IDLH atmosphere; and
1910.134(g)(4)(iii)
All employees engaged in interior structural firefighting use SCBAs.
Note 1 to paragraph (g): One of the two individuals located outside the IDLH atmosphere may be assigned to
an additional role, such as incident commander in charge of the emergency or safety officer, so long as this
individual is able to perform assistance or rescue activities without jeopardizing the safety or health of any
firefighter working at the incident.
Note 2 to paragraph (g): Nothing in this section is meant to preclude firefighters from performing emergency
rescue activities before an entire team has assembled.
1910.134(h) (/laws-regs/interlinking/standards/1910.134(h))
Maintenance and care of respirators. This paragraph requires the employer to provide for the cleaning and
disinfecting, storage, inspection, and repair of respirators used by employees.
1910.134(h)(1) (/laws-regs/interlinking/standards/1910.134(h)(1))
Cleaning and disinfecting. The employer shall provide each respirator user with a respirator that is clean,
sanitary, and in good working order. The employer shall ensure that respirators are cleaned and disinfected
using the procedures in appendix B-2 of this section, or procedures recommended by the respirator
manufacturer, provided that such procedures are of equivalent effectiveness. The respirators shall be cleaned
and disinfected at the following intervals:
1910.134(h)(1)(i)
Respirators issued for the exclusive use of an employee shall be cleaned and disinfected as often as necessary
to be maintained in a sanitary condition;
1910.134(h)(1)(ii)
Respirators issued to more than one employee shall be cleaned and disinfected before being worn by different
individuals;
1910.134(h)(1)(iii) (/laws-regs/interlinking/standards/1910.134(h)(1)(iii))
Respirators maintained for emergency use shall be cleaned and disinfected after each use; and
1910.134(h)(1)(iv)
Respirators used in fit testing and training shall be cleaned and disinfected after each use.
1910.134(h)(2) (/laws-regs/interlinking/standards/1910.134(h)(2))
Storage. The employer shall ensure that respirators are stored as follows:
1910.134(h)(2)(i)
All respirators shall be stored to protect them from damage, contamination, dust, sunlight, extreme
temperatures, excessive moisture, and damaging chemicals, and they shall be packed or stored to prevent
deformation of the facepiece and exhalation valve.
1910.134(h)(2)(ii)
In addition to the requirements of paragraph (h)(2)(i) of this section, emergency respirators shall be:
1910.134(h)(2)(ii)(A)
Kept accessible to the work area;
1910.134(h)(2)(ii)(B)
Stored in compartments or in covers that are clearly marked as containing emergency respirators; and
1910.134(h)(2)(ii)(C)
Stored in accordance with any applicable manufacturer instructions.
1910.134(h)(3)
Inspection.
1910.134(h)(3)(i)
The employer shall ensure that respirators are inspected as follows:
1910.134(h)(3)(i)(A)
All respirators used in routine situations shall be inspected before each use and during cleaning;
1910.134(h)(3)(i)(B)
All respirators maintained for use in emergency situations shall be inspected at least monthly and in accordance
with the manufacturer's recommendations, and shall be checked for proper function before and after each use;
and
1910.134(h)(3)(i)(C)
Emergency escape-only respirators shall be inspected before being carried into the workplace for use.
1910.134(h)(3)(ii)
The employer shall ensure that respirator inspections include the following:
1910.134(h)(3)(ii)(A)
A check of respirator function, tightness of connections, and the condition of the various parts including, but not
limited to, the facepiece, head straps, valves, connecting tube, and cartridges, canisters or filters; and
1910.134(h)(3)(ii)(B)
A check of elastomeric parts for pliability and signs of deterioration.
1910.134(h)(3)(iii) (/laws-regs/interlinking/standards/1910.134(h)(3)(iii))
In addition to the requirements of paragraphs (h)(3)(i) and (ii) of this section, self-contained breathing apparatus
shall be inspected monthly. Air and oxygen cylinders shall be maintained in a fully charged state and shall be
recharged when the pressure falls to 90% of the manufacturer's recommended pressure level. The employer
shall determine that the regulator and warning devices function properly.
1910.134(h)(3)(iv)
For respirators maintained for emergency use, the employer shall:
1910.134(h)(3)(iv)(A)
Certify the respirator by documenting the date the inspection was performed, the name (or signature) of the
person who made the inspection, the findings, required remedial action, and a serial number or other means of
identifying the inspected respirator; and
1910.134(h)(3)(iv)(B)
Provide this information on a tag or label that is attached to the storage compartment for the respirator, is kept
with the respirator, or is included in inspection reports stored as paper or electronic files. This information shall
be maintained until replaced following a subsequent certification.
1910.134(h)(4)
Repairs. The employer shall ensure that respirators that fail an inspection or are otherwise found to be defective
are removed from service, and are discarded or repaired or adjusted in accordance with the following
procedures:
1910.134(h)(4)(i)
Repairs or adjustments to respirators are to be made only by persons appropriately trained to perform such
operations and shall use only the respirator manufacturer's NIOSH-approved parts designed for the respirator;
1910.134(h)(4)(ii)
Repairs shall be made according to the manufacturer's recommendations and specifications for the type and
extent of repairs to be performed; and
1910.134(h)(4)(iii)
Reducing and admission valves, regulators, and alarms shall be adjusted or repaired only by the manufacturer
or a technician trained by the manufacturer.
1910.134(i) (/laws-regs/interlinking/standards/1910.134(i))
Breathing air quality and use. This paragraph requires the employer to provide employees using atmosphere-
supplying respirators (supplied-air and SCBA) with breathing gases of high purity.
1910.134(i)(1)
The employer shall ensure that compressed air, compressed oxygen, liquid air, and liquid oxygen used for
respiration accords with the following specifications:
1910.134(i)(1)(i) (/laws-regs/interlinking/standards/1910.134(i)(1)(i))
Compressed and liquid oxygen shall meet the United States Pharmacopoeia requirements for medical or
breathing oxygen; and
1910.134(i)(1)(ii)
Compressed breathing air shall meet at least the requirements for Grade D breathing air described in
ANSI/Compressed Gas Association Commodity Specification for Air, G-7.1-1989, to include:
1910.134(i)(1)(ii)(A)
Oxygen content (v/v) of 19.5-23.5%;
1910.134(i)(1)(ii)(B)
Hydrocarbon (condensed) content of 5 milligrams per cubic meter of air or less;
1910.134(i)(1)(ii)(C)
Carbon monoxide (CO) content of 10 ppm or less;
1910.134(i)(1)(ii)(D)
Carbon dioxide content of 1,000 ppm or less; and
1910.134(i)(1)(ii)(E)
Lack of noticeable odor.
1910.134(i)(2)
The employer shall ensure that compressed oxygen is not used in atmosphere-supplying respirators that have
previously used compressed air.
1910.134(i)(3)
The employer shall ensure that oxygen concentrations greater than 23.5% are used only in equipment designed
for oxygen service or distribution.
1910.134(i)(4)
The employer shall ensure that cylinders used to supply breathing air to respirators meet the following
requirements:
1910.134(i)(4)(i)
Cylinders are tested and maintained as prescribed in the Shipping Container Specification Regulations of the
Department of Transportation (49 CFR part 180);
1910.134(i)(4)(ii) (/laws-regs/interlinking/standards/1910.134(i)(4)(ii))
Cylinders of purchased breathing air have a certificate of analysis from the supplier that the breathing air meets
the requirements for Grade D breathing air; and
1910.134(i)(4)(iii)
The moisture content in the cylinder does not exceed a dew point of −50 °F (−45.6 °C) at 1 atmosphere
pressure.
1910.134(i)(5)
The employer shall ensure that compressors used to supply breathing air to respirators are constructed and
situated so as to:
1910.134(i)(5)(i)
Prevent entry of contaminated air into the air-supply system;
1910.134(i)(5)(ii)
Minimize moisture content so that the dew point at 1 atmosphere pressure is 10 degrees F (5.56 °C) below the
ambient temperature;
1910.134(i)(5)(iii)
Have suitable in-line air-purifying sorbent beds and filters to further ensure breathing air quality. Sorbent beds
and filters shall be maintained and replaced or refurbished periodically following the manufacturer's instructions.
1910.134(i)(5)(iv)
Have a tag containing the most recent change date and the signature of the person authorized by the employer
to perform the change. The tag shall be maintained at the compressor.
1910.134(i)(6)
For compressors that are not oil-lubricated, the employer shall ensure that carbon monoxide levels in the
breathing air do not exceed 10 ppm.
1910.134(i)(7) (/laws-regs/interlinking/standards/1910.134(i)(7))
For oil-lubricated compressors, the employer shall use a high-temperature or carbon monoxide alarm, or both,
to monitor carbon monoxide levels. If only high-temperature alarms are used, the air supply shall be monitored
at intervals sufficient to prevent carbon monoxide in the breathing air from exceeding 10 ppm.
1910.134(i)(8) (/laws-regs/interlinking/standards/1910.134(i)(8))
The employer shall ensure that breathing air couplings are incompatible with outlets for nonrespirable worksite
air or other gas systems. No asphyxiating substance shall be introduced into breathing air lines.
1910.134(i)(9)
The employer shall use only the respirator manufacturer's NIOSH-approved breathing-gas containers,marked
and maintained in accordance with the Quality Assurance provisions of the NIOSH approval for the SCBA as
issued in accordance with the NIOSH respirator-certification standard at 42 CFR part 84.
1910.134(j)
Identification of filters, cartridges, and canisters. The employer shall ensure that all filters, cartridges and
canisters used in the workplace are labeled and color coded with the NIOSH approval label and that the label is
not removed and remains legible.
1910.134(k) (/laws-regs/interlinking/standards/1910.134(k))
Training and information. This paragraph requires the employer to provide effective training to employees who
are required to use respirators. The training must be comprehensive, understandable, and recur annually, and
more often if necessary. This paragraph also requires the employer to provide the basic information on
respirators in appendix D of this section to employees who wear respirators when not required by this section or
by the employer to do so.
1910.134(k)(1)
The employer shall ensure that each employee can demonstrate knowledge of at least the following:
1910.134(k)(1)(i)
Why the respirator is necessary and how improper fit, usage, or maintenance can compromise the protective
effect of the respirator;
1910.134(k)(1)(ii)
What the limitations and capabilities of the respirator are;
1910.134(k)(1)(iii)
How to use the respirator effectively in emergency situations, including situations in which the respirator
malfunctions;
1910.134(k)(1)(iv)
How to inspect, put on and remove, use, and check the seals of the respirator;
1910.134(k)(1)(v)
What the procedures are for maintenance and storage of the respirator;
1910.134(k)(1)(vi)
How to recognize medical signs and symptoms that may limit or prevent the effective use of respirators; and
1910.134(k)(1)(vii)
The general requirements of this section.
1910.134(k)(2)
The training shall be conducted in a manner that is understandable to the employee.
1910.134(k)(3)
The employer shall provide the training prior to requiring the employee to use a respirator in the workplace.
1910.134(k)(4)
An employer who is able to demonstrate that a new employee has received training within the last 12 months
that addresses the elements specified in paragraph (k)(1)(i) through (vii) is not required to repeat such training
provided that, as required by paragraph (k)(1), the employee can demonstrate knowledge of those element(s).
Previous training not repeated initially by the employer must be provided no later than 12 months from the date
of the previous training.
1910.134(k)(5)
Retraining shall be administered annually, and when the following situations occur:
1910.134(k)(5)(i)
Changes in the workplace or the type of respirator render previous training obsolete;
1910.134(k)(5)(ii) (/laws-regs/interlinking/standards/1910.134(k)(5)(ii))
Inadequacies in the employee's knowledge or use of the respirator indicate that the employee has not retained
the requisite understanding or skill; or
1910.134(k)(5)(iii)
Any other situation arises in which retraining appears necessary to ensure safe respirator use.
1910.134(k)(6)
The basic advisory information on respirators, as presented in appendix D of this section, shall be provided by
the employer in any written or oral format, to employees who wear respirators when such use is not required by
this section or by the employer.
1910.134(l)
Program evaluation. This section requires the employer to conduct evaluations of the workplace to ensure that
the written respiratory protection program is being properly implemented, and to consult employees to ensure
that they are using the respirators properly.
1910.134(l)(1)
The employer shall conduct evaluations of the workplace as necessary to ensure that the provisions of the
current written program are being effectively implemented and that it continues to be effective.
1910.134(l)(2)
The employer shall regularly consult employees required to use respirators to assess the employees' views on
program effectiveness and to identify any problems. Any problems that are identified during this assessment
shall be corrected. Factors to be assessed include, but are not limited to:
1910.134(l)(2)(i)
Respirator fit (including the ability to use the respirator without interfering with effective workplace performance);
1910.134(l)(2)(ii)
Appropriate respirator selection for the hazards to which the employee is exposed;
1910.134(l)(2)(iii)
Proper respirator use under the workplace conditions the employee encounters; and
1910.134(l)(2)(iv)
Proper respirator maintenance.
1910.134(m) (/laws-regs/interlinking/standards/1910.134(m))
Recordkeeping. This section requires the employer to establish and retain written information regarding
medical evaluations, fit testing, and the respirator program. This information will facilitate employee involvement
in the respirator program, assist the employer in auditing the adequacy of the program, and provide a record for
compliance determinations by OSHA.
1910.134(m)(1)
Medical evaluation. Records of medical evaluations required by this section must be retained and made
available in accordance with 29 CFR 1910.1020.
1910.134(m)(2) (/laws-regs/interlinking/standards/1910.134(m)(2))
Fit testing.
1910.134(m)(2)(i)
The employer shall establish a record of the qualitative and quantitative fit tests administered to an employee
including:
1910.134(m)(2)(i)(A)
The name or identification of the employee tested;
1910.134(m)(2)(i)(B)
Type of fit test performed;
1910.134(m)(2)(i)(C)
Specific make, model, style, and size of respirator tested;
1910.134(m)(2)(i)(D)
Date of test; and
1910.134(m)(2)(i)(E)
The pass/fail results for QLFTs or the fit factor and strip chart recording or other recording of the test results for
QNFTs.
1910.134(m)(2)(ii)
Fit test records shall be retained for respirator users until the next fit test is administered.
1910.134(m)(3)
A written copy of the current respirator program shall be retained by the employer.
1910.134(m)(4) (/laws-regs/interlinking/standards/1910.134(m)(4))
Written materials required to be retained under this paragraph shall be made available upon request to affected
employees and to the Assistant Secretary or designee for examination and copying.
1910.134(n)
Effective date. Paragraphs (d)(3)(i)(A) and (d)(3)(i)(B) of this section become effective November 22, 2006.
1910.134(o)
Appendices. Compliance with appendix A, appendix B-1, appendix B-2, appendix C, and appendix D to this
section are mandatory.
[63 FR 1152, Jan. 8, 1998; 63 FR 20098, April 23, 1998; 71 FR 16672, April 3, 2006; 71 FR 50187, August 24,
2006; 73 FR 75584, Dec. 12, 2008; 76 FR 33606, June 8, 2011; 84 FR 50755, Sept. 26, 2019]
UNITED STATES
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By Standard Number (/laws-regs/regulations/standardnumber/1910)
/ 1910.134 App A - Fit Testing Procedures (Mandatory).
Part Number:1910
Part Number Title:Occupational Safety and Health Standards
Subpart:1910 Subpart I
Subpart Title:Personal Protective Equipment
Standard Number:1910.134 App A (/laws-regs/interlinking/standards/1910.134 App A)
Title:Fit Testing Procedures (Mandatory).
GPO Source:e-CFR (https://www.ecfr.gov/cgi-bin/text-idx?
SID=65b279ee2e7530009034c1f152d451e5&tpl=/ecfrbrowse/Title29/29tab_02.tpl)
Appendix A to § 1910.134 - Fit Testing Procedures (Mandatory)
Part I. OSHA-Accepted Fit Test Protocols
A. Fit Testing Procedures - General Requirements
The employer shall conduct fit testing using the following procedures. The requirements in this appendix apply to
all OSHA-accepted fit test methods, both QLFT and QNFT.
1. The test subject shall be allowed to pick the most acceptable respirator from a sufficient number of respirator
models and sizes so that the respirator is acceptable to, and correctly fits, the user.
2. Prior to the selection process, the test subject shall be shown how to put on a respirator, how it should be
positioned on the face, how to set strap tension and how to determine an acceptable fit. A mirror shall be available
to assist the subject in evaluating the fit and positioning of the respirator. This instruction may not constitute the
subject's formal training on respirator use, because it is only a review.
3. The test subject shall be informed that he/she is being asked to select the respirator that provides the most
acceptable fit. Each respirator represents a different size and shape, and if fitted and used properly, will provide
adequate protection.
4. The test subject shall be instructed to hold each chosen facepiece up to the face and eliminate those that
obviously do not give an acceptable fit.
5. The more acceptable facepieces are noted in case the one selected proves unacceptable; the most comfortable
mask is donned and worn at least five minutes to assess comfort. Assistance in assessing comfort can be given by
discussing the points in the following item A.6. If the test subject is not familiar with using a particular respirator,
the test subject shall be directed to don the mask several times and to adjust the straps each time to become
adept at setting proper tension on the straps.
6. Assessment of comfort shall include a review of the following points with the test subject and allowing the test
subject adequate time to determine the comfort of the respirator:
(a) Position of the mask on the nose
(b) Room for eye protection
(c) Room to talk
(d) Position of mask on face and cheeks
7. The following criteria shall be used to help determine the adequacy of the respirator fit:
(a) Chin properly placed;
(b) Adequate strap tension, not overly tightened;
(c) Fit across nose bridge;
(d) Respirator of proper size to span distance from nose to chin;
(e) Tendency of respirator to slip;
(f) Self-observation in mirror to evaluate fit and respirator position.
8. The test subject shall conduct a user seal check, either the negative and positive pressure seal checks
described in appendix B-1 of this section or those recommended by the respirator manufacturer which provide
equivalent protection to the procedures in appendix B-1. Before conducting the negative and positive pressure
checks, the subject shall be told to seat the mask on the face by moving the head from side-to-side and up and
down slowly while taking in a few slow deep breaths. Another facepiece shall be selected and retested if the test
subject fails the user seal check tests.
9. The test shall not be conducted if there is any hair growth between the skin and the facepiece sealing surface,
such as stubble beard growth, beard, mustache or sideburns which cross the respirator sealing surface. Any type
of apparel which interferes with a satisfactory fit shall be altered or removed.
10. If a test subject exhibits difficulty in breathing during the tests, she or he shall be referred to a physician or
other licensed health care professional, as appropriate, to determine whether the test subject can wear a respirator
while performing her or his duties.
11. If the employee finds the fit of the respirator unacceptable, the test subject shall be given the opportunity to
select a different respirator and to be retested.
12. Exercise regimen. Prior to the commencement of the fit test, the test subject shall be given a description of the
fit test and the test subject's responsibilities during the test procedure. The description of the process shall include
a description of the test exercises that the subject will be performing. The respirator to be tested shall be worn for
at least 5 minutes before the start of the fit test.
13. The fit test shall be performed while the test subject is wearing any applicable safety equipment that may be
worn during actual respirator use which could interfere with respirator fit.
14. Test Exercises.
(a) Employers must perform the following test exercises for all fit testing methods prescribed in this appendix,
except for the two modified ambient aerosol CNC quantitative fit testing protocols, the CNP quantitative fit testing
protocol, and the CNP REDON quantitative fit testing protocol. For the modified ambient aerosol CNC quantitative
fit testing protocols, employers shall ensure that the test subjects (i.e., employees) perform the exercise procedure
specified in Part I.C.4(b) of this appendix for full-facepiece and half-mask elastomeric respirators, or the exercise
procedure specified in Part I.C.5(b) for filtering facepiece respirators. Employers shall ensure that the test subjects
(i.e., employees) perform the exercise procedure specified in Part I.C.6(b) of this appendix for the CNP
quantitative fit testing protocol, or the exercise procedure described in Part I.C.7(b) of this appendix for the CNP
REDON quantitative fit testing protocol. For the remaining fit testing methods, employers shall ensure that the test
exercises are performed in the appropriate test environment in the following manner:
(1) Normal breathing. In a normal standing position, without talking, the subject shall breathe normally.
(2) Deep breathing. In a normal standing position, the subject shall breathe slowly and deeply, taking caution so as
not to hyperventilate.
(3) Turning head side to side. Standing in place, the subject shall slowly turn his/her head from side to side
between the extreme positions on each side. The head shall be held at each extreme momentarily so the subject
can inhale at each side.
(4) Moving head up and down. Standing in place, the subject shall slowly move his/her head up and down. The
subject shall be instructed to inhale in the up position (i.e., when looking toward the ceiling).
(5) Talking. The subject shall talk out loud slowly and loud enough so as to be heard clearly by the test conductor.
The subject can read from a prepared text such as the Rainbow Passage, count backward from 100, or recite a
memorized poem or song.
Rainbow Passage
When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of
white light into many beautiful colors. These take the shape of a long round arch, with its path high above, and its
two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People
look, but no one ever finds it. When a man looks for something beyond reach, his friends say he is looking for the
pot of gold at the end of the rainbow.
(6) Grimace. The test subject shall grimace by smiling or frowning. (This applies only to QNFT testing; it is not
performed for QLFT)
(7) Bending over. The test subject shall bend at the waist as if he/she were to touch his/her toes. Jogging in place
shall be substituted for this exercise in those test environments such as shroud type QNFT or QLFT units that do
not permit bending over at the waist.
(8) Normal breathing. Same as exercise (1).
(b) Each test exercise shall be performed for one minute except for the grimace exercise which shall be performed
for 15 seconds. The test subject shall be questioned by the test conductor regarding the comfort of the respirator
upon completion of the protocol. If it has become unacceptable, another model of respirator shall be tried. The
respirator shall not be adjusted once the fit test exercises begin. Any adjustment voids the test, and the fit test
must be repeated.
B. Qualitative Fit Test (QLFT) Protocols
1. GENERAL
(a) The employer shall ensure that persons administering QLFT are able to prepare test solutions, calibrate
equipment and perform tests properly, recognize invalid tests, and ensure that test equipment is in proper working
order.
(b) The employer shall ensure that QLFT equipment is kept clean and well maintained so as to operate within the
parameters for which it was designed.
2. ISIAMYL ACETATE PROTOCOL
Note:
This protocol is not appropriate to use for the fit testing of particulate respirators. If used to fit test particulate
respirators, the respirator must be equipped with an organic vapor filter.
(a) Odor Threshold Screening
Odor threshold screening, performed without wearing a respirator, is intended to determine if the individual tested
can detect the odor of isoamyl acetate at low levels.
(1) Three 1 liter glass jars with metal lids are required.
(2) Odor-free water (e.g., distilled or spring water) at approximately 25 °C (77 °F) shall be used for the solutions.
(3) The isoamyl acetate (IAA) (also known at isopentyl acetate) stock solution is prepared by adding 1 ml of pure
IAA to 800 ml of odor-free water in a 1 liter jar, closing the lid and shaking for 30 seconds. A new solution shall be
prepared at least weekly.
(4) The screening test shall be conducted in a room separate from the room used for actual fit testing. The two
rooms shall be well-ventilated to prevent the odor of IAA from becoming evident in the general room air where
testing takes place.
(5) The odor test solution is prepared in a second jar by placing 0.4 ml of the stock solution into 500 ml of odor-free
water using a clean dropper or pipette. The solution shall be shaken for 30 seconds and allowed to stand for two to
three minutes so that the IAA concentration above the liquid may reach equilibrium. This solution shall be used for
only one day.
(6) A test blank shall be prepared in a third jar by adding 500 cc of odor-free water.
(7) The odor test and test blank jar lids shall be labeled (e.g., 1 and 2) for jar identification. Labels shall be placed
on the lids so that they can be peeled off periodically and switched to maintain the integrity of the test.
(8) The following instruction shall be typed on a card and placed on the table in front of the two test jars (i.e., 1 and
2): “The purpose of this test is to determine if you can smell banana oil at a low concentration. The two bottles in
front of you contain water. One of these bottles also contains a small amount of banana oil. Be sure the covers are
on tight, then shake each bottle for two seconds. Unscrew the lid of each bottle, one at a time, and sniff at the
mouth of the bottle. Indicate to the test conductor which bottle contains banana oil.”
(9) The mixtures used in the IAA odor detection test shall be prepared in an area separate from where the test is
performed, in order to prevent olfactory fatigue in the subject.
(10) If the test subject is unable to correctly identify the jar containing the odor test solution, the IAA qualitative fit
test shall not be performed.
(11) If the test subject correctly identifies the jar containing the odor test solution, the test subject may proceed to
respirator selection and fit testing.
(b) Isoamyl Acetate Fit Test
(1) The fit test chamber shall be a clear 55-gallon drum liner suspended inverted over a 2-foot diameter frame so
that the top of the chamber is about 6 inches above the test subject's head. If no drum liner is available, a similar
chamber shall be constructed using plastic sheeting. The inside top center of the chamber shall have a small hook
attached.
(2) Each respirator used for the fitting and fit testing shall be equipped with organic vapor cartridges or offer
protection against organic vapors.
(3) After selecting, donning, and properly adjusting a respirator, the test subject shall wear it to the fit testing room.
This room shall be separate from the room used for odor threshold screening and respirator selection, and shall be
well-ventilated, as by an exhaust fan or lab hood, to prevent general room contamination.
(4) A copy of the test exercises and any prepared text from which the subject is to read shall be taped to the inside
of the test chamber.
(5) Upon entering the test chamber, the test subject shall be given a 6-inch by 5-inch piece of paper towel, or other
porous, absorbent, single-ply material, folded in half and wetted with 0.75 ml of pure IAA. The test subject shall
hang the wet towel on the hook at the top of the chamber. An IAA test swab or ampule may be substituted for the
IAA wetted paper towel provided it has been demonstrated that the alternative IAA source will generate an IAA test
atmosphere with a concentration equivalent to that generated by the paper towel method.
(6) Allow two minutes for the IAA test concentration to stabilize before starting the fit test exercises. This would be
an appropriate time to talk with the test subject; to explain the fit test, the importance of his/her cooperation, and
the purpose for the test exercises; or to demonstrate some of the exercises.
(7) If at any time during the test, the subject detects the banana-like odor of IAA, the test is failed. The subject shall
quickly exit from the test chamber and leave the test area to avoid olfactory fatigue.
(8) If the test is failed, the subject shall return to the selection room and remove the respirator. The test subject
shall repeat the odor sensitivity test, select and put on another respirator, return to the test area and again begin
the fit test procedure described in (b) (1) through (7) above. The process continues until a respirator that fits well
has been found. Should the odor sensitivity test be failed, the subject shall wait at least 5 minutes before retesting.
Odor sensitivity will usually have returned by this time.
(9) If the subject passes the test, the efficiency of the test procedure shall be demonstrated by having the subject
break the respirator face seal and take a breath before exiting the chamber.
(10) When the test subject leaves the chamber, the subject shall remove the saturated towel and return it to the
person conducting the test, so that there is no significant IAA concentration buildup in the chamber during
subsequent tests. The used towels shall be kept in a self-sealing plastic bag to keep the test area from being
contaminated.
3. SACCHARIN SOLUTION AEROSOL PROTOCOL
The entire screening and testing procedure shall be explained to the test subject prior to the conduct of the
screening test.
(a) Taste threshold screening. The saccharin taste threshold screening, performed without wearing a respirator, is
intended to determine whether the individual being tested can detect the taste of saccharin.
(1) During threshold screening as well as during fit testing, subjects shall wear an enclosure about the head and
shoulders that is approximately 12 inches in diameter by 14 inches tall with at least the front portion clear and that
allows free movements of the head when a respirator is worn. An enclosure substantially similar to the 3M hood
assembly, parts # FT 14 and # FT 15 combined, is adequate.
(2) The test enclosure shall have a ³⁄ -inch (1.9 cm) hole in front of the test subject's nose and mouth area to
accommodate the nebulizer nozzle.
(3) The test subject shall don the test enclosure. Throughout the threshold screening test, the test subject shall
breathe through his/her slightly open mouth with tongue extended. The subject is instructed to report when he/she
detects a sweet taste.
(4) Using a DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent, the test conductor shall spray the
threshold check solution into the enclosure. The nozzle is directed away from the nose and mouth of the person.
This nebulizer shall be clearly marked to distinguish it from the fit test solution nebulizer.
(5) The threshold check solution is prepared by dissolving 0.83 gram of sodium saccharin USP in 100 ml of warm
water. It can be prepared by putting 1 ml of the fit test solution (see (b)(5) below) in 100 ml of distilled water.
(6) To produce the aerosol, the nebulizer bulb is firmly squeezed so that it collapses completely, then released and
allowed to fully expand.
(7) Ten squeezes are repeated rapidly and then the test subject is asked whether the saccharin can be tasted. If
the test subject reports tasting the sweet taste during the ten squeezes, the screening test is completed. The taste
threshold is noted as ten regardless of the number of squeezes actually completed.
(8) If the first response is negative, ten more squeezes are repeated rapidly and the test subject is again asked
whether the saccharin is tasted. If the test subject reports tasting the sweet taste during the second ten squeezes,
the screening test is completed. The taste threshold is noted as twenty regardless of the number of squeezes
actually completed.
(9) If the second response is negative, ten more squeezes are repeated rapidly and the test subject is again asked
whether the saccharin is tasted. If the test subject reports tasting the sweet taste during the third set of ten
squeezes, the screening test is completed. The taste threshold is noted as thirty regardless of the number of
squeezes actually completed.
(10) The test conductor will take note of the number of squeezes required to solicit a taste response.
(11) If the saccharin is not tasted after 30 squeezes (step 10), the test subject is unable to taste saccharin and may
not perform the saccharin fit test.
Note to paragraph 3(a):
If the test subject eats or drinks something sweet before the screening test, he/she may be unable to taste the
weak saccharin solution.
(12) If a taste response is elicited, the test subject shall be asked to take note of the taste for reference in the fit
test.
(13) Correct use of the nebulizer means that approximately 1 ml of liquid is used at a time in the nebulizer body.
(14) The nebulizer shall be thoroughly rinsed in water, shaken dry, and refilled at least each morning and afternoon
or at least every four hours.
(b) Saccharin solution aerosol fit test procedure.
(1) The test subject may not eat, drink (except plain water), smoke, or chew gum for 15 minutes before the test.
(2) The fit test uses the same enclosure described in 3. (a) above.
(3) The test subject shall don the enclosure while wearing the respirator selected in section I. A. of this appendix.
The respirator shall be properly adjusted and equipped with a particulate filter(s).
(4) A second DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent is used to spray the fit test solution
into the enclosure. This nebulizer shall be clearly marked to distinguish it from the screening test solution
nebulizer.
(5) The fit test solution is prepared by adding 83 grams of sodium saccharin to 100 ml of warm water.
(6) As before, the test subject shall breathe through the slightly open mouth with tongue extended, and report if
he/she tastes the sweet taste of saccharin.
(7) The nebulizer is inserted into the hole in the front of the enclosure and an initial concentration of saccharin fit
test solution is sprayed into the enclosure using the same number of squeezes (either 10, 20 or 30 squeezes)
based on the number of squeezes required to elicit a taste response as noted during the screening test. A
minimum of 10 squeezes is required.
(8) After generating the aerosol, the test subject shall be instructed to perform the exercises in section I. A. 14. of
this appendix.
(9) Every 30 seconds the aerosol concentration shall be replenished using one half the original number of
squeezes used initially (e.g., 5, 10 or 15).
(10) The test subject shall indicate to the test conductor if at any time during the fit test the taste of saccharin is
detected. If the test subject does not report tasting the saccharin, the test is passed.
(11) If the taste of saccharin is detected, the fit is deemed unsatisfactory and the test is failed. A different respirator
shall be tried and the entire test procedure is repeated (taste threshold screening and fit testing).
(12) Since the nebulizer has a tendency to clog during use, the test operator must make periodic checks of the
nebulizer to ensure that it is not clogged. If clogging is found at the end of the test session, the test is invalid.
4. BITREX (DENATONIUM BENZOATE) SOLUTION AEROSOL QUALITATIVE FIT TEST
PROTOCOL
The Bitrex (Denatonium benzoate) solution aerosol QLFT protocol uses the published saccharin test protocol
because that protocol is widely accepted. Bitrex is routinely used as a taste aversion agent in household liquids
which children should not be drinking and is endorsed by the American Medical Association, the National Safety
Council, and the American Association of Poison Control Centers. The entire screening and testing procedure
shall be explained to the test subject prior to the conduct of the screening test.
(a) Taste Threshold Screening.
The Bitrex taste threshold screening, performed without wearing a respirator, is intended to determine whether the
individual being tested can detect the taste of Bitrex.
(1) During threshold screening as well as during fit testing, subjects shall wear an enclosure about the head and
shoulders that is approximately 12 inches (30.5 cm) in diameter by 14 inches (35.6 cm) tall. The front portion of the
enclosure shall be clear from the respirator and allow free movement of the head when a respirator is worn. An
enclosure substantially similar to the 3M hood assembly, parts # FT 14 and # FT 15 combined, is adequate.
(2) The test enclosure shall have a ³⁄ inch (1.9 cm) hole in front of the test subject's nose and mouth area to
accommodate the nebulizer nozzle.
(3) The test subject shall don the test enclosure. Throughout the threshold screening test, the test subject shall
breathe through his or her slightly open mouth with tongue extended. The subject is instructed to report when
he/she detects a bitter taste.
(4) Using a DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent, the test conductor shall spray the
Threshold Check Solution into the enclosure. This Nebulizer shall be clearly marked to distinguish it from the fit
test solution nebulizer.
(5) The Threshold Check Solution is prepared by adding 13.5 milligrams of Bitrex to 100 ml of 5% salt (NaCl)
solution in distilled water.
(6) To produce the aerosol, the nebulizer bulb is firmly squeezed so that the bulb collapses completely, and is then
released and allowed to fully expand.
(7) An initial ten squeezes are repeated rapidly and then the test subject is asked whether the Bitrex can be tasted.
If the test subject reports tasting the bitter taste during the ten squeezes, the screening test is completed. The
taste threshold is noted as ten regardless of the number of squeezes actually completed.
(8) If the first response is negative, ten more squeezes are repeated rapidly and the test subject is again asked
whether the Bitrex is tasted. If the test subject reports tasting the bitter taste during the second ten squeezes, the
screening test is completed. The taste threshold is noted as twenty regardless of the number of squeezes actually
completed.
™
™
(9) If the second response is negative, ten more squeezes are repeated rapidly and the test subject is again asked
whether the Bitrex is tasted. If the test subject reports tasting the bitter taste during the third set of ten squeezes,
the screening test is completed. The taste threshold is noted as thirty regardless of the number of squeezes
actually completed.
(10) The test conductor will take note of the number of squeezes required to solicit a taste response.
(11) If the Bitrex is not tasted after 30 squeezes (step 10), the test subject is unable to taste Bitrex and may not
perform the Bitrex fit test.
(12) If a taste response is elicited, the test subject shall be asked to take note of the taste for reference in the fit
test.
(13) Correct use of the nebulizer means that approximately 1 ml of liquid is used at a time in the nebulizer body.
(14) The nebulizer shall be thoroughly rinsed in water, shaken to dry, and refilled at least each morning and
afternoon or at least every four hours.
(b) Bitrex Solution Aerosol Fit Test Procedure.
(1) The test subject may not eat, drink (except plain water), smoke, or chew gum for 15 minutes before the test.
(2) The fit test uses the same enclosure as that described in 4. (a) above.
(3) The test subject shall don the enclosure while wearing the respirator selected according to section I. A. of this
appendix. The respirator shall be properly adjusted and equipped with any type particulate filter(s).
(4) A second DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent is used to spray the fit test solution
into the enclosure. This nebulizer shall be clearly marked to distinguish it from the screening test solution
nebulizer.
(5) The fit test solution is prepared by adding 337.5 mg of Bitrex to 200 ml of a 5% salt (NaCl) solution in warm
water.
(6) As before, the test subject shall breathe through his or her slightly open mouth with tongue extended, and be
instructed to report if he/she tastes the bitter taste of Bitrex.
(7) The nebulizer is inserted into the hole in the front of the enclosure and an initial concentration of the fit test
solution is sprayed into the enclosure using the same number of squeezes (either 10, 20 or 30 squeezes) based
on the number of squeezes required to elicit a taste response as noted during the screening test.
(8) After generating the aerosol, the test subject shall be instructed to perform the exercises in section I. A. 14. of
this appendix.
(9) Every 30 seconds the aerosol concentration shall be replenished using one half the number of squeezes used
initially (e.g., 5, 10 or 15).
(10) The test subject shall indicate to the test conductor if at any time during the fit test the taste of Bitrex is
detected. If the test subject does not report tasting the Bitrex, the test is passed.
(11) If the taste of Bitrex is detected, the fit is deemed unsatisfactory and the test is failed. A different respirator
shall be tried and the entire test procedure is repeated (taste threshold screening and fit testing).
5. IRRITANT SMOKE (STANNIC CHLORIDE) PROTOCOL
This qualitative fit test uses a person's response to the irritating chemicals released in the “smoke” produced by a
stannic chloride ventilation smoke tube to detect leakage into the respirator.
(a) General Requirements and Precautions
(1) The respirator to be tested shall be equipped with high efficiency particulate air (HEPA) or P100 series filter(s).
(2) Only stannic chloride smoke tubes shall be used for this protocol.
(3) No form of test enclosure or hood for the test subject shall be used.
(4) The smoke can be irritating to the eyes, lungs, and nasal passages. The test conductor shall take precautions
to minimize the test subject's exposure to irritant smoke. Sensitivity varies, and certain individuals may respond to
a greater degree to irritant smoke. Care shall be taken when performing the sensitivity screening checks that
determine whether the test subject can detect irritant smoke to use only the minimum amount of smoke necessary
to elicit a response from the test subject.
(5) The fit test shall be performed in an area with adequate ventilation to prevent exposure of the person
conducting the fit test or the build-up of irritant smoke in the general atmosphere.
(b) Sensitivity Screening Check
The person to be tested must demonstrate his or her ability to detect a weak concentration of the irritant smoke.
(1) The test operator shall break both ends of a ventilation smoke tube containing stannic chloride, and attach one
end of the smoke tube to a low flow air pump set to deliver 200 milliliters per minute, or an aspirator squeeze bulb.
The test operator shall cover the other end of the smoke tube with a short piece of tubing to prevent potential injury
from the jagged end of the smoke tube.
(2) The test operator shall advise the test subject that the smoke can be irritating to the eyes, lungs, and nasal
passages and instruct the subject to keep his/her eyes closed while the test is performed.
(3) The test subject shall be allowed to smell a weak concentration of the irritant smoke before the respirator is
donned to become familiar with its irritating properties and to determine if he/she can detect the irritating properties
of the smoke. The test operator shall carefully direct a small amount of the irritant smoke in the test subject's
direction to determine that he/she can detect it.
(c) Irritant Smoke Fit Test Procedure
(1) The person being fit tested shall don the respirator without assistance, and perform the required user seal
check(s).
(2) The test subject shall be instructed to keep his/her eyes closed.
(3) The test operator shall direct the stream of irritant smoke from the smoke tube toward the faceseal area of the
test subject, using the low flow pump or the squeeze bulb. The test operator shall begin at least 12 inches from the
facepiece and move the smoke stream around the whole perimeter of the mask. The operator shall gradually
make two more passes around the perimeter of the mask, moving to within six inches of the respirator.
(4) If the person being tested has not had an involuntary response and/or detected the irritant smoke, proceed with
the test exercises.
(5) The exercises identified in section I.A. 14. of this appendix shall be performed by the test subject while the
respirator seal is being continually challenged by the smoke, directed around the perimeter of the respirator at a
distance of six inches.
(6) If the person being fit tested reports detecting the irritant smoke at any time, the test is failed. The person being
retested must repeat the entire sensitivity check and fit test procedure.
(7) Each test subject passing the irritant smoke test without evidence of a response (involuntary cough, irritation)
shall be given a second sensitivity screening check, with the smoke from the same smoke tube used during the fit
test, once the respirator has been removed, to determine whether he/she still reacts to the smoke. Failure to evoke
a response shall void the fit test.
(8) If a response is produced during this second sensitivity check, then the fit test is passed.
C. Quantitative Fit Test (QNFT) Protocols
The following quantitative fit testing procedures have been demonstrated to be acceptable: Quantitative fit testing
using a non-hazardous test aerosol (such as corn oil, polyethylene glycol 400 [PEG 400], di-2-ethyl hexyl sebacate
[DEHS], or sodium chloride) generated in a test chamber, and employing instrumentation to quantify the fit of the
respirator; Quantitative fit testing using ambient aerosol as the test agent and appropriate instrumentation
(condensation nuclei counter) to quantify the respirator fit; Quantitative fit testing using controlled negative
pressure and appropriate instrumentation to measure the volumetric leak rate of a facepiece to quantify the
respirator fit.
1. GENERAL
(a) The employer shall ensure that persons administering QNFT are able to calibrate equipment and perform tests
properly, recognize invalid tests, calculate fit factors properly and ensure that test equipment is in proper working
order.
(b) The employer shall ensure that QNFT equipment is kept clean, and is maintained and calibrated according to
the manufacturer's instructions so as to operate at the parameters for which it was designed.
2. GENERATED AEROSOL QUANTITATIVE FIT TESTING PROTOCOL
(a) Apparatus.
(1) Instrumentation. Aerosol generation, dilution, and measurement systems using particulates (corn oil,
polyethylene glycol 400 [PEG 400], di-2-ethyl hexyl sebacate [DEHS] or sodium chloride) as test aerosols shall be
used for quantitative fit testing.
(2) Test chamber. The test chamber shall be large enough to permit all test subjects to perform freely all required
exercises without disturbing the test agent concentration or the measurement apparatus. The test chamber shall
be equipped and constructed so that the test agent is effectively isolated from the ambient air, yet uniform in
concentration throughout the chamber.
(3) When testing air-purifying respirators, the normal filter or cartridge element shall be replaced with a high
efficiency particulate air (HEPA) or P100 series filter supplied by the same manufacturer.
(4) The sampling instrument shall be selected so that a computer record or strip chart record may be made of the
test showing the rise and fall of the test agent concentration with each inspiration and expiration at fit factors of at
least 2,000. Integrators or computers that integrate the amount of test agent penetration leakage into the respirator
for each exercise may be used provided a record of the readings is made.
(5) The combination of substitute air-purifying elements, test agent and test agent concentration shall be such that
the test subject is not exposed in excess of an established exposure limit for the test agent at any time during the
testing process, based upon the length of the exposure and the exposure limit duration.
(6) The sampling port on the test specimen respirator shall be placed and constructed so that no leakage occurs
around the port (e.g., where the respirator is probed), a free air flow is allowed into the sampling line at all times,
and there is no interference with the fit or performance of the respirator. The in-mask sampling device (probe) shall
be designed and used so that the air sample is drawn from the breathing zone of the test subject, midway between
the nose and mouth and with the probe extending into the facepiece cavity at least ¹⁄ inch.
(7) The test setup shall permit the person administering the test to observe the test subject inside the chamber
during the test.
(8) The equipment generating the test atmosphere shall maintain the concentration of test agent constant to within
a 10 percent variation for the duration of the test.
(9) The time lag (interval between an event and the recording of the event on the strip chart or computer or
integrator) shall be kept to a minimum. There shall be a clear association between the occurrence of an event and
its being recorded.
(10) The sampling line tubing for the test chamber atmosphere and for the respirator sampling port shall be of
equal diameter and of the same material. The length of the two lines shall be equal.
(11) The exhaust flow from the test chamber shall pass through an appropriate filter (i.e., high efficiency particulate
filter) before release.
(12) When sodium chloride aerosol is used, the relative humidity inside the test chamber shall not exceed 50
percent.
(13) The limitations of instrument detection shall be taken into account when determining the fit factor.
(14) Test respirators shall be maintained in proper working order and be inspected regularly for deficiencies such
as cracks or missing valves and gaskets.
(b) Procedural Requirements.
(1) When performing the initial user seal check using a positive or negative pressure check, the sampling line shall
be crimped closed in order to avoid air pressure leakage during either of these pressure checks.
(2) The use of an abbreviated screening QLFT test is optional. Such a test may be utilized in order to quickly
identify poor fitting respirators that passed the positive and/or negative pressure test and reduce the amount of
QNFT time. The use of the CNC QNFT instrument in the count mode is another optional method to obtain a quick
estimate of fit and eliminate poor fitting respirators before going on to perform a full QNFT.
(3) A reasonably stable test agent concentration shall be measured in the test chamber prior to testing. For canopy
or shower curtain types of test units, the determination of the test agent's stability may be established after the test
subject has entered the test environment.
(4) Immediately after the subject enters the test chamber, the test agent concentration inside the respirator shall be
measured to ensure that the peak penetration does not exceed 5 percent for a half mask or 1 percent for a full
facepiece respirator.
(5) A stable test agent concentration shall be obtained prior to the actual start of testing.
(6) Respirator restraining straps shall not be over-tightened for testing. The straps shall be adjusted by the wearer
without assistance from other persons to give a reasonably comfortable fit typical of normal use. The respirator
shall not be adjusted once the fit test exercises begin.
(7) The test shall be terminated whenever any single peak penetration exceeds 5 percent for half masks and 1
percent for full facepiece respirators. The test subject shall be refitted and retested.
(8) Calculation of fit factors.
(i) The fit factor shall be determined for the quantitative fit test by taking the ratio of the average chamber
concentration to the concentration measured inside the respirator for each test exercise except the grimace
exercise.
(ii) The average test chamber concentration shall be calculated as the arithmetic average of the concentration
measured before and after each test (i.e., 7 exercises) or the arithmetic average of the concentration measured
before and after each exercise or the true average measured continuously during the respirator sample.
(iii) The concentration of the challenge agent inside the respirator shall be determined by one of the following
methods:
(A) Average peak penetration method means the method of determining test agent penetration into the respirator
utilizing a strip chart recorder, integrator, or computer. The agent penetration is determined by an average of the
peak heights on the graph or by computer integration, for each exercise except the grimace exercise. Integrators
or computers that calculate the actual test agent penetration into the respirator for each exercise will also be
considered to meet the requirements of the average peak penetration method.
(B) Maximum peak penetration method means the method of determining test agent penetration in the respirator
as determined by strip chart recordings of the test. The highest peak penetration for a given exercise is taken to be
representative of average penetration into the respirator for that exercise.
(C) Integration by calculation of the area under the individual peak for each exercise except the grimace exercise.
This includes computerized integration.
(D) The calculation of the overall fit factor using individual exercise fit factors involves first converting the exercise
fit factors to penetration values, determining the average, and then converting that result back to a fit factor. This
procedure is described in the following equation:
Where ff , ff , ff , etc. are the fit factors for exercises 1, 2, 3, etc.
(9) The test subject shall not be permitted to wear a half mask or quarter facepiece respirator unless a minimum fit
factor of 100 is obtained, or a full facepiece respirator unless a minimum fit factor of 500 is obtained.
(10) Filters used for quantitative fit testing shall be replaced whenever increased breathing resistance is
encountered, or when the test agent has altered the integrity of the filter media.
3. AMBIENT AEROSOL CONDENSATION NUCLEI COUNTER (CNC) QUANTITATIVE FIT
TESTING PROTOCOL.
The ambient aerosol condensation nuclei counter (CNC) quantitative fit testing (PortaCount®) protocol
quantitatively fit tests respirators with the use of a probe. The probed respirator is only used for quantitative fit
tests. A probed respirator has a special sampling device, installed on the respirator, that allows the probe to
sample the air from inside the mask. A probed respirator is required for each make, style, model, and size that the
employer uses and can be obtained from the respirator manufacturer or distributor. The primary CNC instrument
manufacturer, TSI Incorporated, also provides probe attachments (TSI mask sampling adapters) that permit fit
testing in an employee's own respirator. A minimum fit factor pass level of at least 100 is necessary for a half-mask
respirator (elastomeric or filtering facepiece), and a minimum fit factor pass level of at least 500 is required for a
full-facepiece elastomeric respirator. The entire screening and testing procedure shall be explained to the test
subject prior to the conduct of the screening test.
(a) PortaCount® Fit Test Requirements. (1) Check the respirator to make sure the sampling probe and line are
properly attached to the facepiece and that the respirator is fitted with a particulate filter capable of preventing
significant penetration by the ambient particles used for the fit test (e.g., NIOSH 42 CFR 84 series 100, series 99,
or series 95 particulate filter) per manufacturer's instruction.
(2) Instruct the person to be tested to don the respirator for five minutes before the fit test starts. This purges the
ambient particles trapped inside the respirator and permits the wearer to make certain the respirator is
comfortable. This individual shall already have been trained on how to wear the respirator properly.
1 2 3
(3) Check the following conditions for the adequacy of the respirator fit: Chin properly placed; Adequate strap
tension, not overly tightened; Fit across nose bridge; Respirator of proper size to span distance from nose to chin;
Tendency of the respirator to slip; Self-observation in a mirror to evaluate fit and respirator position.
(4) Have the person wearing the respirator do a user seal check. If leakage is detected, determine the cause. If
leakage is from a poorly fitting facepiece, try another size of the same model respirator, or another model of
respirator.
(5) Follow the manufacturer's instructions for operating the Portacount® and proceed with the test.
(6) The test subject shall be instructed to perform the exercises in section I. A. 14. of this appendix.
(7) After the test exercises, the test subject shall be questioned by the test conductor regarding the comfort of the
respirator upon completion of the protocol. If it has become unacceptable, another model of respirator shall be
tried.
(b) PortaCount® Test Instrument.
(1) The PortaCount® will automatically stop and calculate the overall fit factor for the entire set of exercises. The
overall fit factor is what counts. The Pass or Fail message will indicate whether or not the test was successful. If
the test was a Pass, the fit test is over.
(2) Since the pass or fail criterion of the PortaCount® is user programmable, the test operator shall ensure that the
pass or fail criterion meet the requirements for minimum respirator performance in this Appendix.
(3) A record of the test needs to be kept on file, assuming the fit test was successful. The record must contain the
test subject's name; overall fit factor; make, model, style, and size of respirator used; and date tested.
4. MODIFIED AMBIENT AEROSOL CONDENSATION NUCLEI COUNTER (CNC) QUANTITATIVE
FIT TESTING PROTOCOL FOR FULL-FACEPIECE AND HALF-MASK ELASTOMERIC
RESPIRATORS.
(a) When administering this protocol to test subjects, employers shall comply with the requirements specified in
Part I.C.3 of this appendix (ambient aerosol condensation nuclei counter (CNC) quantitative fit testing protocol),
except they shall use the test exercises described below in paragraph (b) of this protocol instead of the test
exercises specified in section I.C.3(a)(6) of this appendix.
(b) Employers shall ensure that each test subject being fit tested using this protocol follows the exercise and
duration procedures, including the order of administration, described in Table A-1 of this appendix.
Table A-1 - Modified Ambient Aerosal CNC Quantitative Fit Testing Protocol for Full Facepiece and
Half-Mask Elastomeric Respirators
Exercises Exercise procedure Measurement procedure
Bending Over The test subject shall bend at the waist, as if going to
touch his/her toes for 50 seconds and inhale 2 times
at the bottom
A 20 second ambient sample,
followed by a 30 second mask
sample.
Jogging-in-Place The test subject shall jog in place comfortably for 30
seconds
A 30 second mask sample.
Head Side-to-Side The test subject shall stand in place, slowly turning
his/her head from side to side for 30 seconds and
inhale 2 times at each extreme
A 30 second mask sample.
1
2
2
Exercises Exercise procedure Measurement procedure
Head Up-and-Down The test subject shall stand in place, slowly moving
his/her head up and down for 39 seconds and inhale 2
times at each extreme
A 30 second mask sample
followed by a 9 second
ambient sample.
Exercises are listed in the order in which they are to be administered.
It is optional for test subjects to take additional breaths at other times during this exercise.
5. MODIFIED AMBIENT AEROSOL CONDENSATION NUCLEI COUNTER (CNC) QUANTITATIVE
FIT TESTING PROTOCOL FOR FILTERING FACEPIECE RESPIRATORS.
(a) When administering this protocol to test subjects, employers shall comply with the requirements specified in
Part I.C.3 of this appendix (ambient aerosol condensation nuclei counter (CNC) quantitative fit testing protocol),
except they shall use the test exercises described below in paragraph (b) of this protocol instead of the test
exercises specified in section I.C.3(a)(6) of this appendix.
(b) Employers shall ensure that each test subject being fit tested using this protocol follows the exercise and
duration procedures, including the order of administration, described in Table A-2 of this appendix.
Table A-2 - Modified Ambient Aerosal CNC Quantitative Fit Testing Protocol for Filtering Facepiece
Respirators
Exercises
Exercise
procedure
Measurement
procedure
Bending Over The test subject shall bend at the waist, as if going to
touch his/her toes for 50 seconds and inhale 2 times
at the bottom
A 20 second ambient sample,
followed by a 30 second mask
sample.
Talking The test subject shall talk out loud slowly and loud
enough so as to be heard clearly by the test conductor
for 30 seconds. He/she will either read from a
prepared text such as the Rainbow Passage, count
backward from 100, or recite a memorized poem or
song
A 30 second mask sample.
Head Side-to-Side The test subject shall stand in place, slowly turning
his/her head from side to side for 30 seconds and
inhale 2 times at each extreme
A 30 second mask sample.
Head Up-and-Down The test subject shall stand in place, slowly moving
his/her head up and down for 39 seconds and inhale 2
times at each extreme
A 30 second mask sample
followed by a 9 second
ambient sample.
Exercises are listed in the order in which they are to be administered.
It is optional for test subjects to take additional breaths at other times during this exercise.
6. CONTROLLED NEGATIVE PRESSURE (CNP) QUANTITATIVE FIT TESTING PROTOCOL.
1
2
1
2
1
2
2
2
1
2
The CNP protocol provides an alternative to aerosol fit test methods. The CNP fit test method technology is based
on exhausting air from a temporarily sealed respirator facepiece to generate and then maintain a constant
negative pressure inside the facepiece. The rate of air exhaust is controlled so that a constant negative pressure is
maintained in the respirator during the fit test. The level of pressure is selected to replicate the mean inspiratory
pressure that causes leakage into the respirator under normal use conditions. With pressure held constant, air flow
out of the respirator is equal to air flow into the respirator. Therefore, measurement of the exhaust stream that is
required to hold the pressure in the temporarily sealed respirator constant yields a direct measure of leakage air
flow into the respirator. The CNP fit test method measures leak rates through the facepiece as a method for
determining the facepiece fit for negative pressure respirators. The CNP instrument manufacturer Occupational
Health Dynamics of Birmingham, Alabama also provides attachments (sampling manifolds) that replace the filter
cartridges to permit fit testing in an employee's own respirator. To perform the test, the test subject closes his or
her mouth and holds his/her breath, after which an air pump removes air from the respirator facepiece at a pre-
selected constant pressure. The facepiece fit is expressed as the leak rate through the facepiece, expressed as
milliliters per minute. The quality and validity of the CNP fit tests are determined by the degree to which the in-
mask pressure tracks the test pressure during the system measurement time of approximately five seconds.
Instantaneous feedback in the form of a real-time pressure trace of the in-mask pressure is provided and used to
determine test validity and quality. A minimum fit factor pass level of 100 is necessary for a half-mask respirator
and a minimum fit factor of at least 500 is required for a full facepiece respirator. The entire screening and testing
procedure shall be explained to the test subject prior to the conduct of the screening test.
(a) CNP Fit Test Requirements.
(1) The instrument shall have a non-adjustable test pressure of 15.0 mm water pressure.
(2) The CNP system defaults selected for test pressure shall be set at −15 mm of water (-0.58 inches of water)
and the modeled inspiratory flow rate shall be 53.8 liters per minute for performing fit tests.
Note:
CNP systems have built-in capability to conduct fit testing that is specific to unique work rate, mask, and gender
situations that might apply in a specific workplace. Use of system default values, which were selected to represent
respirator wear with medium cartridge resistance at a low-moderate work rate, will allow inter-test comparison of
the respirator fit.)
(3) The individual who conducts the CNP fit testing shall be thoroughly trained to perform the test.
(4) The respirator filter or cartridge needs to be replaced with the CNP test manifold. The inhalation valve
downstream from the manifold either needs to be temporarily removed or propped open.
(5) The employer must train the test subject to hold his or her breath for at least 10 seconds.
(6) The test subject must don the test respirator without any assistance from the test administrator who is
conducting the CNP fit test. The respirator must not be adjusted once the fit-test exercises begin. Any adjustment
voids the test, and the test subject must repeat the fit test.
(7) The QNFT protocol shall be followed according to section I. C. 1. of this appendix with an exception for the
CNP test exercises.
(b) CNP Test Exercises.
(1) Normal breathing. In a normal standing position, without talking, the subject shall breathe normally for 1 minute.
After the normal breathing exercise, the subject needs to hold head straight ahead and hold his or her breath for
10 seconds during the test measurement.
(2) Deep breathing. In a normal standing position, the subject shall breathe slowly and deeply for 1 minute, being
careful not to hyperventilate. After the deep breathing exercise, the subject shall hold his or her head straight
ahead and hold his or her breath for 10 seconds during test measurement.
(3) Turning head side to side. Standing in place, the subject shall slowly turn his or her head from side to side
between the extreme positions on each side for 1 minute. The head shall be held at each extreme momentarily so
the subject can inhale at each side. After the turning head side to side exercise, the subject needs to hold head full
left and hold his or her breath for 10 seconds during test measurement. Next, the subject needs to hold head full
right and hold his or her breath for 10 seconds during test measurement.
(4) Moving head up and down. Standing in place, the subject shall slowly move his or her head up and down for 1
minute. The subject shall be instructed to inhale in the up position (i.e., when looking toward the ceiling). After the
moving head up and down exercise, the subject shall hold his or her head full up and hold his or her breath for 10
seconds during test measurement. Next, the subject shall hold his or her head full down and hold his or her breath
for 10 seconds during test measurement.
(5) Talking. The subject shall talk out loud slowly and loud enough so as to be heard clearly by the test conductor.
The subject can read from a prepared text such as the Rainbow Passage, count backward from 100, or recite a
memorized poem or song for 1 minute. After the talking exercise, the subject shall hold his or her head straight
ahead and hold his or her breath for 10 seconds during the test measurement.
(6) Grimace. The test subject shall grimace by smiling or frowning for 15 seconds.
(7) Bending Over. The test subject shall bend at the waist as if he or she were to touch his or her toes for 1 minute.
Jogging in place shall be substituted for this exercise in those test environments such as shroud-type QNFT units
that prohibit bending at the waist. After the bending over exercise, the subject shall hold his or her head straight
ahead and hold his or her breath for 10 seconds during the test measurement.
(8) Normal Breathing. The test subject shall remove and re-don the respirator within a one-minute period. Then, in
a normal standing position, without talking, the subject shall breathe normally for 1 minute. After the normal
breathing exercise, the subject shall hold his or her head straight ahead and hold his or her breath for 10 seconds
during the test measurement. After the test exercises, the test subject shall be questioned by the test conductor
regarding the comfort of the respirator upon completion of the protocol. If it has become unacceptable, another
model of a respirator shall be tried.
(c) CNP Test Instrument.
(1) The test instrument must have an effective audio-warning device, or a visual-warning device in the form of a
screen tracing, that indicates when the test subject fails to hold his or her breath during the test. The test must be
terminated and restarted from the beginning when the test subject fails to hold his or her breath during the test.
The test subject then may be refitted and retested.
(2) A record of the test shall be kept on file, assuming the fit test was successful. The record must contain the test
subject's name; overall fit factor; make, model, style and size of respirator used; and date tested.
7. CONTROLLED NEGATIVE PRESSURE (CNP) REDON QUANTITATIVE FIT TESTING
PROTOCOL.
(a) When administering this protocol to test subjects, employers must comply with the requirements specified in
paragraphs (a) and (c) of part I.C.6 of this appendix (“Controlled negative pressure (CNP) quantitative fit testing
protocol,”) as well as use the test exercises described below in paragraph (b) of this protocol instead of the test
exercises specified in paragraph (b) of part I.C.6 of this appendix.
(b) Employers must ensure that each test subject being fit tested using this protocol follows the exercise and
measurement procedures, including the order of administration described in Table A-3 of this appendix.
Table A-3 - CNP REDON Quantitative Fit Testing Protocol
Exercises Exercise procedure Measurement procedure
Facing Forward Stand and breathe normally, without talking, for 30
seconds
Face forward, while holding
breath for 10 seconds.
Bending Over Bend at the waist, as if going to touch his or her toes,
for 30 seconds
Face parallel to the floor, while
holding breath for 10 seconds
Head Shaking For about three seconds, shake head back and forth
vigorously several times while shouting
Face forward, while holding
breath for 10 seconds
REDON 1 Remove the respirator mask, loosen all facepiece
straps, and then redon the respirator mask
Face forward, while holding
breath for 10 seconds.
REDON 2 Remove the respirator mask, loosen all facepiece
straps, and then redon the respirator mask again
Face forward, while holding
breath for 10 seconds.
Exercises are listed in the order in which they are to be administered.
(c) After completing the test exercises, the test administrator must question each test subject regarding the comfort
of the respirator. When a test subject states that the respirator is unacceptable, the employer must ensure that the
test administrator repeats the protocol using another respirator model.
(d) Employers must determine the overall fit factor for each test subject by calculating the harmonic mean of the fit
testing exercises as follows:
Where:
N = The number of exercises;
FF = The fit factor for the first exercise;
FF = The fit factor for the second exercise; and
FF = The fit factor for the nth exercise.
Part II. New Fit Test Protocols
A. Any person may submit to OSHA an application for approval of a new fit test protocol. If the application meets
the following criteria, OSHA will initiate a rulemaking proceeding under section 6(b)(7) of the OSH Act to determine
whether to list the new protocol as an approved protocol in this appendix A.
B. The application must include a detailed description of the proposed new fit test protocol. This application must
be supported by either:
1
1
1
2
N
1. A test report prepared by an independent government research laboratory (e.g., Lawrence Livermore National
Laboratory, Los Alamos National Laboratory, the National Institute for Standards and Technology) stating that the
laboratory has tested the protocol and had found it to be accurate and reliable; or
2. An article that has been published in a peer-reviewed industrial hygiene journal describing the protocol and
explaining how test data support the protocol's accuracy and reliability.
C. If OSHA determines that additional information is required before the Agency commences a rulemaking
proceeding under this section, OSHA will so notify the applicant and afford the applicant the opportunity to submit
the supplemental information. Initiation of a rulemaking proceeding will be deferred until OSHA has received and
evaluated the supplemental information.
[63 FR 20098, April 23, 1998; 69 FR 46993, August 4, 2004]
UNITED STATES
DEPARTMENT OF LABOR
(https://www.dol.gov)
Occupational Safety & Health Administration
200 Constitution Ave NW
Washington, DC 20210
800-321-6742 (tel:+18003216742) (OSHA)
TTY (https://www.dol.gov/general/contact/contact-phone-call-center#tty)
www.OSHA.gov (https://www.osha.gov/)
FEDERAL GOVERNMENT
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(https://www.whitehouse.gov)
Severe Storm and Flood Recovery
Assistance
(https://www.dol.gov/general/stormrecovery)
Disaster Recovery Assistance
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DisasterAssistance.gov
(https://www.disasterassistance.gov/)
USA.gov (https://www.usa.gov/)
No Fear Act Data
(https://www.dol.gov/agencies/oasam/centers-
offices/civil-rights-
center/resports/notification-and-federal-
employee-antidiscrimination-retaliation-
act-of-2002)
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(https://osc.gov/)
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SAFETY & HEALTH
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Questions
(https://www.osha.gov/faq)
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z)
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By Standard Number (/laws-regs/regulations/standardnumber/1910)
/ 1910.134 App B-2 - Respirator Cleaning Procedures (Mandatory)
Part Number:1910
Part Number Title:Occupational Safety and Health Standards
Subpart:1910 Subpart I
Subpart Title:Personal Protective Equipment
Standard Number:1910.134 App B-2 (/laws-regs/interlinking/standards/1910.134 App B-2)
Title:Respirator Cleaning Procedures (Mandatory)
GPO Source:e-CFR (https://www.ecfr.gov/cgi-bin/text-idx?
SID=65b279ee2e7530009034c1f152d451e5&tpl=/ecfrbrowse/Title29/29tab_02.tpl)
Appendix B-2 to § 1910.134: Respirator Cleaning Procedures (Mandatory)
These procedures are provided for employer use when cleaning respirators. They are general in nature, and the
employer as an alternative may use the cleaning recommendations provided by the manufacturer of the
respirators used by their employees, provided such procedures are as effective as those listed here in appendix B-
2. Equivalent effectiveness simply means that the procedures used must accomplish the objectives set forth in
appendix B-2, i.e., must ensure that the respirator is properly cleaned and disinfected in a manner that prevents
damage to the respirator and does not cause harm to the user.
I. Procedures for Cleaning Respirators
A. Remove filters, cartridges, or canisters. Disassemble facepieces by removing speaking diaphragms, demand
and pressure-demand valve assemblies, hoses, or any components recommended by the manufacturer. Discard
or repair any defective parts.
B. Wash components in warm (43 °C [110 °F] maximum) water with a mild detergent or with a cleaner
recommended by the manufacturer. A stiff bristle (not wire) brush may be used to facilitate the removal of dirt.
C. Rinse components thoroughly in clean, warm (43 °C [110 °F] maximum), preferably running water. Drain.
D. When the cleaner used does not contain a disinfecting agent, respirator components should be immersed for
two minutes in one of the following:
1. Hypochlorite solution (50 ppm of chlorine) made by adding approximately one milliliter of laundry bleach to one
liter of water at 43 °C (110 °F); or,
2. Aqueous solution of iodine (50 ppm iodine) made by adding approximately 0.8 milliliters of tincture of iodine (6-8
grams ammonium and/or potassium iodide/100 cc of 45% alcohol) to one liter of water at 43 °C (110 °F); or,
3. Other commercially available cleansers of equivalent disinfectant quality when used as directed, if their use is
recommended or approved by the respirator manufacturer.
E. Rinse components thoroughly in clean, warm (43 °C [110 °F] maximum), preferably running water. Drain. The
importance of thorough rinsing cannot be overemphasized. Detergents or disinfectants that dry on facepieces may
result in dermatitis. In addition, some disinfectants may cause deterioration of rubber or corrosion of metal parts if
not completely removed.
F. Components should be hand-dried with a clean lint-free cloth or air-dried.
G. Reassemble facepiece, replacing filters, cartridges, and canisters where necessary.
H. Test the respirator to ensure that all components work properly.
[63 FR 1152, Jan. 8, 1998]
UNITED STATES
DEPARTMENT OF LABOR
(https://www.dol.gov)
Occupational Safety & Health Administration
200 Constitution Ave NW
Washington, DC 20210
800-321-6742 (tel:+18003216742) (OSHA)
TTY (https://www.dol.gov/general/contact/contact-phone-call-center#tty)
www.OSHA.gov (https://www.osha.gov/)
FEDERAL GOVERNMENT
White House
(https://www.whitehouse.gov)
Severe Storm and Flood Recovery
Assistance
(https://www.dol.gov/general/stormrecovery)
Disaster Recovery Assistance
(https://www.dol.gov/general/disasterrecovery)
DisasterAssistance.gov
(https://www.disasterassistance.gov/)
USA.gov (https://www.usa.gov/)
No Fear Act Data
(https://www.dol.gov/agencies/oasam/centers-
offices/civil-rights-
center/resports/notification-and-federal-
employee-antidiscrimination-retaliation-
act-of-2002)
U.S. Office of Special Counsel
(https://osc.gov/)
OCCUPATIONAL
SAFETY & HEALTH
Frequently Asked
Questions
(https://www.osha.gov/faq)
A - Z Index
(https://www.osha.gov/a-
z)
Freedom of Information
Act - OSHA
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Read The OSHA
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(https://www.osha.gov/quicktakes/)
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By Standard Number (/laws-regs/regulations/standardnumber/1910)
/ 1910.134 App C - OSHA Respirator Medical Evaluation Questionnaire (Mandatory).
Part Number:1910
Part Number Title:Occupational Safety and Health Standards
Subpart:1910 Subpart I
Subpart Title:Personal Protective Equipment
Standard Number:1910.134 App C (/laws-regs/interlinking/standards/1910.134 App C)
Title:OSHA Respirator Medical Evaluation Questionnaire (Mandatory).
GPO Source:e-CFR (https://www.ecfr.gov/cgi-bin/text-idx?
SID=65b279ee2e7530009034c1f152d451e5&tpl=/ecfrbrowse/Title29/29tab_02.tpl)
Appendix C to § 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory)
To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of part A, do not require a
medical examination.
To the employee:
Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place
that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review
your answers, and your employer must tell you how to deliver or send this questionnaire to the health care
professional who will review it.
Part A. Section 1. (Mandatory) The following information must be provided by every employee who has been
selected to use any type of respirator (please print).
1. Today's date:_______________________________________________________
2. Your name:__________________________________________________________
3. Your age (to nearest year):_________________________________________
4. Sex (circle one): Male/Female
5. Your height: __________ ft. __________ in.
6. Your weight: ____________ lbs.
7. Your job title:_____________________________________________________
8. A phone number where you can be reached by the health care professional who reviews this questionnaire
(include the Area Code): ____________________
9. The best time to phone you at this number: ________________
10. Has your employer told you how to contact the health care professional who will review this questionnaire
(circle one): Yes/No
11. Check the type of respirator you will use (you can check more than one category):
a. ______ N, R, or P disposable respirator (filter-mask, non-cartridge type only).
b. ______ Other type (for example, half- or full-facepiece type, powered-air purifying, supplied-air, self-contained
breathing apparatus).
12. Have you worn a respirator (circle one): Yes/No
If "yes," what type(s):___________________________________________________________
_____________________________________________________________
Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been
selected to use any type of respirator (please circle "yes" or "no").
1. Do you currently smoke tobacco, or have you smoked tobacco in the last month: Yes/No
2. Have you ever had any of the following conditions?
a. Seizures: Yes/No
b. Diabetes (sugar disease): Yes/No
c. Allergic reactions that interfere with your breathing: Yes/No
d. Claustrophobia (fear of closed-in places): Yes/No
e. Trouble smelling odors: Yes/No
3. Have you ever had any of the following pulmonary or lung problems?
a. Asbestosis: Yes/No
b. Asthma: Yes/No
c. Chronic bronchitis: Yes/No
d. Emphysema: Yes/No
e. Pneumonia: Yes/No
f. Tuberculosis: Yes/No
g. Silicosis: Yes/No
h. Pneumothorax (collapsed lung): Yes/No
i. Lung cancer: Yes/No
j. Broken ribs: Yes/No
k. Any chest injuries or surgeries: Yes/No
l. Any other lung problem that you've been told about: Yes/No
4. Do you currently have any of the following symptoms of pulmonary or lung illness?
a. Shortness of breath: Yes/No
b. Shortness of breath when walking fast on level ground or walking up a slight hill or incline: Yes/No
c. Shortness of breath when walking with other people at an ordinary pace on level ground: Yes/No
d. Have to stop for breath when walking at your own pace on level ground: Yes/No
e. Shortness of breath when washing or dressing yourself: Yes/No
f. Shortness of breath that interferes with your job: Yes/No
g. Coughing that produces phlegm (thick sputum): Yes/No
h. Coughing that wakes you early in the morning: Yes/No
i. Coughing that occurs mostly when you are lying down: Yes/No
j. Coughing up blood in the last month: Yes/No
k. Wheezing: Yes/No
l. Wheezing that interferes with your job: Yes/No
m. Chest pain when you breathe deeply: Yes/No
n. Any other symptoms that you think may be related to lung problems: Yes/No
5. Have you ever had any of the following cardiovascular or heart problems?
a. Heart attack: Yes/No
b. Stroke: Yes/No
c. Angina: Yes/No
d. Heart failure: Yes/No
e. Swelling in your legs or feet (not caused by walking): Yes/No
f. Heart arrhythmia (heart beating irregularly): Yes/No
g. High blood pressure: Yes/No
h. Any other heart problem that you've been told about: Yes/No
6. Have you ever had any of the following cardiovascular or heart symptoms?
a. Frequent pain or tightness in your chest: Yes/No
b. Pain or tightness in your chest during physical activity: Yes/No
c. Pain or tightness in your chest that interferes with your job: Yes/No
d. In the past two years, have you noticed your heart skipping or missing a beat: Yes/No
e. Heartburn or indigestion that is not related to eating: Yes/No
f. Any other symptoms that you think may be related to heart or circulation problems: Yes/No
7. Do you currently take medication for any of the following problems?
a. Breathing or lung problems: Yes/No
b. Heart trouble: Yes/No
c. Blood pressure: Yes/No
d. Seizures: Yes/No
8. If you've used a respirator, have you ever had any of the following problems? (If you've never used a respirator,
check the following space and go to question 9:)
a. Eye irritation: Yes/No
b. Skin allergies or rashes: Yes/No
c. Anxiety: Yes/No
d. General weakness or fatigue: Yes/No
e. Any other problem that interferes with your use of a respirator: Yes/No
9. Would you like to talk to the health care professional who will review this questionnaire about your answers to
this questionnaire: Yes/No
Questions 10 to 15 below must be answered by every employee who has been selected to use either a full-
facepiece respirator or a self-contained breathing apparatus (SCBA). For employees who have been selected to
use other types of respirators, answering these questions is voluntary.
10. Have you ever lost vision in either eye (temporarily or permanently): Yes/No
11. Do you currently have any of the following vision problems?
a. Wear contact lenses: Yes/No
b. Wear glasses: Yes/No
c. Color blind: Yes/No
d. Any other eye or vision problem: Yes/No
12. Have you ever had an injury to your ears, including a broken ear drum: Yes/No
13. Do you currently have any of the following hearing problems?
a. Difficulty hearing: Yes/No
b. Wear a hearing aid: Yes/No
c. Any other hearing or ear problem: Yes/No
14. Have you ever had a back injury: Yes/No
15. Do you currently have any of the following musculoskeletal problems?
a. Weakness in any of your arms, hands, legs, or feet: Yes/No
b. Back pain: Yes/No
c. Difficulty fully moving your arms and legs: Yes/No
d. Pain or stiffness when you lean forward or backward at the waist: Yes/No
e. Difficulty fully moving your head up or down: Yes/No
f. Difficulty fully moving your head side to side: Yes/No
g. Difficulty bending at your knees: Yes/No
h. Difficulty squatting to the ground: Yes/No
i. Climbing a flight of stairs or a ladder carrying more than 25 lbs: Yes/No
j. Any other muscle or skeletal problem that interferes with using a respirator: Yes/No
Part B Any of the following questions, and other questions not listed, may be added to the questionnaire at the
discretion of the health care professional who will review the questionnaire.
1. In your present job, are you working at high altitudes (over 5,000 feet) or in a place that has lower than normal
amounts of oxygen: Yes/No
If "yes," do you have feelings of dizziness, shortness of breath, pounding in your chest, or other symptoms when
you're working under these conditions: Yes/No
2. At work or at home, have you ever been exposed to hazardous solvents, hazardous airborne chemicals (e.g.,
gases, fumes, or dust), or have you come into skin contact with hazardous chemicals: Yes/No
If "yes," name the chemicals if you know them:_________________________
_______________________________________________________________________
_______________________________________________________________________
3. Have you ever worked with any of the materials, or under any of the conditions, listed below:
a. Asbestos: Yes/No
b. Silica (e.g., in sandblasting): Yes/No
c. Tungsten/cobalt (e.g., grinding or welding this material): Yes/No
d. Beryllium: Yes/No
e. Aluminum: Yes/No
f. Coal (for example, mining): Yes/No
g. Iron: Yes/No
h. Tin: Yes/No
i. Dusty environments: Yes/No
j. Any other hazardous exposures: Yes/No
If "yes," describe these exposures:____________________________________
_______________________________________________________________________
_______________________________________________________________________
4. List any second jobs or side businesses you have:___________________
_______________________________________________________________________
5. List your previous occupations:_____________________________________
_______________________________________________________________________
6. List your current and previous hobbies:________________________________
_______________________________________________________________________
7. Have you been in the military services? Yes/No
If "yes," were you exposed to biological or chemical agents (either in training or combat): Yes/No
8. Have you ever worked on a HAZMAT team? Yes/No
9. Other than medications for breathing and lung problems, heart trouble, blood pressure, and seizures mentioned
earlier in this questionnaire, are you taking any other medications for any reason (including over-the-counter
medications): Yes/No
If "yes," name the medications if you know them:_______________________
10. Will you be using any of the following items with your respirator(s)?
a. HEPA Filters: Yes/No
b. Canisters (for example, gas masks): Yes/No
c. Cartridges: Yes/No
11. How often are you expected to use the respirator(s) (circle "yes" or "no" for all answers that apply to you)?:
a. Escape only (no rescue): Yes/No
b. Emergency rescue only: Yes/No
c. Less than 5 hours per week: Yes/No
d. Less than 2 hours per day: Yes/No
e. 2 to 4 hours per day: Yes/No
f. Over 4 hours per day: Yes/No
12. During the period you are using the respirator(s), is your work effort:
a. Light (less than 200 kcal per hour): Yes/No
If "yes," how long does this period last during the average shift:____________hrs.____________mins.
Examples of a light work effort are sitting while writing, typing, drafting, or performing light assembly work; or
standing while operating a drill press (1-3 lbs.) or controlling machines.
b. Moderate (200 to 350 kcal per hour): Yes/No
If "yes," how long does this period last during the average shift:____________hrs.____________mins.
Examples of moderate work effort are sitting while nailing or filing; driving a truck or bus in urban traffic; standing
while drilling, nailing, performing assembly work, or transferring a moderate load (about 35 lbs.) at trunk level;
walking on a level surface about 2 mph or down a 5-degree grade about 3 mph; or pushing a wheelbarrow with a
heavy load (about 100 lbs.) on a level surface.
c. Heavy (above 350 kcal per hour): Yes/No
If "yes," how long does this period last during the average shift:____________hrs.____________mins.
Examples of heavy work are lifting a heavy load (about 50 lbs.) from the floor to your waist or shoulder; working on
a loading dock; shoveling; standing while bricklaying or chipping castings; walking up an 8-degree grade about 2
mph; climbing stairs with a heavy load (about 50 lbs.).
13. Will you be wearing protective clothing and/or equipment (other than the respirator) when you're using your
respirator: Yes/No
If "yes," describe this protective clothing and/or equipment:__________
_______________________________________________________________________
14. Will you be working under hot conditions (temperature exceeding 77 °F): Yes/No
15. Will you be working under humid conditions: Yes/No
16. Describe the work you'll be doing while you're using your respirator(s):
_______________________________________________________________________
_______________________________________________________________________
17. Describe any special or hazardous conditions you might encounter when you're using your respirator(s) (for
example, confined spaces, life-threatening gases):
_______________________________________________________________________
_______________________________________________________________________
18. Provide the following information, if you know it, for each toxic substance that you'll be exposed to when you're
using your respirator(s):
Name of the first toxic substance:___________________________________________
Estimated maximum exposure level per shift:__________________________________
Duration of exposure per shift:______________________________________________
Name of the second toxic substance:__________________________________________
Estimated maximum exposure level per shift:__________________________________
Duration of exposure per shift:______________________________________________
Name of the third toxic substance:___________________________________________
Estimated maximum exposure level per shift:__________________________________
Duration of exposure per shift:______________________________________________
The name of any other toxic substances that you'll be exposed to while using your respirator:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
19. Describe any special responsibilities you'll have while using your respirator(s) that may affect the safety and
well-being of others (for example, rescue, security):
_____________________________________________________________________________
[63 FR 1152, Jan. 8, 1998; 63 FR 20098, April 23, 1998; 76 FR 33607, June 8, 2011; 77 FR 46949, Aug. 7, 2012]
UNITED STATES
DEPARTMENT OF LABOR
(https://www.dol.gov)
Occupational Safety & Health Administration
200 Constitution Ave NW
Washington, DC 20210
800-321-6742 (tel:+18003216742) (OSHA)
TTY (https://www.dol.gov/general/contact/contact-phone-call-center#tty)
www.OSHA.gov (https://www.osha.gov/)
FEDERAL GOVERNMENT
White House
(https://www.whitehouse.gov)
Severe Storm and Flood Recovery
Assistance
(https://www.dol.gov/general/stormrecovery)
Disaster Recovery Assistance
(https://www.dol.gov/general/disasterrecovery)
DisasterAssistance.gov
(https://www.disasterassistance.gov/)
USA.gov (https://www.usa.gov/)
No Fear Act Data
(https://www.dol.gov/agencies/oasam/centers-
offices/civil-rights-
center/resports/notification-and-federal-
employee-antidiscrimination-retaliation-
act-of-2002)
U.S. Office of Special Counsel
(https://osc.gov/)
OCCUPATIONAL
SAFETY & HEALTH
Frequently Asked
Questions
(https://www.osha.gov/faq)
A - Z Index
(https://www.osha.gov/a-
z)
Freedom of Information
Act - OSHA
(https://www.osha.gov/foia)
Read The OSHA
Newsletter
(https://www.osha.gov/quicktakes/)
Subscribe to the OSHA
Newsletter
(https://www.osha.gov/quicktakes/#subscribe)
OSHA Publications
(https://www.osha.gov/publications)
Office of Inspector
General
(https://www.oig.dol.gov/)
ABOUT THIS SITE
Freedom of Information Act - DOL
(https://www.dol.gov/general/foia)
Privacy & Security Statement
(https://www.dol.gov/general/privacynotice)
Disclaimers
(https://www.dol.gov/general/disclaim)
Important Web Site Notices
(https://www.dol.gov/general/aboutdol/website-
policies)
Plug-ins Used by DOL
(https://www.dol.gov/general/aboutdol/file-
formats)
Accessibility Statement
(https://www.dol.gov/general/aboutdol/accessibility)
By Standard Number (/laws-regs/regulations/standardnumber/1910)
/ 1910.134 App D - (Mandatory) Information for Employees Using Respirators When not Required Under the
Standard.
Part Number:1910
Part Number Title:Occupational Safety and Health Standards
Subpart:1910 Subpart I
Subpart Title:Personal Protective Equipment
Standard Number:1910.134 App D (/laws-regs/interlinking/standards/1910.134 App D)
Title:(Mandatory) Information for Employees Using Respirators When not Required Under the
Standard.
GPO Source:e-CFR (https://www.ecfr.gov/cgi-bin/text-idx?
SID=65b279ee2e7530009034c1f152d451e5&tpl=/ecfrbrowse/Title29/29tab_02.tpl)
Appendix D to § 1910.134 (Mandatory) Information for Employees Using Respirators When Not Required
Under the Standard
Respirators are an effective method of protection against designated hazards when properly selected and worn.
Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of
comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator
itself can become a hazard to the worker. Sometimes, workers may wear respirators to avoid exposures to
hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards. If your
employer provides respirators for your voluntary use, or if you provide your own respirator, you need to take
certain precautions to be sure that the respirator itself does not present a hazard.
You should do the following:
1. Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and
warnings regarding the respirators limitations.
2. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute
for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A
label or statement of certification should appear on the respirator or respirator packaging. It will tell you what the
respirator is designed for and how much it will protect you.
3. Do not wear your respirator into atmospheres containing contaminants for which your respirator is not designed
to protect against. For example, a respirator designed to filter dust particles will not protect you against gases,
vapors, or very small solid particles of fumes or smoke.
4. Keep track of your respirator so that you do not mistakenly use someone else's respirator.
[63 FR 1152, Jan. 8, 1998; 63 FR 20098, April 23, 1998]
UNITED STATES
DEPARTMENT OF LABOR
(https://www.dol.gov)
Occupational Safety & Health Administration
200 Constitution Ave NW
Washington, DC 20210
800-321-6742 (tel:+18003216742) (OSHA)
TTY (https://www.dol.gov/general/contact/contact-phone-call-center#tty)
www.OSHA.gov (https://www.osha.gov/)
FEDERAL GOVERNMENT
White House
(https://www.whitehouse.gov)
Severe Storm and Flood Recovery
Assistance
(https://www.dol.gov/general/stormrecovery)
Disaster Recovery Assistance
(https://www.dol.gov/general/disasterrecovery)
DisasterAssistance.gov
(https://www.disasterassistance.gov/)
USA.gov (https://www.usa.gov/)
No Fear Act Data
(https://www.dol.gov/agencies/oasam/centers-
offices/civil-rights-
center/resports/notification-and-federal-
employee-antidiscrimination-retaliation-
act-of-2002)
U.S. Office of Special Counsel
(https://osc.gov/)
OCCUPATIONAL
SAFETY & HEALTH
Frequently Asked
Questions
(https://www.osha.gov/faq)
A - Z Index
(https://www.osha.gov/a-
z)
Freedom of Information
Act - OSHA
(https://www.osha.gov/foia)
Read The OSHA
Newsletter
(https://www.osha.gov/quicktakes/)
Subscribe to the OSHA
Newsletter
(https://www.osha.gov/quicktakes/#subscribe)
OSHA Publications
(https://www.osha.gov/publications)
Office of Inspector
General
(https://www.oig.dol.gov/)
ABOUT THIS SITE
Freedom of Information Act - DOL
(https://www.dol.gov/general/foia)
Privacy & Security Statement
(https://www.dol.gov/general/privacynotice)
Disclaimers
(https://www.dol.gov/general/disclaim)
Important Web Site Notices
(https://www.dol.gov/general/aboutdol/website-
policies)
Plug-ins Used by DOL
(https://www.dol.gov/general/aboutdol/file-
formats)
Accessibility Statement
(https://www.dol.gov/general/aboutdol/accessibility)
CONFINED SPACE ENTRY
Confined Space Entry 02.07.2023
Page 1 of 5
1.00 POLICY
The Confined Space Entry policy has been developed to ensure the safety of all persons entering
confined spaces or permit required confined spaces. This policy applies to Public Works
employees and meets the requirements of OSHA Standard 29 CFR § 1910.146 (g) (k) and Minn
Rules 5207.0300-0304.
1.05 DEFINITIONS
A Confined Space will have these three criteria:
a. Any space that is large enough and configured such that an employee can bodily enter
and perform work;
b. Has limited or restricted means of entry or exit;
c. and Is not intended for continuous employee occupancy.
A Hazardous (Permit-Required) Confined Space will meet all three criteria above for a
confined space, and will contain one or more of the following hazards:
a. Contains or has the potential to contain a hazardous atmosphere;
b. Potential for engulfment;
c. Internal configuration such that an employee could be trapped or asphyxiated by inwardly
converging walls or a floor that slopes downward and tapers to a smaller cross section;
OR
d. Any other recognized safety or health hazard.
For the purpose of this regulation, Permit-required confined spaces will be referred to as
Hazardous Confined Spaces.
An Entry Permit1 is written documentation that once approved by all members of an entry
team, certifies a hazardous (permit-required) confined space is safe for entry. The City’s entry
permit can be found in Appendix A of this regulation.
1.10 GENERAL REQUIREMENTS
An inspection of all confined spaces and hazardous confined spaces must be performed to
evaluate the hazards of the spaces before employees enter them. Upon request, the Safety
Director is available to perform a review of workplace confined spaces and hazardous (permit-
required) confined spaces.
If work is to be performed inside of a confined space, the affected parties shall document how
the space was determined or modified to be safe for entry with an Entry Permit that contains
the date, location of the space, and the signature of the person certifying the space is safe for
entry. Prior to each hazardous (permit-required) confined space entry all employees shall
review any air monitoring performed and review and sign the entry permit. If an employee
identifies a step that has been missed or is incomplete, they shall notify the entry supervisor and
all other entrants and attendants. Any member of the entry team has the right to stop work until
the situation has been corrected.
CONFINED SPACE ENTRY
Confined Space Entry 02.07.2023
Page 2 of 5
All employees that enter confined spaces are required by law to attend confined spaces training
annually to be certified / re-certified for confined space entry. All OSHA regulations shall be
followed regarding confined space entry. Each entry must have a trained attendant, and pre-
entry atmosphere testing.
No employee is allowed to smoke within 25 feet of any confined space area.
It is the employee’s responsibility to follow all OSHA regulations as instructed and to wear all
PPE each time they enter a confined space.
Hazardous (permit-required) Confined Spaces with only Atmospheric Hazards
When the only hazard posed by the hazardous (permit-required) confined space is an actual or
potential hazardous atmosphere and continuous forced air ventilation alone can maintain a safe
atmosphere, the following conditions shall be met prior to entry:
a. Forced air ventilation shall be supplied from a clean source and directed to ventilate
the immediate areas where an employee is or will be present.
b. Atmospheric testing for oxygen content, flammable gases and vapors, and potential
toxic air contaminants shall be performed prior to opening, when possible, and before
entry and continuously while occupied. Employees shall immediately leave the space if
a hazardous atmosphere is detected during monitoring. Where possible, all entrants
should wear confined space monitors.
c. Barriers to prevent an accidental fall or foreign objects entering the space shall be
used.
Changing a Hazardous Confined Space to a Confined Space (Reclassification)
When there is no potential for a hazardous atmosphere and all “other hazards” within the space
can be eliminated without entry into the space, then procedures for entry will be developed to
instruct the employees how to eliminate the hazards from the space prior to entry. These
procedures should be attached to the entry permit. The “other hazards” of these confined spaces
include but are not limited to mechanical or electrical hazards.
Performing work inside a Hazardous (permit-required) Confined Space or performing
work which creates a Hazardous (permit-required) Confined Space.
When employees must enter hazardous (permit-required) confined spaces or when the work to be
performed inside a confined space creates or has the potential to create a hazardous work
environment (i.e. welding in a confined space) employees are expected to take the following
precautions:
a. Develop safe entry procedures; b. Institute measures to prevent unauthorized entry;
c. Specify acceptable entry conditions;
CONFINED SPACE ENTRY
Confined Space Entry 02.07.2023
Page 3 of 5
d. Isolate the hazardous space, purging, flushing, or ventilating the hazardous space as
necessary to eliminate or control the atmospheric hazards; and
e. Verify that conditions in the hazardous space are acceptable for entry throughout the
duration of an authorized entry.
If hot work is required, a Hot Work Permit shall be completed with the appropriate fire watch.
(See Fire Prevention and Protection Regulation for additional information.)
1.15 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Issue and administer this program and review it for update, as necessary.
2. Train new employees on this policy before they begin work.
3. Ensure annual training is conducted.
4. Upon request, perform a review of workplace confined spaces and hazardous (permit-
required) confined spaces.
5. Ensure all entry team members are informed of the hazards associated with the hazardous
confined space including information on signs, symptoms, and consequences of exposure
(i.e. entrants may exhibit impaired coordination, deeper respiration, or poor judgment in
oxygen-deficient environments). For each hazardous (permit-required) confined space
entry, an entry team shall be assembled to perform the following duties:
A. Entry Supervisors Entry Supervisors are responsible for:
1. Ensuring that the following equipment is provided and used appropriately:
a. Testing and monitoring equipment
b. Ventilation equipment
c. Communications equipment
d. Personal protective equipment
e. Lighting equipment
f. Barriers and shields
g. Equipment for ingress and egress (ladders)
h. Rescue and emergency equipment for non-entry rescue
i. Any other equipment necessary for safe entry
2. Verifying that safeguards required by the documented procedures have been
implemented;
3. Verifying the means for summoning emergency rescue services is operable;
4. Remove personnel who are not authorized to enter the hazardous (permit-
required) confined space during entry operations;
CONFINED SPACE ENTRY
Confined Space Entry 02.07.2023
Page 4 of 5
5. Regularly determine that the entry operation is being performed in a manner
consistent with the requirements of the documented entry procedures and that
acceptable entry conditions are maintained;
6. Authorize entry and close out permit at the end of the entry; and
7. When the confined space presents unique or unusual hazards the Entry Supervisor
should notify the Fire Department in advance
Note: Duties of an Entry Supervisor may be passed from one individual to another during the
course of an entry operation so long as the replacement is trained to fulfill the role.
B. Attendant Duties
During a hazardous (permit-required) confined space entry operation, an Attendant must remain
outside the permit space continuously and not be assigned any other duties during the entry
operation. The Attendant may also serve as the Entry Supervisor. The Attendant:
1. Maintains a head count of entrants in the space;
2. Monitors the conditions inside and outside the hazardous confined space and maintains
communication with entrants;
3. Determines when an evacuation is necessary and alerts the entrants to evacuate; and
4. Summons emergency rescue services when necessary.
C. Entrant Duties
All Entrants shall:
1. Be familiar with and properly use the entry equipment provided
2. Regularly communicate to the attendant the conditions of the hazardous confined space
and alert the attendant if you recognize signs or symptoms of exposure to a dangerous
situation or if you detect a prohibited condition
3. Exit the hazardous confined space as soon as possible whenever: a. You have been advised to do so by the attendant or entry supervisor;
b. If you recognize any warning sign or symptom of exposure to a dangerous
situation or a prohibited condition; or
c. An evacuation alarm is activated
1.20 RESCUE AND EMERGENCY SERVICES
Only the Fire Department shall be authorized to enter confined spaces in order to perform
rescue services. All other employees are not permitted to enter a hazardous confined space to
rescue someone; however, they may attempt to use non-entry rescue equipment to retrieve
personnel from the space.
During rescue operations emergency rescue services shall operate under their standard
operating procedures.
1.25 TRAINING
All employees who enter a confined space to perform work shall be trained in the required
CONFINED SPACE ENTRY
Confined Space Entry 02.07.2023
Page 5 of 5
duties and procedures for safe entry and operations. They shall also be trained on the hazards
of the confined space(s) they must enter. Upon request the Safety Director will facilitate
training on general confined space entry operations. Each department will be responsible for
informing their employees of the specific hazards involved with a particular confined space.
1.30 CONFINED SPACE IDENTIFICATION
OSHA compels employers to identify a list of all confined spaces on premises. The City’s list is
as follows:
City of Medina Confined Spaces
All Sanitary Sewer Manholes
Valve Pits – both Lift Station and Water
All Lift Stations
Storm Sewer Manholes
1.35 CONTRACTOR SERVICES
If a department acquires a contractor to perform work that involves joint confined space entry
by City employees and contractor employees, the department shall ensure all the requirements
of this regulation are followed.
1.40 FORMS
1Refer to the Safety Manual Appendix for all forms.
F023 – Confined Space Entry Permit
CHAIN SAW AND TREE TRIMMING SAFETY
Chain Saw Safety 02.07.2023
Page 1 of 6
1.00 POLICY
The Chain Saw Safety policy has been developed to reduce the risk of injury or fatality from use
of chain saws for felling, cutting, or trimming trees or wood. This policy applies to Public
Works employees and meets the requirements of OSHA Standard 29 CFR § 1910.266.
Public Works and other occupations often use chain saws in tree trimming, landscaping
maintenance, and brush control. There are many risks involved requiring proper instructions on
safe procedures.
1.05 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Develop and administer the Chain Saw Safety Program.
2. Conduct hazard assessments and develop site safety plans for particular operations.
3. Direct the purchase of all necessary work equipment, tools and Personal Protective
Equipment3 that meets current recognized standards.
4. Ensure employees are trained on the policy and procedures included in this section.
Supervisors:
1. Purchase work equipment, tools and Personal Protective Equipment3 that meets current
recognized standards.
2. Ensure safe use of chain saws, tree trimming and tree removal operations.
3. Assure that safe work practices are utilized and prohibit the use of poor of forbidden
practices.
Employees:
1. Follow supervisory direction and abide by the prescribed work practices
2. Wear appropriate Personal Protective Equipment3 described in this section
3. Inspect all tools before and after use, report issues to supervisor.
4. Participate in safety training.
1.10 PROCEDURES
Chain saws are among the most hazardous power tools used. The unguarded blade, difficult
terrain upon which one must often work, and stresses applied to the materials to be cut creates
high potential hazard. The use of proper operating procedures, Personal Protective Equipment3,
safeguards on saws and proper work planning and execution can greatly reduce these potential
hazards. Note: safe use of a chain saw requires an alert operator. Do not operate a chain saw if
CHAIN SAW AND TREE TRIMMING SAFETY
Chain Saw Safety 02.07.2023
Page 2 of 6
feeling fatigued or are taking prescription medication or non-prescription drugs that cause
drowsiness or may otherwise impair the ability to function.
A. Be Aware of the Risk of Chain Saw Injury During Tree Removal:
Each year, approximately 36,000 people are treated in hospital emergency departments for
injuries from using chain saws. The United States Product Safety Commission prepared the
following accident location and frequency as related to chain saw use visual:
B. Safeguards Against Injury While Using a Chain Saws:
1) Whenever possible, never work alone with a chainsaw.
2) Never “Drop Start” a Chain Saw! This is a dangerous practice and specifically
prohibited by OSHA. Always start it on the ground or on a stable surface.
3) Operate, adjust, and maintain the saw according to manufacturer’s
instructions provided in the manual for the chain saw.
4) Properly sharpen chain saw teeth and properly lubricate the blade with bar and
chain oil. Additionally, periodically check and adjust the blade to keep the correct tension
on the chain to keep it from coming off the blade and ensure good cutting action.
5) Choose the proper size of chain saw to match the job, and include safety features such
as a chain brake, front and rear hand guards, stop switch, chain catcher and a spark
arrester.
6) Wear the appropriate Personal Protective Equipment3 including hard hat, safety glasses,
hearing protection, heavy work gloves, cut-resistant legwear (chain saw chaps) that
extend from the waist to the top of the foot, and boots which cover the ankle.
7) Check around the area where you are cutting for possible hazards like nails or
cables, both inside the wood itself, or in debris laying around the tree or limb.
CHAIN SAW AND TREE TRIMMING SAFETY
Chain Saw Safety 02.07.2023
Page 3 of 6
8) All vehicles used for tree trimming shall have a clear rear view unless they are equipped
with a reverse alarm or another employee supervises reverse movement. The operator
must stay in the truck while any load is suspended.
9) All employees shall be tied in with a safety harness when working above ground.
10) Avoid contact with power lines until the lines are verified as being de-energized.
11) Plan and make the cuts carefully. Cutting must be done uphill from or on the same
level as previously felled trees. Always keep in mind where the chain will go if it breaks;
never position yourself or other people in line with the chain.
12) Always cut at waist level or below to ensure that you maintain secure control over the
chain saw.
13) Clear the area of cut limbs and wood as you work to allow for safer use of the saw,
and to provide an escape path in case of sudden unanticipated movement by trees and
limbs. If a backpack blower unit is used to clear the area proper PPE must be worn and
no other person shall be within 10 feet of the operator.
14) Retreat when the tree starts to fall. Shut off the chain saw, set it down safely (don’t
throw it), and leave by the planned escape route. Do not return to the site until the tree is
down and no longer moving. If the tree should roll, let it; one person cannot stop or
control a moving tree.
15) If a tree happens to be so well balanced that it does not fall after a felling cut has been
made, two wedges can be used to start the fall and influence its direction. Always use two
wedges and a sledge that has a face 1/3 larger than the face of the wedge.
16) Bystanders or coworkers should remain at least 2 tree lengths (at least 150 feet)
away from anyone felling a tree and at least 30 feet from anyone operating a chain saw to
remove limbs or a fallen tree
17) If injury occurs, apply direct pressure over site(s) of heavy bleeding; this may save
lives.
C. Beware of Injury from the Release of Bent Trees or Branches
Take extra care in cutting “spring poles” or “danger” trees or branches that have gotten bent,
twisted, hung up on, or caught under another object during a high wind. If the tree or the branch
is suddenly released, it may strike the person cutting it, or a bystander, with enough force to
cause serious injury or death. Even a seemingly small tree or branch (2 inches in diameter, for
example) may pose a hazard when it is released from tension. To avoid injury:
1) Identify the maximum point of tension on the spring pole
2) Slowly shave the underside of the tree rather than cut through to allow the tree or branch
to release tension slowly
D. Felling Trees:
There are many things to do and consider before starting to cut a tree. To determine the fall
direction, consider:
1) rot or defect in the tree
2) tree lean
CHAIN SAW AND TREE TRIMMING SAFETY
Chain Saw Safety 02.07.2023
Page 4 of 6
3) wind – will it have an effect on how and where the tree will fall?
4) crown shape and limb weight
5) surrounding terrain
6) other trees – a very dangerous hazard is made when the cut tree entangles with another
and does not fall completely
Smaller trees (up to a 5-inch diameter) may be cut clear through with one pass (ANSI Z133).
Larger trees may require a series of cuts. Start with a 45-degree notch on the side that the tree
will fall towards. Cut the bottom of the notch first, about one third of the way through the
diameter. The second cut is made at a 45-degree angle that will meet the depth of the first cut.
The felling cut should be made from the opposite side, about 2 inches higher than the floor of the
notch. Do not cut all the way through but leave a hinge that will keep the tree from kicking back
and upward as it falls. The hinge will be about 1/8 to 1/6 of the diameter where you are cutting
but it may vary depending on when the tree starts to fall.
E. Trimming/Limbing the Tree:
Cutting a limb while you have only one hand controlling the saw is very dangerous. Never force
a chain saw through a cut, if it is properly sharpened and adjusted it will cut, almost by itself.
Keep in mind that the hardness of the wood will have a major effect on how quickly it cuts.
Be sure that the fallen tree is stable and will not move as you work. Examine the situation at
every limb to be removed. Be certain that the limb will not bind against the saw. Cut on the
opposite side of the tree trunk whenever possible, this keeps the trunk between you and the saw.
Never make cuts with the saw between your legs, always cut with the saw to the outside of your
legs. Don’t stand on a log and saw between your feet.
Never cut above shoulder height.
Never stand on the downhill side when removing limbs. Always keep in mind that the tree trunk
may roll as limbs are removed. Watch for limbs that may spring out when they are cut due to the
released tension. These limbs can cause injury.
Whenever possible, keep the tree limb or similar barrier between yourself and the saw
blade.
Always stand to one side of the limb you are to cut, never straddle it.
Larger limbs may require more than one cut to be removed safely. Plan the cuts so that there will
be no binding. Remember that stored energy can cause a cut to pinch the blade and immobilize
your saw. Wedges can be used as previously mentioned. Always plan an escape route when
removing large limbs since they may roll when they become free of the tree trunk.
When cutting large limbs and the trunk of the tree into convenient lengths be sure the trunk is
supported along its entire length and will not roll. Block or wedge the trunk in place, if needed.
Cut downward from the top of the trunk about one-third of the diameter and then roll it over to
make final cuts.
CHAIN SAW AND TREE TRIMMING SAFETY
Chain Saw Safety 02.07.2023
Page 5 of 6
Wedges can be used to keep the cut open if the log cannot be rolled over. They must be driven
with care so they will not come into contact with the chain saw. Even though this should prevent
pinching, always be alert to the situation.
F. Prevent Kick Back:
Saw kick back is one of the primary hazards of chainsaw work. Kickback of a chainsaw is when
the teeth on the chain catch on something as they rotate around the tip of the blade. The teeth
may have enough force to cause the blade to kick back violently toward you, hence the term
“kickback.” There are three primary situations that can cause kickback:
1) When the nose of the blade strikes another object.
2) Starting a bore cut improperly.
3) When the blade nose or tip catches the bottom or side of a saw cut during reinsertion.
The best defense against kickback is to keep the tip guard on the chain saw. However, this does
limit what you can do with the tool.
Some kickback control can be maintained by keeping a firm hold on the saw and using a saw
which has a chain-brake or kickback guard.
Be alert for blade-pinching situations.
Cut branches at the base of the blade; don’t saw with the tip of the blade. Use a high chain speed
when reinserting the blade in a cut or removing it from a cut. Keep the saw teeth sharp so they
will cut; dull teeth are more likely to cause a kickback.
Always cut below shoulder height, otherwise the saw is difficult to control and is too close
to your face.
Helpers should never work so close to the chainsaw operator that they may be struck by the saw
if it kicks back, or by a limb or a tree segment, which may spring due to stress.
1.15 TRAINING
Training shall be provided to all Public Works personnel assigned to use or work on a crew that
uses chain saws. The training shall include:
1) Safe performance of work tasks
2) Safe use, operation and maintenance of chain saws and other tools used
3) Review of the manufacturer’s operating and maintenance instructions, warnings and
precautions
4) Recognition, prevention and control of other safety and health hazards that may be
encountered during typical work tasks
5) Review of the requirements of the City of Medina’s policies pertaining to the required
tasks
CHAIN SAW AND TREE TRIMMING SAFETY
Chain Saw Safety 02.07.2023
Page 6 of 6
The following regulations shall be followed when using a chainsaw over 15 pounds:
1. If climbing, a separate line shall support the saw unless an aerial lift is used or no
supporting limb is available.
2. The chainsaw shall have a control to return the saw to idle when released.
3. Chainsaw shall have a clutch.
4. Saw must be started on the ground or where firmly supported. Drop starting is only
allowed if saw is less than 15 pounds or the area below is clear.
5. The saw may not be running while being carried up into a tree.
6. The saw must be stopped for cleaning, repairing or refueling.
7. The saw must be started at least 10 feet from fuel and open flame or any ignition source.
8. The saw can be started when chain break is engaged.
Each new employee and each employee who is required to be trained shall work under the close
supervision until the employee demonstrates to the supervisor the ability to safely perform their
new duties independently.
1.20 APPENDIX REFERENCES
3Appendix A – Personal Protective Equipment (Minimum PPE Guide)
Chain Saw Safety Appendix A 02.07.2023
MINIMUM PPE FOR CHAINSAW OPERATORS
HAZARDS DESCRIBE SPECIFIC HAZARDS PPE REQUIRED
Eye Hazard/Face
Impact/Projectile
Wood chips thrown into eye during
cutting.
Branches whipping into face/eyes.
Debris falling into eyes.
Logger mesh face shield when felling
or trimming. Safety glasses with side
shields and top shields may be used
when cutting limbs/logs on ground.
Head Hazard
Impact
Falling limbs and debris during cutting.
Moving into overhead hazards in
bucket on truck.
Hardhat
Foot/Leg Hazard
Impact
Cut by saw blade
Uneven terrain
Wet Conditions
Log sections may drop on feet.
Operating saw blade may contact feet
or legs.
Work on uneven terrain.
Steel Toed, water proof, cut-resistant
boots with ankle support. Cut-
resistant leg coverings (pants, chaps,
etc.)
Hand Hazard
Crushing
Vibration
Penetration
Abrasion
Vibration from operation of saw.
Crush/smash/abrasion from catching
fingers between log pieces.
Contact with poison plants.
Leather work gloves, leather anti
vibration gloves (for saws not
equipped with anti-vibration systems
and operators that use saw greater
than 24 hours per month or
experiencing symptoms)
Other Safety/Health Hazards
Noise
Fall from bucket truck
Hearing protection with an NRR of at least 27 must be used when operating saw
or helping. Employees must be enrolled in Occupational Noise Exposure Program
training. A fall protection system including a full body harness and lanyard must
be used when working from bucket truck.
MINIMUM PPE FOR TREE TRIMMER ASSISTANT
HAZARDS DESCRIBE SPECIFIC HAZARDS PPE REQUIRED
Eye Hazard/Face
Impact/Projectile
Wood chips thrown into eye during
cutting.
Debris falling into eyes.
Safety glasses with side shields and
top shields.
Head Hazard
Impact
Falling limbs and debris during cutting. Hardhat
Foot/Leg Hazard
Impact
Uneven terrain
Wet Conditions
Log sections may drop on feet.
Work on uneven terrain.
Steel Toed, water proof, boots with
ankle support
Hand Hazard
Crushing
Penetration
Abrasion
Crush/smash/abrasion from catching
fingers between log pieces.
Contact with poison plants.
Leather work gloves
Other Safety/Health Hazards
Noise
Hearing protection with an NRR of at least 27 must be used when operating saw
or helping. Employees must be enrolled in Occupational Noise Exposure Program
training.
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ELECTRICAL SAFETY PROGRAM
1.00 POLICY
The Electrical Safety policy has been developed to establish safe work practices that are intended to
prevent electric shock or other injuries resulting from direct/indirect electrical contacts when work is
performed near or on equipment or circuits which are or may be energized. This policy applies to Public
Works employees and meets the requirements of 29 CFR § 1910.332 through 1910.335.
1.05 DEFINITIONS
De-energized – all stored or residual energy source has been blocked or cut off and tested for the absence
of voltage by approved means.
Energized – connected to an energy source or potentially containing residual or stored energy.
Energy Isolating Device – a mechanical device that physically prevents the transmission or release of
energy, including but not limited to the following:
1. A manually operated electrical circuit breaker;
2. A disconnect switch;
3. A manually operated switch by which the conductors of a circuit can be disconnected from all
ungrounded supply conductors, and in addition, no pole can be operated independently;
4. A line valve;
5. A block;
6. And any similar device used to block or isolate energy.
Push buttons, selector switches and other control circuit type devices are not energy isolating devices.
Energy Source – any source of electrical voltage/power.
Voltage, nominal – a nominal value assigned to a circuit or system for the purpose of conveniently
designating its voltage class (as 120/240, 480Y/277, 600, etc). The actual voltage at which a circuit
operates can vary from the nominal within a range that permits satisfactory operation of equipment.
Unqualified Person – one not familiar with the construction and operations of the equipment and hazards
involved.
Qualified Person – one familiar with the construction and operations of the equipment and the hazards
involved; and is permitted to work on or near exposed energized parts who has been trained in and
familiar with:
1. The skills and techniques necessary to distinguish exposed live parts from other parts of electric
equipment;
2. The skills and techniques necessary to determine the nominal voltage of exposed live parts;
3. The knowledge, skills and techniques to work safely on energized circuits;
4. The proper use of special precautionary techniques, personal protective equipment, Insulating and
Electrical Safety 02.07.2023
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shielding materials, and insulated tools; and
5. The clearance distances for work performed near overhead lines that are specified in the OSHA
standard that appears in 29 CFR § 1910.333
1.10 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1) Train all employees on this policy before they begin work.
2) Enforce this policy.
3) Complete periodic inspections, at a minimum annually, for compliance and procedures.
4) Recognize when re-training is needed.
5) Maintain training records.
Supervisor:
1) Participate in the development of specific job procedures.
2) Train all employees on specific job procedures.
3) Recognize when re-training is needed.
Employee:
1) Understand the hazards of electrical shock.
2) Be careful to avoid electrical shock.
3) Understand the importance of following approved work practices to prevent electrical shock.
1.15 APPLICATION
This policy applies to both Qualified and Unqualified persons who are working on, near, or with the
following electrical installations:
1. Premises Wiring. Installations of electrical conductors and equipment within or on buildings or
other structures, and on other premises such as yards, carnival, parking and other lots and
industrial substations;
2. Wiring For Connection To Supply. Installations of conductors that connect to the supply of
electricity;
3. Other Wiring. Installations of other outside conductors on the premises;
4. Optical Fiber Cable. Installations of optical fiber cable where such installations are made along
with electrical conductors; and 5. Exposed Energized Parts. Installations that involve work
performed by unqualified persons on or near exposed energized parts.
1.20 GENERAL REQUIREMENT
Appropriate safe work practices will be employed to prevent electric shock or other injuries resulting from
either direct or indirect electrical contacts when work is performed near or on equipment or circuits that
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are or may be energized. Those specific work practices will be consistent with the nature and extent of the
associated electrical hazards.
1.25 WORK ON OR NEAR EXPOSED DE-ENERGIZED PARTS
1. Live parts to which an employee may be exposed will be de-energized before any employee works on
or near them, unless deenergizing will introduce additional or increased hazards or is not feasible due
to equipment design or operational limitations (See below for examples).
Live parts that operate at less than 50 volts to ground need not be de-energized if there will be no
increased exposure to electrical burns or to explosion due to electric arcs.
a. Examples of increased or additional hazards include interruption of life support equipment,
deactivation of emergency alarm systems, shutdown of hazardous location ventilation equipment,
or removal of illumination for an area.
b. Examples of work that may be performed on or near energized circuit parts because of infeasibility
due to equipment design or operational limitations include testing of electric circuits that can only
be performed with the circuit energized and work on circuits that form an integral part of a
continuous process that would otherwise need to be completely shut down in order to permit work
on one circuit or piece of equipment.
2. Whenever any employee is exposed to contact with parts of fixed electric equipment or circuits that
have been de-energized, the circuits energizing the parts will be properly locked out.
3. Safe procedures for deenergizing circuits and equipment will be determined before circuits or
equipment are de-energized.
4. The circuits and equipment to be worked on will be disconnected from all electric energy sources.
Control circuit devices, such as push buttons, selector switches, and interlocks, may not be used as the
sole means for deenergizing circuits or equipment. Interlocks for electric equipment may not be used
as a substitute for lockout procedures.
5. Stored electric energy that might endanger personnel will be released before starting work. Capacitors
shall be discharged and high capacitance elements shall be short-circuited and grounded, if the stored
electric energy might endanger personnel.
6. Stored non-electrical energy in devices that could reenergize electric circuit parts will be blocked or
relieved to the extent that the circuit parts could not be accidentally energized by the device.
7. No work will be performed on or near de-energized live parts, circuits or equipment until their de-
energized condition has been verified. Verification of the de-energized condition will be made as
follows:
a. A qualified person will operate the equipment operating controls or otherwise verify that the
equipment cannot be restarted.
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b. A qualified person will use test equipment to test the circuit elements and electrical parts of
equipment to which employees will be exposed and will verify that the circuit elements and
equipment parts are de-energized.
c. The test shall also determine if any energized condition exists as a result of inadvertently induced
voltage or unrelated voltage backfeed even though specific parts of the circuit have been de-
energized and presumed to be safe.
8. Before any circuit or equipment is reenergized (even temporarily) the following requirements will be
met in the order listed:
a. A qualified person will conduct tests and visual inspections, as necessary, to verify that all tools,
electrical jumpers, shorts, grounds, and other such devices have been removed, so that the circuits
and equipment can be safely energized.
b. Employees exposed to the hazards associated with reenergizing the circuit or equipment will be
warned to stay clear of circuits and equipment.
c. Each lock will be removed by the employee who applied it or under his or her direct supervision.
d. There will be a visual determination that all employees are clear of the circuits and equipment.
1.30 WORK ON OR NEAR EXPOSED ENERGIZED PARTS
1. In those cases where the exposed live parts are not de-energized, either because of increased or
additional hazards or because of infeasibility due to equipment design or operational limitations, other
safety-related work practices must be used to protect employees who may be exposed to the electrical
hazards involved.
The work practices used must protect employees against contact with energized circuit parts directly
with any part of their body or indirectly through some other conductive object or where employees are
near enough to be exposed to any hazard they present.
2. Only qualified persons may work on electric circuit parts or equipment that has not been de-energized.
These employees must be familiar with the proper use of special precautionary techniques, personal
protective equipment, insulating and shielding materials, and insulated tools.
3. Whenever work is to be performed near overhead lines, the lines will be de-energized and grounded,
or other protective measures will be provided before work is started.
4. When overhead lines are to be de-energized, arrangements to deenergize and ground them will be
made with the organization that operates or controls the electrical circuits involved.
5. When protective measures are provided such as guarding, isolating, or insulating, those precautions
shall prevent employees from contacting such lines directly with any part of their body or indirectly
through conductive materials, tools, or equipment.
6. Only qualified employees will be permitted to install insulating devices on overhead power
transmission or distribution lines.
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7. Whenever an unqualified employee is working in an elevated positions near overhead lines, the
location will be such that the person and the longest conductive object he or she may contact cannot
come closer to any unguarded, energized overhead line than the following distances:
a. For voltages to ground 50kV or below - 10ft.(305cm);
b. For voltages to ground over 50kV - 10 ft. (305cm) plus 4 inches (10 cm) for every l0kV over
50kV.
8. Whenever an unqualified employee is working on the ground in the vicinity of overhead lines, the
person may not bring any conductive object closer to unguarded energized overhead lines than the
distances given above.
9. For voltages normally encountered with overhead power lines, objects which do not have an insulating
rating for the voltage Involved are considered to be conductive.
10. Whenever a qualified person is working in the vicinity of overhead lines, whether in an elevated
position or on the ground, the person may not approach or take any conductive object without an
approved insulating handle closer to exposed energized parts than that shown in Table S-5 of 29 CFR
§ 1910.333(c)(3) (see paragraph 11 below), unless:
a. The person is insulated from the energized part. Gloves, with sleeves if necessary, rated for the
voltage involved, are considered to be insulation of the person from the energized part on which
work is performed, or
b. The energized part is insulated both from all other conductive objects at a different potential and
from the person, or
c. The person is insulated from all conductive objects at a potential different from that of the
energized part.
11. The minimum safe approach distances are as follows:
Voltage Range (Phase to Phase) Minimum Approach Distance
300V and less Avoid Contact
Over 300V, not over 750 V 1 ft. 0 in. (30.5 cm)
Over 750V, not over 2kV 1 ft. 6 in. (46 cm)
Over 2kV, not over 15kV 2 ft. 0 in. (61 cm)
Over 15kV, not over 37kV 3 ft. 0 in. (91 cm)
Over 37kV, not over 87.5kV 3 ft. 6 in. (107 cm)
Over 87.5V, not over 121kV 4 ft. 0 in. (122 cm)
Over 12lkV, not over l40kV 4 ft. 6 in. (137 cm)
Table S-5 Approach Distances for Qualified Employees - Alternating Current 1910.333(c)(3)(ii)(C)
12. Any vehicle or mechanical equipment capable of having parts of its structure elevated near energized
overhead lines will be operated so that a clearance of 10 ft. (305 cm) is maintained. If the voltage is
Electrical Safety 02.07.2023
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higher than 50kV, the clearance will be increased 4 in. (10 cm) for every 10kV over that voltage.
However, under any of the following conditions, the clearance may be reduced:
a. If the vehicle is in transit with its structure lowered, the clearance may be reduced to 4 ft. (122
cm). If the voltage is higher than 50kV, the clearance will be increased 4 in. (10 cm) for every
10kV over that voltage.
b. If insulating barriers are installed to prevent contact with the lines, and if the barriers are rated for
the voltage of the line being guarded and are not a part of or an attachment to the vehicle or its
raised structure, the clearance may be reduced to a distance within the designed working
dimensions of the insulating barrier.
c. If the equipment is an aerial lift insulated for the voltage involved, and if the work is performed
by a qualified person, the clearance (between the uninsulated portion of the aerial lift and the
power line) may be reduced to the distance given in said Table S-5 (see paragraph no. 11, above).
13. Employees standing on the ground may not contact the vehicle or mechanical equipment or any of its
attachments, unless:
a. The employee is using protective equipment rated for the voltage; or
b. The equipment is located so that no uninsulated part its structure (that portion of the structure that
provides a conductive path to employees on the ground) can come closer to the line than permitted
in paragraph number 12 (see above).
14. If any vehicle or mechanical equipment capable of having parts of its structure elevated near energized
overhead lines is intentionally grounded, employees working on the ground near the point of
grounding will not stand at the grounding location whenever there is a possibility of overhead line
contact.
15. Additional precautions, such as the use of barricades or insulation, will be taken to protect employees
from hazardous ground potentials, depending on earth resistivity and fault currents, that can develop
within the first few feet or more outward from the grounding point.
16. Employees may not enter spaces containing exposed energized parts, unless illumination is provided
that enables the employees to perform the work safely.
17. Where lack of illumination or an obstruction precludes observation of the work to be performed,
employees may not perform tasks near exposed energized parts.
18. Employees must not reach blindly into areas which may contain energized parts.
19. Whenever an employee works in a confined or enclosed space (such as a manhole or vault) that
contains exposed energized parts, he/she must be provided with, and he will use, protective shields,
protective barriers, or insulating materials as necessary to avoid inadvertent contact with those parts.
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20. Doors, hinged panels, and the like that are present in any confined or enclosed space will be secured to
prevent their swinging into an employee and causing the employee to contact exposed energized parts.
21. Conductive materials and equipment that are in contact with any part of an employees body will be
handled in a manner that will prevent them from contacting exposed energized conductors or circuit
parts.
22. Whenever an employee must handle long dimensional conductive objects (such as ducts and pipes) in
areas with exposed live parts, appropriate work practices (such as the use of insulation, guarding and
material handling techniques) shall be instituted which will minimize the hazard.
23. Only wooden ladders or ladders with nonconductive siderails if they are used where the employee or
the ladder could contact exposed energized parts.
24. Conductive articles of jewelry and clothing (such as watch bands, bracelets, rings, keychains,
necklaces, metalized aprons, cloth with conductive thread, or metal headgear) may not be worn if they
might contact exposed energized parts. However, such articles may be worn if they are rendered
nonconductive by covering, wrapping, or other insulating means.
25. Where live parts present an electrical contact hazard, employees may not perform housekeeping duties
at such close distances to the parts that there is a possibility of contact, unless adequate safeguards
(such as insulating equipment or arrears) are provided.
26. Electrically conductive cleaning materials (including conductive solids such as steel wool, metalized
cloth, and silicon carbide, as well as conductive liquid solutions) may not be used in proximity to
energized parts unless appropriate procedures are followed that will prevent electrical contact.
27. Only a qualified person following the requirements of the procedures set forth in this section of the
policy may defeat an electrical safety interlock and then only temporarily while he or she is working
on the equipment.
28. The interlock system will be returned to its operable condition when such work is completed.
1.35 PORTABLE ELECTRIC EQUIPMENT
1. All cord and plug connected electric equipment, flexible cord sets (extension cords), and portable
electric equipment will be handled in a manner that will not cause damage.
2. Flexible electric cords connected to equipment may not be used for raising or lowering the equipment.
3. Flexible cords may not be fastened with staples or otherwise hung in such a fashion as could damage
the outer jacket or insulation.
4. Portable cord- and plug- connected equipment and flexible cord sets (extension cords) shall be visually
inspected before use and missing pins, or damage to outer jacket or insulation) and for evidence of
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possible internal damage (such as pinched or crushed outer jacket). However, cord- and plug-
connected equipment and flexible cord sets (extension cords) which remain connected once they are
put in place and are not exposed to damage need not be visually inspected until they are relocated.
5. If there is a defect or evidence of damage that might expose an employee to injury, the defective or
damaged item will be removed from service, and no employee may use it until necessary repair and
tests have been made to render the equipment safe.
6. Whenever an attachment plug is to be connected to a receptacle (including any on a cord set), the
relationship of the plug and receptacle contacts will first be checked to ensure that they are of proper
mating configurations.
7. A flexible cord used with grounding-type equipment will contain an equipment grounding conductor.
8. Attachment plugs and receptacles may not be connected or altered In a manner that would prevent
proper continuity of the equipment grounding conductor at the point where plugs are attached to
receptacles. Additionally, those devices may not be altered to allow the grounding pole of a plug to be
inserted into slots intended for connection to the current carrying conductors.
9. Adapters that interrupt the continuity of the equipment grounding connection may not be used.
10. Portable electric equipment and flexible cords used in highly conductive work locations (such as those
inundated with water or other conductive liquids), or in job locations where employees are likely to
contact water or conductive liquids.
11. Employees' hands may not be wet when plugging and unplugging flexible cords and cord and plug-
connected equipment, if energized equipment is involved.
12. Energized plug and receptacle connections may be handled only with insulating protective equipment
if the condition of the connection could provide a conducting path to the employees hand (if, for
example, a cord connector is wet from being immersed in water).
13. Locking-type connectors will be properly secured after connection.
1.40 ELECTRICAL POWER AND LIGHTING CIRCUITS
1. Load rated switches, circuit breakers, or other devices specifically designed as disconnecting means
will be used for the routine opening, reversing, or closing of circuits under load conditions.
2. Cable connectors not of the load-break type, fuses, terminal lugs, and cable splice connections may not
be used for such purposes, except In an emergency.
3. After a circuit is de-energized by a circuit protective device, the circuit may not be manually
reenergized until it has been determined that the equipment and circuit can be safety energized.
However, when it can be determined from the design of the circuit and the overcurrent devices
involved that the automatic operating of a device was caused by an overload connected equipment is
needed before the circuit is reenergized.
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4. Repetitive manual reclosing of circuit breakers or reenergizing circuits through replaced fuses is
prohibited.
5. Overcurrent protection of circuits and conductors may not be modified, even on a temporary basis,
beyond that allowed by the OSHA standard regulating the installation safety requirements for
overcurrent protection (See 29 CFR § 1910.304(e).
1.45 TEST INSTRUMENTS AND EQUIPMENT
1. Only qualified persons may perform testing work on electric circuits or equipment.
2. Test instruments and equipment and all associated test leads, cables, power cords, probes, and
connectors will be visually inspected for external defects and damage before the equipment is used. If
there is a defect or evidence of damage that might expose an employee to injury, the defective or
damaged item will be removed from service, and no employee may use the item until necessary repairs
and tests to render the equipment safe have been made.
3. Test instruments and equipment and their accessories will be rated for the circuits and equipment to
which they will be connected and will be designed for the environment in which they will be used.
1.50 FLAMMABLE OR IGNITABLE MATERIALS
1. In those situations where flammable materials are present only occasionally, electric equipment
capable of igniting them will not be used, unless measures are taken to prevent hazardous conditions
from developing.
2. Flammable materials include, but are not limited to: flammable gases, vapors, or liquids; combustible
dust and ignitable fibers or flyings.
3. In those situations where flammable vapors, liquids or gases, or combustible dusts or fibers are (or
may be) present on a regular basis, the electrical installation requirements contained in the OSHA
standard regulating hazardous locations must be observed (See 29 CFR § 1910.307).
1.55 PERSONAL PROTECTION SAFEGUARDS
1. Employees working in areas where there are potential electrical hazards will be provided with, and
will use, electrical protective equipment that is appropriate for the specific parts of the body to be
protected and for the work to be performed. This equipment may include rubber protective equipment
such as insulating gloves, blankets, hoods, line hose, sleeves, and matting for use around electric
apparatus.
2. Protective equipment will be maintained in a safe, reliable condition and will be periodically inspected
and/or tested.
3. If the insulating capability of protective equipment may be subject to damage during use, the
insulating material shall be protected. For example, an outer covering of leather can be used for the
protection of rubber insulating material.
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4. Employees will wear nonconductive head protection wherever there is a danger of head injury from
electric shock or burns due to contact with exposed energized parts.
5. Employees will wear protective equipment for the eyes or face wherever there is danger of injury to
the eyes or face from electric arcs or flashes or from flying objects resulting from electrical explosion.
6. When working near exposed energized conductors or circuit parts, each employee will use insulated
tools or handling equipment if the tools or handling equipment might make contact with such
conductors or parts. If the insulating capability of insulated tools or handling equipment is subject to
damage, the insulating material will be protected.
7. Fuse handling equipment, insulated for the circuit voltage, will be used to remove or install fuses when
the fuse terminals are energized.
8. Ropes and handlines used near exposed energized parts shall be nonconductive.
9. Protective shields, protective barriers, or insulating materials will be used to protect each employee
from shock, burns, or other electrically related injuries while that employee is working near exposed
energized parts which might be accidentally contacted or where dangerous electric heating or arcing
might occur.
10. When normally enclosed live parts are exposed for maintenance or repair, they will be guarded to
protect unqualified persons from contact with their live parts.
11. Alerting techniques will be used to warn and protect employees from hazards which could cause injury
due to electric shock, burns, or failure of electric equipment parts as follows:
a. Safety Signs and Tags: Safety signs, safety symbols, or accident prevention tags will be used
where necessary to warn employees about electrical hazards which may endanger them.
b. Barricades: Barricades will be used in conjunction with safety signs where it is necessary to
prevent or limit employee access to work areas exposing employees to uninsulated energized
conductors or circuit parts. Conductive barricades may not be used where they might cause an
electrical contact hazard.
c. Attendants: If signs and barricades do not provide sufficient seaming and protection from
electrical hazards, an attendant will be stationed to warn and protect employees.
1.60 TRAINING
1. Appropriate training will be provided for those employees who face a risk of electric shock in the form
of classroom and/or on the job instruction.
2. Each employee required to be trained will become familiar with the safe work practices required by
this policy and those sections of the OSHA Electrical Standard that pertain to his/her respective job
assignment(s).
3. Qualified persons (i.e. those persons permitted to work on or near exposed energized parts) will, at a
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minimum, be trained in the following:
a. The skills and techniques necessary to distinguish exposed live parts from other parts of electric
equipment,
b. The skills and techniques necessary to determine the nominal voltage of exposed parts, and
c. The clearance distances specified in Table S-5 of 29 CFR § 1910.333(c) (see paragraph #11 of
Part 1.30 of this Policy) and the corresponding voltages to which the qualified person will be
exposed.
The degree of training will be determined by the risk likely to be encountered by the employee. The
training given to “qualified persons” will be documented.
TRENCHING AND SHORING EXCAVATION
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1.00 POLICY
The Trenching and Shoring Excavation program has been developed to provide procedures for
safeguarding staff working in or around trenching operations. All trench-excavations will be
performed in accordance with regulatory and department requirements. This policy applies to
Public Works employees and meets the requirements of OSHA Standard 29 CFR, Subpart P,
Excavations, § 1926.650, 651, and 652.
1.05 DEFINITIONS
Benching: a method of protecting employees from cave-ins by excavating the sides of an
excavation to form one or a series of horizontal levels or steps, usually with vertical or near-
vertical surfaces between levels. Benching is not allowed for Type C soils and is, therefore,
not allowed in excavations done by Public Works staff.
Cave-in: the separation of a mass of soil or rock material from the side of an excavation, or
the loss of soil from under a trench shield or support system, and its sudden movement into
the excavation, either by falling or sliding, in sufficient quantity so that it could entrap, bury,
or otherwise injure and immobilize a person.
Competent Person: someone who is capable of identifying existing and predictable hazards
in the surroundings, or working conditions which are unsanitary, hazardous, or dangerous to
employees, and who has authorization to take prompt corrective measures to eliminate them.
Excavation: any man-made cut, cavity, trench, or depression in an earth surface, formed by
earth removal.
Failure: the breakage, displacement, or permanent deformation of a structure member or
connection so as to reduce its structure integrity and its supportive capabilities.
Protective Systems: a method of protecting employees from cave-ins. Protective systems
include shoring systems, sloping and benching systems, shield systems, and other systems
that provide the necessary protection.
Shield (shield system): a structure that is able to withstand the forces imposed on it by a
cave-in and thereby protect employees with the structure. Shields can be permanent structure
or can be designed to be portable and moved along as work progresses. In trenches, a shield is
also known as a trench box or trench shield.
Shoring (shoring system): a support system for trench faces used to prevent cave-ins.
Sloping (sloping system): a method of protecting employees from cave-ins by excavating to
form sides of an excavation that are inclined away from the excavation so as to prevent cave-
ins.
Trench: a narrow excavation that, in general, is deeper than the wide, but has a width not
greater than 15 feet.
TRENCHING AND SHORING EXCAVATION
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1.10 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Implement and enforce these guidelines.
Supervisor:
1. Ensure that affected employees are aware of the requirements of these guidelines
2. Ensure that trenching/excavation activities comply with these guidelines
3. Monitor for hazardous atmospheres in trenches/excavations where they could accumulate
4. Complete trenching/excavation permits generated on site
Competent Person:
1. Classify and document soil type(s) and assist supervisor in determining protection
requirements
2. Soil classifications must be made; upon starting work, per 100 feet of trenching /
excavation work or when soil conditions change. Maintain a copy of the OSHA
excavation standard on site while trenching/shoring work is performed. Daily, inspect all
trenching/shoring work to ensure compliance with these guidelines and document these
inspections.
Employee:
1. Be aware of the warning signs of failure.
2. Notify the Competent Person of any concerns.
3. Do not enter any trench/excavation determined or suspected to be unsafe.
1.15 PROCEDURE
General Requirements:
1. No employee shall use heavy equipment or take part in trenching activities until they are
trained and certified by a qualified instructor.
2. All surface encumbrances that are located so as to create a hazard to employees shall be
removed or supported, as necessary, to safeguard employees.
3. The estimated location of all utility installations, such as sewer, telephone, gas, electric,
water lines, or any other underground installations that reasonably may be expected to be
encountered during excavation work, shall be determined prior to opening an excavation.
4. Utility companies, electric, gas or property owners shall be contacted within established
or customary local response times, advised of the proposed work, and asked to establish
TRENCHING AND SHORING EXCAVATION
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the location of the utility underground installations prior to the start of the actual
excavation.
5. Soil in all trench excavations done by Public Works staff will be treated as Type C soils,
29 CFR 1926 Subpart P 2Appendix A.
6. Workers in an excavation of 5-ft or greater in depth shall be protected from cave-ins by
an adequate protective system such as shoring, shielding (trench box) and or sloping in
accordance with the requirements set forth for Type C soils in OSHA's Excavation
standard, 29 CFR 1926.652 (a), (b), (c), and Subpart P 2Appendix B. In addition,
shallower trenches that have indicators of potential cave-in must also be similarly
shielded, shored, or sloped, 29 CFR 1926.652(a)(1)(ii).
7. Workers in an excavation of 4-ft or greater in depth, where oxygen deficiency or a
hazardous atmosphere exists or could reasonably be expected to exist, such as in
excavations in landfill areas or excavations in areas where hazardous substances are
stored nearby, the atmospheres in the excavation shall be tested before employees enter,
1926.651(g)(1)(i).
8. Excavations or trenches 20 feet deep or greater must have a protective system designed
by a registered professional engineer, 29 CFR 1926.652(b)(4).
9. All An on-site Competent Person shall be designated and placed in charge of all
excavations at all times. The Competent Person shall conduct inspections in accordance
with this policy. Public Works staff shall receive Competent Person training. All Public
Works staff are expected to understand and acknowledge their individual and collective
responsibilities for trench safety.
Soil Assessment:
By this policy, all trench excavations done by Public Works staff shall be assumed to
have Type C soils and shall require procedures appropriate for Type C soils.
Protective Systems Requirements:
1) Sloping
All soils in trench excavations are assumed to occur in Type C, therefore, in
accordance with 29 CFR 1926, 2Appendix B, the maximum allowable slopes are as
follows:
Soil Type Height/depth ratio Slope angle
Type C 1 1/2:1 34 degrees
TRENCHING AND SHORING EXCAVATION
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For example, a 10-foot-deep trench in Type C soil must be sloped at a 34 degree
angle, or 15 feet back in both directions, excluding the bottom width of the trench.
Figure 1 – Slope requirements for Type C Soil
2) Shoring
a) Material and equipment used for shoring shall be used and maintained in a manner
that is consistent with the recommendations of the manufacturer, and in a manner that
will prevent employee exposure to hazards. 29 CFR 1926.652(d)(2)
b) Support systems shall be installed and removed in a manner that protects employees
from cave-ins, structural collapses, or from being struck by members of the support
system. 29 CFR 1926.652(e)(1)(ii)
c) When material or equipment that is used for protective systems is damaged, a
competent person shall examine the material or equipment and evaluate its suitability
for continued use. If the competent person cannot assure the material or equipment is
able to support the intended loads or is otherwise suitable for safe use, then such
material or equipment shall be removed from service and shall be evaluated and
approved by a registered professional engineer before being returned to service. 29
CFR 1926.652(d)(3)
3) Shielding or Trench Box
a) Shields shall be installed in a manner to restrict lateral or other hazardous movement
of the shield in the event of the application of sudden lateral loads, 29 CFR
1926.652(g)(1)(ii).
b) Trench boxes may not be subjected to loads exceeding those which the system was
designed to withstand, 29 CFR 1926.652(g)(1)(i).
c) The box must extend at least 18 inches above the surrounding area if there is sloping
toward the excavation, 29 CFR 1926, 2Appendix B.
a. Shields may ride two feet above the bottom of an excavation, provided they
are calculated to support the full depth of the excavation and there is no
caving under or behind the shield, 29 CFR 1926.652(e)(2)(i).
b. Workers shall be protected from the hazard of cave-ins when entering or
exiting the areas protected by shields, 29 CFR 1926.652(g)(1)(iii).
c. Workers shall not be allowed in shields when shields are being installed,
removed, or moved vertically, 29 CFR 1926.652(g)(1)(iv).
TRENCHING AND SHORING EXCAVATION
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Material & Equipment
4) Benching
Benching is not allowed for Type C soil and is, therefore, not allowed in trench
excavations, 29 CFR 1926, 2Appendix B.
Additional Required Safety Procedures:
1) During Trench-Excavation
a) When excavation operations approach the estimated location of underground
installations, the exact location of the installations shall be determined by safe and
acceptable means, 29 CFR 1926.651(b)(3).
b) Sidewalks, pavement and other structures shall not be undermined unless a support
system or another method of protection is provided to protect employees from the
possible collapse of such structures, 29 CFR 1926.651(i)(3).
c) Materials and equipment shall be placed no closer than 2 feet from the surface edge
of the excavation measured from the nearest base of the spoil to the cut, 29 CFR
1926.651(j)(2).
Figure 2 – Material & equipment placement
2) Ingress (in) and Egress (out)
A stairway, ladder, ramp or other safe means of egress shall be located in trench
excavations that are 4 feet or more in depth so as to require no more than 25 feet of
lateral travel for employees, 29 CFR 1926.651(c)(2).
3) Exposure to Falling Loads
a) All employees on an excavation site must wear hard hats, 29 CFR 1926.100.
b) No employee shall be permitted underneath loads handled by lifting or digging
equipment, 29 CFR 1926.651(e).
c) Employees shall be required to stand away from any vehicle being loaded or
unloaded to avoid being struck by any spillage or falling materials, 29 CFR
1926.651(e).
TRENCHING AND SHORING EXCAVATION
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d) Operators may remain in the cabs of vehicles being loaded or unloaded when the
vehicles are equipped, in accordance with 1926.601(b)(6), to provide adequate
protection for the operator during loading and unloading operations, 29 CFR
1926.651(e).
4) Atmospheric Testing
Atmospheric testing will be performed in all excavations employing shoring and greater than
4 feet in depth and where there is a possibility of a hazardous or toxic atmosphere present
(i.e., maintenance on all sewer lines, working around natural gas lines, near landfills).
a. No employee will enter a permitted excavation space until the Oxygen,
Combustibles, and Toxic gas readings are below or within required settings.
b. The use of gas powered equipment (i.e., pipe saw) within excavations will require
the use of ventilation equipment to prevent carbon monoxide build-up.
c. Self-contained Breathing Apparatus will not be worn while working within any
permit required excavation for any reason; to include atmosphere testing.
Before an employee enters the excavation where hazardous atmospheres may be present, the
internal atmosphere shall be tested, with a calibrated direct-reading instrument, for the
following conditions in the order given:
a. Between 19.5% - 23.5% Oxygen
b. Less than 10% LFL for Combustible
c. Less than 10 PPM for Toxic (H2S)
d. Less than 10 PPM for CO
If atmosphere inside an excavation fails to meet any of the above criteria, space will be
ventilated using continuous forced air ventilation. At this time, the excavation will be
classified as a permit-required confined space and require a confined space permit to be filled
out and posted at the excavation.
Atmosphere within the permit required excavation will be tested prior to entry then hourly
and results noted on the Confined Space Permit. If entrants exit the confined space for more
than 15 minutes, the excavation will be re-tested prior to re-entry.
If a hazardous atmosphere is detected or a dangerous situation develops:
a. Each entrant shall leave the excavation immediately;
b. The space shall be evaluated to determine how the hazardous atmosphere developed;
and
c. Measures shall be implemented to protect employees from the hazardous atmosphere
before any subsequent entry takes place.
TRENCHING AND SHORING EXCAVATION
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5) Standing Water and Water Accumulation
a) Employees shall not work in excavations in which there is accumulated water, or in
excavations in which water is accumulating, unless adequate precautions have been
taken to protect employees against the hazards posed by water accumulation. The
precautions necessary to protect employees adequately vary with each situation but
could include special support or shield systems to protect from cave-ins, water
removal to control the level of accumulating water, or use of a safety harness and
lifeline, 29 CFR 1926.651(h)(1).
b) If water is controlled or prevented from accumulating by the use of water removal
equipment, the water removal equipment and operations shall be monitored by a
competent person to ensure proper operation, 29 CFR 1926.651(h)(2).
6) Inspections
a) For trenches 5-feet or greater in depth and those less than 5-ft in depth that have
indicators of potential cave-in, a trench inspection form shall be completed.
b) Daily inspections of trench-excavations, the adjacent areas, and protective systems
shall be made by a competent person for evidence of a situation that could result in
possible cave-ins, indications of failure of protective systems, hazardous atmospheres,
or other hazardous conditions. These inspections are only required when employee
exposure can be reasonably anticipated. 29 CFR 1926.651(k)(1).
c) An inspection shall be conducted by the competent person prior to the start of work
and as needed throughout the shift. Inspections shall also be made after every
rainstorm or other hazard increasing occurrence.
d) Where the competent person finds evidence of a situation that could result in a
possible cave-in, indications of failure of protective systems, hazardous atmospheres,
or other hazardous conditions, exposed employees shall be removed from the
hazardous area until the necessary precautions have been taken to ensure their safety.
No one is allowed to re-enter a trench wherein a hazardous condition occurred until
corrective action and a new permit is generated.29 CFR 1926.651(k)(2).
7) Installation and Removal of Support
This section applies to excavation activities that require protection beyond the trench boxes
normally used by Public Works crews. The use of trench boxes shall be the primary means of
protecting employees during excavation activities. If trench boxes are not possible,
supervisors should refer to 29 CFR 1926, OSHA Standards for the Construction Industry;
2Appendix B and C to 1926 Subpart P- Shoring and Benching illustrations for further
assistance.
1) Members of support systems shall be securely connected in a manner that protects
employees from cave-ins, structural collapses, or from being struck by members of the
support system.
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2) Individual members of support systems shall not be subjected to loads exceeding those
that those members were designed to withstand.
3) Before temporary removal of individual members begins, additional precautions shall be
taken to ensure the safety of employees, such as installing other structural members to
carry the loads imposed on the support system.
4) Removal shall begin at, and progress from, the bottom of the excavation. Members shall
be released slowly so as to note any indication of possible failure of the remaining
members of the structure or possible cave-in of the sides of the excavation.
5) Backfilling shall progress together with the removal of support systems from excavations.
1.20 EXCAVATION DAMAGES
For any excavation the City does or is involved with the owner shall be notified as soon as
possible when any excavation damages any underground facility.
Call 911 immediately if work damages a facility that results in a release of natural gas or
other hazardous substance or potentially endangers life, health or property.
Facility Owner Contact – 24 Hour
Wright-Hennepin Electric 763-477-3000
CenterPoint Energy 612-372-4900
Xcel Energy 1-800-641-4400
CenturyLink Telephone 1-800-214-8043
Mediacom Cable TV 1-855-633-4226
Frontier Telephone 1-800-921-8104
1.25 APPENDIX REFERENCES
2Appendix A - Soil Classification
2Appendix B - Sloping and Benching
2Appendix C - Timber Shoring for Trenches
By Standard Number / 1926 Subpart P App A - Soil Classification
Part Number:1926
Part Number Title:Safety and Health Regulations for Construction
Subpart:1926 Subpart P
Subpart Title:Excavations
Standard Number:1926 Subpart P App A
Title:Soil Classification
GPO Source:e-CFR
(a) Scope and application-
(1) Scope. This appendix describes a method of classifying soil and rock deposits based on site and
environmental conditions, and on the structure and composition of the earth deposits. The appendix contains
definitions, sets forth requirements, and describes acceptable visual and manual tests for use in classifying soils.
(2) Application. This appendix applies when a sloping or benching system is designed in accordance with the
requirements set forth in § 1926.652(b)(2) as a method of protection for employees from cave-ins. This appendix
also applies when timber shoring for excavations is designed as a method of protection from cave-ins in
accordance with appendix C to subpart P of part 1926, and when aluminum hydraulic shoring is designed in
accordance with appendix D. This appendix also applies if other protective systems are designed and selected for
use from data prepared in accordance with the requirements set forth in § 1926.652(c), and the use of the data is
predicated on the use of the soil classification system set forth in this appendix.
(b) Definitions. The definitions and examples given below are based on, in whole or in part, the following: American
Society for Testing Materials (ASTM) Standards D653–85 and D2488; The Unified Soils Classification System, the
U.S. Department of Agriculture (USDA) Textural Classification Scheme; and The National Bureau of Standards
Report BSS–121.
Cemented soil means a soil in which the particles are held together by a chemical agent, such as calcium
carbonate, such that a hand-size sample cannot be crushed into powder or individual soil particles by finger
pressure.
Cohesive soil means clay (fine grained soil), or soil with a high clay content, which has cohesive strength.
Cohesive soil does not crumble, can be excavated with vertical sideslopes, and is plastic when moist. Cohesive
soil is hard to break up when dry, and exhibits significant cohesion when submerged. Cohesive soils include
clayey silt, sandy clay, silty clay, clay and organic clay.
Dry soil means soil that does not exhibit visible signs of moisture content.
Fissured means a soil material that has a tendency to break along definite planes of fracture with little resistance,
or a material that exhibits open cracks, such as tension cracks, in an exposed surface.
Granular soil means gravel, sand, or silt, (coarse grained soil) with little or no clay content. Granular soil has no
cohesive strength. Some moist granular soils exhibit apparent cohesion. Granular soil cannot be molded when
moist and crumbles easily when dry.
Layered system means two or more distinctly different soil or rock types arranged in layers. Micaceous seams or
weakened planes in rock or shale are considered layered.
Moist soil means a condition in which a soil looks and feels damp. Moist cohesive soil can easily be shaped into a
ball and rolled into small diameter threads before crumbling. Moist granular soil that contains some cohesive
material will exhibit signs of cohesion between particles.
Plastic means a property of a soil which allows the soil to be deformed or molded without cracking, or appreciable
volume change.
Saturated soil means a soil in which the voids are filled with water. Saturation does not require flow. Saturation, or
near saturation, is necessary for the proper use of instruments such as a pocket penetrometer or sheer vane.
Soil classification system means, for the purpose of this subpart, a method of categorizing soil and rock deposits in
a hierarchy of Stable Rock, Type A, Type B, and Type C, in decreasing order of stability. The categories are
determined based on an analysis of the properties and performance characteristics of the deposits and the
environmental conditions of exposure.
Stable rock means natural solid mineral matter that can be excavated with vertical sides and remain intact while
exposed.
Submerged soil means soil which is underwater or is free seeping.
Type A means cohesive soils with an unconfined compressive strength of 1.5 ton per square foot (tsf) (144 kPa) or
greater. Examples of cohesive soils are: clay, silty clay, sandy clay, clay loam and, in some cases, silty clay loam
and sandy clay loam. Cemented soils such as caliche and hardpan are also considered Type A. However, no soil
is Type A if:
(i) The soil is fissured; or
(ii) The soil is subject to vibration from heavy traffic, pile driving, or similar effects; or
(iii) The soil has been previously disturbed; or
(iv) The soil is part of a sloped, layered system where the layers dip into the excavation on a slope of four
horizontal to one vertical (4H:1V) or greater; or
(v) The material is subject to other factors that would require it to be classified as a less stable material.
Type B means:
(i) Cohesive soil with an unconfined compressive strength greater than 0.5 tsf (48 kPa) but less than 1.5 tsf (144
kPa); or
(ii) Granular cohesionless soils including: angular gravel (similar to crushed rock), silt, silt loam, sandy loam and, in
some cases, silty clay loam and sandy clay loam.
(iii) Previously disturbed soils except those which would otherwise be classified as Type C soil.
(iv) Soil that meets the unconfined compressive strength or cementation requirements for Type A, but is fissured or
subject to vibration; or
(v) Dry rock that is not stable; or
(vi) Material that is part of a sloped, layered system where the layers dip into the excavation on a slope less steep
than four horizontal to one vertical (4H:1V), but only if the material would otherwise be classified as Type B.
Type C means:
(i) Cohesive soil with an unconfined compressive strength of 0.5 tsf (48 kPa) or less; or
(ii) Granular soils including gravel, sand, and loamy sand; or
(iii) Submerged soil or soil from which water is freely seeping; or
(iv) Submerged rock that is not stable; or
(v) Material in a sloped, layered system where the layers dip into the excavation on a slope of four horizontal to
one vertical (4H:1V) or steeper.
Unconfined compressive strength means the load per unit area at which a soil will fail in compression. It can be
determined by laboratory testing, or estimated in the field using a pocket penetrometer, by thumb penetration tests,
and other methods.
Wet soil means soil that contains significantly more moisture than moist soil, but in such a range of values that
cohesive material will slump or begin to flow when vibrated. Granular material that would exhibit cohesive
properties when moist will lose those cohesive properties when wet.
(c) Requirements-
(1) Classification of soil and rock deposits. Each soil and rock deposit shall be classified by a competent person as
Stable Rock, Type A, Type B, or Type C in accordance with the definitions set forth in paragraph (b) of this
appendix.
(2) Basis of classification. The classification of the deposits shall be made based on the results of at least one
visual and at least one manual analysis. Such analyses shall be conducted by a competent person using tests
described in paragraph (d) below, or in other recognized methods of soil classification and testing such as those
adopted by the America Society for Testing Materials, or the U.S. Department of Agriculture textural classification
system.
(3) Visual and manual analyses. The visual and manual analyses, such as those noted as being acceptable in
paragraph (d) of this appendix, shall be designed and conducted to provide sufficient quantitative and qualitative
information as may be necessary to identify properly the properties, factors, and conditions affecting the
classification of the deposits.
(4) Layered systems. In a layered system, the system shall be classified in accordance with its weakest layer.
However, each layer may be classified individually where a more stable layer lies under a less stable layer.
(5) Reclassification. If, after classifying a deposit, the properties, factors, or conditions affecting its classification
change in any way, the changes shall be evaluated by a competent person. The deposit shall be reclassified as
necessary to reflect the changed circumstances.
(d) Acceptable visual and manual tests-
(1) Visual tests. Visual analysis is conducted to determine qualitative information regarding the excavation site in
general, the soil adjacent to the excavation, the soil forming the sides of the open excavation, and the soil taken as
samples from excavated material.
(i) Observe samples of soil that are excavated and soil in the sides of the excavation. Estimate the range of
particle sizes and the relative amounts of the particle sizes. Soil that is primarily composed of finegrained material
is cohesive material. Soil composed primarily of coarse-grained sand or gravel is granular material.
(ii) Observe soil as it is excavated. Soil that remains in clumps when excavated is cohesive. Soil that breaks up
easily and does not stay in clumps is granular.
(iii) Observe the side of the opened excavation and the surface area adjacent to the excavation. Crack-like
openings such as tension cracks could indicate fissured material. If chunks of soil spall off a vertical side, the soil
could be fissured. Small spalls are evidence of moving ground and are indications of potentially hazardous
situations.
(iv) Observe the area adjacent to the excavation and the excavation itself for evidence of existing utility and other
underground structures, and to identify previously disturbed soil.
(v) Observe the opened side of the excavation to identify layered systems. Examine layered systems to identify if
the layers slope toward the excavation. Estimate the degree of slope of the layers.
(vi) Observe the area adjacent to the excavation and the sides of the opened excavation for evidence of surface
water, water seeping from the sides of the excavation, or the location of the level of the water table.
(vii) Observe the area adjacent to the excavation and the area within the excavation for sources of vibration that
may affect the stability of the excavation face.
(2) Manual tests. Manual analysis of soil samples is conducted to determine quantitative as well as qualitative
properties of soil and to provide more information in order to classify soil properly.
(i) Plasticity. Mold a moist or wet sample of soil into a ball and attempt to roll it into threads as thin as ¹⁄ -inch in
diameter. Cohesive material can be successfully rolled into threads without crumbling. For example, if at least a
two inch (50 mm) length of ¹⁄ - inch thread can be held on one end without tearing, the soil is cohesive.
(ii) Dry strength. If the soil is dry and crumbles on its own or with moderate pressure into individual grains or fine
powder, it is granular (any combination of gravel, sand, or silt). If the soil is dry and falls into clumps which break
up into smaller clumps, but the smaller clumps can only be broken up with difficulty, it may be clay in any
combination with gravel, sand or silt. If the dry soil breaks into clumps which do not break up into small clumps and
which can only be broken with difficulty, and there is no visual indication the soil is fissured, the soil may be
considered unfissured.
(iii) Thumb penetration. The thumb penetration test can be used to estimate the unconfined compressive strength
of cohesive soils. (This test is based on the thumb penetration test described in American Society for Testing and
Materials (ASTM) Standard designation D2488—‘‘Standard Recommended Practice for Description of Soils
(Visual—Manual Procedure).’’) Type A soils with an unconfined compressive strength of 1.5 tsf can be readily
indented by the thumb; however, they can be penetrated by the thumb only with very great effort. Type C soils with
an unconfined compressive strength of 0.5 tsf can be easily penetrated several inches by the thumb, and can be
molded by light finger pressure. This test should be conducted on an undisturbed soil sample, such as a large
clump of spoil, as soon as practicable after excavation to keep to a minimum the effects of exposure to drying
influences. If the excavation is later exposed to wetting influences (rain, flooding), the classification of the soil must
be changed accordingly.
(iv) Other strength tests. Estimates of unconfined compressive strength of soils can also be obtained by use of a
pocket penetrometer or by using a hand-operated shearvane.
(v) Drying test. The basic purpose of the drying test is to differentiate between cohesive material with fissures,
unfissured cohesive material, and granular material. The procedure for the drying test involves drying a sample of
soil that is approximately one inch thick (2.54 cm) and six inches (15.24 cm) in diameter until it is thoroughly dry:
(A) If the sample develops cracks as it dries, significant fissures are indicated.
(B) Samples that dry without cracking are to be broken by hand. If considerable force is necessary to break a
sample, the soil has significant cohesive material content. The soil can be classified as an unfissured cohesive
material and the unconfined compressive strength should be determined.
(C) If a sample breaks easily by hand, it is either a fissured cohesive material or a granular material. To distinguish
between the two, pulverize the dried clumps of the sample by hand or by stepping on them. If the clumps do not
pulverize easily, the material is cohesive with fissures. If they pulverize easily into very small fragments, the
material is granular
[85 FR 8737, February 18, 2020]
UNITED STATES
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By Standard Number / 1926 Subpart P App B - Sloping and Benching
Part Number:1926
Part Number Title:Safety and Health Regulations for Construction
Subpart:1926 Subpart P
Subpart Title:Excavations
Standard Number:1926 Subpart P App B
Title:Sloping and Benching
GPO Source:e-CFR
(a) Scope and application. This appendix contains specifications for sloping and benching when used as
methods of protecting employees working in excavations from cave-ins. The requirements of this appendix apply
when the design of sloping and benching protective systems is to be performed in accordance with the
requirements set forth in § 1926.652(b)(2).
(b) Definitions.
Actual slope means the slope to which an excavation face is excavated.
Distress means that the soil is in a condition where a cave-in is imminent or is likely to occur. Distress is
evidenced by such phenomena as the development of fissures in the face of or adjacent to an open excavation;
the subsidence of the edge of an excavation; the slumping of material from the face or the bulging or heaving of
material from the bottom of an excavation; the spalling of material from the face of an excavation; and ravelling,
i.e., small amounts of material such as pebbles or little clumps of material suddenly separating from the face of an
excavation and trickling or rolling down into the excavation.
Maximum allowable slope means the steepest incline of an excavation face that is acceptable for the most
favorable site conditions as protection against cave-ins, and is expressed as the ratio of horizontal distance to
vertical rise (H:V).
Short term exposure means a period of time less than or equal to 24 hours that an excavation is open.
(c) Requirements -- (1) Soil classification. Soil and rock deposits shall be classified in accordance with appendix
A to subpart P of part 1926.
(2) Maximum allowable slope. The maximum allowable slope for a soil or rock deposit shall be determined from
Table B-1 of this appendix.
(3) Actual slope. (i) The actual slope shall not be steeper than the maximum allowable slope.
(ii) The actual slope shall be less steep than the maximum allowable slope, when there are signs of distress. If that
situation occurs, the slope shall be cut back to an actual slope which is at least ½ horizontal to one vertical
(½H:1V) less steep than the maximum allowable slope.
(iii) When surcharge loads from stored material or equipment, operating equipment, or traffic are present, a
competent person shall determine the degree to which the actual slope must be reduced below the maximum
allowable slope, and shall assure that such reduction is achieved. Surcharge loads from adjacent structures shall
be evaluated in accordance with § 1926.651(i).
(4) Configurations. Configurations of sloping and benching systems shall be in accordance with Figure B-1.
TABLE B-1
MAXIMUM ALLOWABLE SLOPES
SOIL OR ROCK TYPE MAXIMUM ALLOWABLE SLOPES (H:V)(1) FOR
EXCAVATIONS LESS THAN 20 FEET DEEP(3)
STABLE ROCK
TYPE A (2)
TYPE B
TYPE C
VERTICAL (90º)
3/4:1 (53º)
1:1 (45º)
1 ½:1 (34º)
Footnote(1) Numbers shown in parentheses next to maximum allowable slopes are angles expressed in degrees
from the horizontal. Angles have been rounded off.
Footnote(2) A short-term maximum allowable slope of 1/2H:1V (63º) is allowed in excavations in Type A soil that
are 12 feet (3.67 m) or less in depth. Short-term maximum allowable slopes for excavations greater than 12 feet
(3.67 m) in depth shall be 3/4H:1V (53º).
Footnote(3) Sloping or benching for excavations greater than 20 feet deep shall be designed by a registered
professional engineer.
Figure B-1
Slope Configurations
(All slopes stated below are in the horizontal to vertical ratio)
B-1.1 Excavations made in Type A soil.
1. All simple slope excavation 20 feet or less in depth shall have a maximum allowable slope of ¾:1.
SIMPLE SLOPE -- GENERAL
Exception: Simple slope excavations which are open 24 hours or less (short term) and which are 12 feet or less in
depth shall have a maximum allowable slope of ½:1.
SIMPLE SLOPE -- SHORT TERM
2. All benched excavations 20 feet or less in depth shall have a maximum allowable slope of 3/4 to 1 and
maximum bench dimensions as follows:
SIMPLE BENCH
MULTIPLE BENCH
3. All excavations 8 feet or less in depth which have unsupported vertically sided lower portions shall have a
maximum vertical side of 3½ feet.
UNSUPPORTED VERTICALLY SIDED LOWER PORTION -- MAXIMUM 8 FEET IN DEPTH)
All excavations more than 8 feet but not more than 12 feet in depth with unsupported vertically sided lower
portions shall have a maximum allowable slope of 1:1 and a maximum vertical side of 3½ feet.
UNSUPPORTED VERTICALLY SIDED LOWER PORTION -- MAXIMUM 12 FEET IN DEPTH)
All excavations 20 feet or less in depth which have vertically sided lower portions that are supported or shielded
shall have a maximum allowable slope of ¾:1. The support or shield system must extend at least 18 inches above
the top of the vertical side.
SUPPORTED OR SHIELDED VERTICALLY SIDED LOWER PORTION
4. All other simple slope, compound slope, and vertically sided lower portion excavations shall be in accordance
with the other options permitted under § 1926.652(b).
B-1.2 Excavations Made in Type B Soil
1. All simple slope excavations 20 feet or less in depth shall have a maximum allowable slope of 1:1.
SIMPLE SLOPE
2. All benched excavations 20 feet or less in depth shall have a maximum allowable slope of 1:1 and maximum
bench dimensions as follows:
SINGLE BENCH
MULTIPLE BENCH
3. All excavations 20 feet or less in depth which have vertically sided lower portions shall be shielded or supported
to a height at least 18 inches above the top of the vertical side. All such excavations shall have a maximum
allowable slope of 1:1.
VERTICALLY SIDED LOWER PORTION
4. All other sloped excavations shall be in accordance with the other options permitted in § 1926.652(b).
B-1.3 Excavations Made in Type C Soil
1. All simple slope excavations 20 feet or less in depth shall have a maximum allowable slope of 1½:1.
SIMPLE SLOPE
2. All excavations 20 feet or less in depth which have vertically sided lower portions shall be shielded or supported
to a height at least 18 inches above the top of the vertical side. All such excavations shall have a maximum
allowable slope of 1½:1.
VERTICAL SIDED LOWER PORTION
3. All other sloped excavations shall be in accordance with the other options permitted in § 1926.652(b).
B-1.4 Excavations Made in Layered Soils
1. All excavations 20 feet or less in depth made in layered soils shall have a maximum allowable slope for each
layer as set forth below.
B OVER A
C OVER A
C OVER B
A OVER B
A OVER C
B OVER C
2. All other sloped excavations shall be in accordance with the other options permitted in § 1926.652(b).
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By Standard Number / 1926 Subpart P App C - Timber Shoring for Trenches
Part Number:1926
Part Number Title:Safety and Health Regulations for Construction
Subpart:1926 Subpart P
Subpart Title:Excavations
Standard Number:1926 Subpart P App C
Title:Timber Shoring for Trenches
GPO Source:e-CFR
(a) Scope. This appendix contains information that can be used when timber shoring is provided as a method of
protection from cave-ins in trenches that do not exceed 20 feet (6.1 m) in depth. This appendix must be used when
design of timber shoring protective systems is to be performed in accordance with 1926.652(c)(1). Other timber
shoring configurations; other systems of support such as hydraulic and pneumatic systems; and other protective
systems such as sloping, benching, shielding, and freezing systems must be designed in accordance with the
requirements set forth in 1926.652(b) and 1926.652(c).
(b) Soil Classification. In order to use the data presented in this appendix, the soil type or types in which the
excavation is made must first be determined using the soil classification method set forth in appendix A of subpart
P of this part.
(c) Presentation of Information. Information is presented in several forms as follows:
(1) Information is presented in tabular form in Tables C-1.1, C-1.2 and C-1.3, and Tables C-2.1, C-2.2 and C-2.3
following paragraph (g) of the appendix. Each table presents the minimum sizes of timber members to use in a
shoring system, and each table contains data only for the particular soil type in which the excavation or portion of
the excavation is made. The data are arranged to allow the user the flexibility to select from among several
acceptable configurations of members based on varying the horizontal spacing of the crossbraces. Stable rock is
exempt from shoring requirements and therefore, no data are presented for this condition.
(2) Information concerning the basis of the tabular data and the limitations of the data is presented in paragraph
(d) of this appendix, and on the tables themselves.
(3) Information explaining the use of the tabular data is presented in paragraph (e) of this appendix.
(4) Information illustrating the use of the tabular data is presented in paragraph (f) of this appendix.
(5) Miscellaneous notations regarding Tables C-1.1 through C-1.3 and Tables C-2.1 through C-2.3 are presented in
paragraph (g) of this Appendix.
(d) Basis and limitations of the data. - (1) Dimensions of timber members. (i) The sizes of the timber members
listed in Tables C-1.1 through C-1.3 are taken from the National Bureau of Standards (NBS) report,
"Recommended Technical Provisions for Construction Practice in Shoring and Sloping of Trenches and
Excavations." In addition, where NBS did not recommend specific sizes of members, member sizes are based on
an analysis of the sizes required for use by existing codes and on empirical practice.
(ii) The required dimensions of the members listed in Tables C-1.1 through C-1.3 refer to actual dimensions and
not nominal dimensions of the timber. Employers wanting to use nominal size shoring are directed to Tables C-2.1
through C-2.3, or have this choice under 1926.652(c)(3), and are referred to The Corps of engineers, The Bureau
of Reclamation or data from other acceptable sources.
(2) Limitation of application. (i) It is not intended that the timber shoring specification apply to every situation that
may be experienced in the field. These data were developed to apply to the situations that are most commonly
experienced in current trenching practice. Shoring systems for use in situations that are not covered by the data in
this appendix must be designed as specified in 1926.652(c).
(ii) When any of the following conditions are present, the members specified in the tables are not considered
adequate. Either an alternate timber shoring system must be designed or another type of protective system
designed in accordance with 1926.652.
(A) When loads imposed by structures or by stored material adjacent to the trench weigh in excess of the load
imposed by a two-foot soil surcharge. The term "adjacent" as used here means the area within a horizontal
distance from the edge of the trench equal to the depth of the trench.
(B) When vertical loads imposed on cross braces exceed a 240-pound gravity load distributed on a one-foot
section of the center of the crossbrace.
(C) When surcharge loads are present from equipment weighing in excess of 20,000 pounds.
(D) When only the lower portion of a trench is shored and the remaining portion of the trench is sloped or benched
unless: The sloped portion is sloped at an angle less steep than three horizontal to one vertical; or the members
are selected from the tables for use at a depth which is determined from the top of the overall trench, and not from
the toe of the sloped portion.
(e) Use of Tables. The members of the shoring system that are to be selected using this information are the cross
braces, the uprights, and the wales, where wales are required. Minimum sizes of members are specified for use in
different types of soil. There are six tables of information, two for each soil type. The soil type must first be
determined in accordance with the soil classification system described in appendix A to subpart P of part 1926.
Using the appropriate table, the selection of the size and spacing of the members is then made. The selection is
based on the depth and width of the trench where the members are to be installed and, in most instances, the
selection is also based on the horizontal spacing of the crossbraces. Instances where a choice of horizontal
spacing of crossbracing is available, the horizontal spacing of the crossbraces must be chosen by the user before
the size of any member can be determined. When the soil type, the width and depth of the trench, and the
horizontal spacing of the crossbraces are known, the size and vertical spacing of the crossbraces are known, the
size and vertical spacing of the crossbraces, the size and vertical spacing of the wales, and the size and horizontal
spacing of the uprights can be read from the appropriate table.
(f) Examples to Illustrate the Use of Tables C-1.1 through C-1.3.
(1) Example 1.
A trench dug in Type A soil is 13 feet deep and five feet wide.
From Table C-1.1, for acceptable arrangements of timber can be used.
Arrangement #1
Space 4X4 crossbraces at six feet horizontally and four feet vertically.
Wales are not required.
Space 3X8 uprights at six feet horizontally. This arrangement is
commonly called "skip shoring."
Arrangement #2
Space 4X6 crossbraces at eight feet horizontally and four feet
vertically.
Space 8X8 wales at four feet vertically.
Space 2X6 uprights at four feet horizontally.
Arrangement #3
Space 6X6 crossbraces at 10 feet horizontally and four feet vertically.
Space 8X10 wales at four feet vertically.
Space 2X6 uprights at five feet horizontally.
Arrangement #4
Space 6X6 crossbraces at 12 feet horizontally and four feet vertically.
Space 10X10 wales at four feet vertically.
Space 3X8 uprights at six feet horizontally.
(2) Example 2.
A trench dug in Type B soil is 13 feet deep and five feet wide. From
Table C-1.2 three acceptable arrangements of members are listed.
Arrangement #1
Space 6X6 crossbraces at six feet horizontally and five feet vertically.
Space 8X8 wales at five feet vertically.
Space 2X6 uprights at two feet horizontally.
Arrangement #2
Space 6X8 crossbraces at eight feet horizontally and five feet
vertically.
Space 10X10 wales at five feet vertically.
Space 2X6 uprights at two feet horizontally.
Arrangement #3
Space 8X8 crossbraces at 10 feet horizontally and five feet vertically.
Space 10X12 wales at five feet vertically.
Space 2X6 uprights at two feet vertically.
(3) Example 3.
A trench dug in Type C soil is 13 feet deep and five feet wide.
From Table C-1.3 two acceptable arrangements of members can be used.
Arrangement #1
Space 8X8 crossbraces at six feet horizontally and five feet vertically.
Space 10X12 wales at five feet vertically.
Position 2X6 uprights as closely together as possible.
If water must be retained use special tongue and groove uprights to form
tight sheeting.
Arrangement #2
Space 8X10 crossbraces at eight feet horizontally and five feet
vertically.
Space 12X12 wales at five feet vertically.
Position 2X6 uprights in a close sheeting configuration unless water
pressure must be resisted. Tight sheeting must be used where water must be
retained.
(4) Example 4.
A trench dug in Type C soil is 20 feet deep and 11 feet wide. The size and spacing of members for the section of
trench that is over 15 feet in depth is determined using Table C-1.3. Only one arrangement of members is
provided.
Space 8X10 crossbraces at six feet horizontally and five feet vertically.
Space 12X12 wales at five feet vertically.
Use 3X6 tight sheeting.
Use of Tables C-2.1 through C-2.3 would follow the same procedures.
(g) Notes for all Tables.
1. Member sizes at spacings other than indicated are to be determined as specified in 1926.652(c), "Design of
Protective Systems."
2. When conditions are saturated or submerged use Tight Sheeting. Tight Sheeting refers to the use of specially-
edged timber planks (e.g., tongue and groove) at least three inches thick, steel sheet piling, or similar construction
that when driven or placed in position provide a tight wall to resist the lateral pressure of water and to prevent the
loss of backfill material. Close Sheeting refers to the placement of planks side-by-side allowing as little space as
possible between them.
3. All spacing indicated is measured center to center.
4. Wales to be installed with greater dimension horizontal.
5. If the vertical distance from the center of the lowest crossbrace to the bottom of the trench exceeds two and
one-half feet, uprights shall be firmly embedded or a mudsill shall be used. Where uprights are embedded, the
vertical distance from the center of the lowest crossbrace to the bottom of the trench shall not exceed 36 inches.
When mudsills are used, the vertical distance shall not exceed 42 inches. Mudsills are wales that are installed at
the tow of the trench side.
6. Trench jacks may be used in lieu of or in combination with timber crossbraces.
7. Placement of crossbraces. When the vertical spacing of crossbraces is four feet, place the top crossbrace no
more than two feet below the top of the trench. When the vertical spacing of crossbraces is five feet, place the top
crossbrace no more than 2.5 feet below the top of the trench.
TABLE C-1.1
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE A P(a) = 25 X H + 72 psf (2 ft Surcharge)
____________________________________________________________________
|
| SIZE (ACTUAL) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH |
| CROSS BRACES
OF |_____________________________________________________________
| | |
| HORIZ.| WIDTH OF TRENCH (FEET) | VERT.
TRENCH|SPACING|_______________________________________| SPACING
| | | | | | |
| | UP TO | UP TO | UP TO | UP TO | UP TO |
(FEET)| (FEET)| 4 | 6 | 9 | 12 | 15 | (FEET)
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 4X4 | 4X4 | 4X6 | 6X6 | 6X6 | 4
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | UP TO | | | | | |
| 8 | 4X4 | 4X4 | 4X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 10 | 4X6 | 4X6 | 4X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 12 | 4X6 | 4X6 | 6X6 | 6X6 | 6X6 | 4
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 4X4 | 4X4 | 4X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 8 | 4X6 | 4X6 | 6X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| UP TO | | | | | |
| 10 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 4
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| UP TO | | | | | |
| 12 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 4
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 4
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| UP TO | | | | | |
| 8 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 4
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| UP TO | | | | | |
| 10 | 8X8 | 8X8 | 8X8 | 8X8 | 8X10 | 4
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| UP TO | | | | | |
| 12 | 8X8 | 8X8 | 8X8 | 8X8 | 8X10 | 4
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
TABLE C-1.1
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE A P(a) = 25 X H + 72 psf (2 ft Surcharge)
[Continued]
____________________________________________________________________
|
| SIZE (ACTUAL) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH | |
| WALES | UPRIGHTS
OF |_______________|_____________________________________________
| | |
TRENCH| | VERT. | MAXIMUM ALLOWABLE HORIZONTAL SPACING
| |SPACING| (FEET)
| SIZE | |_____________________________________________
| | | | | | |
(FEET)| (IN) |(FEET) | CLOSE | 4 | 5 | 6 | 8
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| Not | | | | | |
| Req'd | --- | | | | 2X6 |
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | Not | | | | | |
| Req'd | --- | | | | | 2X8
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 8X8 | 4 | | | 2X6 | |
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 8X8 | 4 | | | | 2X6 |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| Not | | | | | |
| Req'd | --- | | | | 3X8 |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 8X8 | 4 | | 2X6 | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| 8X10 | 4 | | | 2X6 | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| 10X10 | 4 | | | | 3X8 |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 6X8 | 4 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| 8X8 | 4 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| 8X10 | 4 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| | | | | | |
| 10X10 | 4 | 3X6 | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
* Mixed oak or equivalent with a bending strength not less than 850
psi.
** Manufactured members of equivalent strength may be substituted for
wood.
TABLE C-1.2
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE B P(a) = 45 X H + 72 psf (2 ft Surcharge)
____________________________________________________________________
|
| SIZE (ACTUAL) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH |
| CROSS BRACES
OF |_____________________________________________________________
| | |
| HORIZ.| WIDTH OF TRENCH (FEET) | VERT.
TRENCH|SPACING|_______________________________________| SPACING
| | | | | | |
| | UP TO | UP TO | UP TO | UP TO | UP TO |
(FEET)| (FEET)| 4 | 6 | 9 | 12 | 15 | (FEET)
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 4X6 | 4X6 | 6X6 | 6X6 | 6X6 | 5
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | UP TO | | | | | |
| 8 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 10 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 8 | 6X8 | 6X8 | 6X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| UP TO | | | | | |
| 10 | 8X8 | 8X8 | 8X8 | 8X8 | 8X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X8 | 6X8 | 6X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| UP TO | | | | | |
| 8 | 8X8 | 8X8 | 8X8 | 8X8 | 8X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| UP TO | | | | | |
| 10 | 8X10 | 8X10 | 8X10 | 8X10 | 10X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
TABLE C-1.2
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE B P(a) = 45 X H + 72 psf (2 ft Surcharge)
[Continued]
____________________________________________________________________
|
| SIZE (ACTUAL) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH | |
| WALES | UPRIGHTS
OF |_______________|_____________________________________________
| | |
TRENCH| | VERT. | MAXIMUM ALLOWABLE HORIZONTAL SPACING
| |SPACING| (FEET)
| SIZE | |_____________________________________________
| | | | | | |
(FEET)| (IN) |(FEET) | CLOSE | 2 | 3 | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 6X8 | 5 | | | 2X6 | |
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | | | | | | |
| 8X10 | 5 | | | 2X6 | |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 10X10 | 5 | | | 2X6 | |
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 8X8 | 5 | | 2X6 | | |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 10X10 | 5 | | 2X6 | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| 10X12 | 5 | | 2X6 | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 8X10 | 5 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| 10X12 | 5 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| 12X12 | 5 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
* Mixed oak or equivalent with a bending strength not less than 850
psi.
** Manufactured members of equivalent strength may be substituted for
wood.
TABLE C-1.3
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE C P(a) = 80 X H + 72 psf (2 ft Surcharge)
____________________________________________________________________
|
| SIZE (ACTUAL) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH |
| CROSS BRACES
OF |_____________________________________________________________
| | |
| HORIZ.| WIDTH OF TRENCH (FEET) | VERT.
TRENCH|SPACING|_______________________________________| SPACING
| | | | | | |
| | UP TO | UP TO | UP TO | UP TO | UP TO |
(FEET)| (FEET)| 4 | 6 | 9 | 12 | 15 | (FEET)
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X8 | 6X8 | 6X8 | 8X8 | 8X8 | 5
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | UP TO | | | | | |
| 8 | 8X8 | 8X8 | 8X8 | 8X8 | 8X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 10 | 8X10 | 8X10 | 8X10 | 8X10 | 10X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 8X8 | 8X8 | 8X8 | 8X8 | 8X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 8 | 8X10 | 8X10 | 8X10 | 8X10 | 10X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| See | | | | | |
| Note 1| | | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 8X10 | 8X10 | 8X10 | 8X10 | 10X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| See | | | | | |
| Note 1| | | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| See | | | | | |
| Note 1| | | | | |
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
TABLE C-1.3
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE C P(a) = 80 X H + 72 psf (2 ft Surcharge)
[Continued]
____________________________________________________________________
|
| SIZE (ACTUAL) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH | |
| WALES | UPRIGHTS
OF |_______________|_____________________________________________
| | |
TRENCH| | VERT. | MAXIMUM ALLOWABLE HORIZONTAL SPACING
| |SPACING| (FEET)
| SIZE | |_____________________________________________
| | | | | | |
(FEET)| (IN) |(FEET) | CLOSE | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 8X10 | 5 | 2X6 | | | |
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | | | | | | |
| 10X12 | 5 | 2X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 12X12 | 5 | 2X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 10X12 | 5 | 2X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 12X12 | 5 | 2X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| | | | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 12X12 | 5 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| | | | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| | | | | | |
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
* Mixed oak or equivalent with a bending strength not less than 850
psi.
** Manufactured members of equivalent strength may be substituted for
wood.
TABLE C-2.1
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE A P(a) = 25 X H + 72 psf (2 ft Surcharge)
____________________________________________________________________
|
| SIZE (S4S) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH |
| CROSS BRACES
OF |_____________________________________________________________
| | |
| HORIZ.| WIDTH OF TRENCH (FEET) | VERT.
TRENCH|SPACING|_______________________________________| SPACING
| | | | | | |
| | UP TO | UP TO | UP TO | UP TO | UP TO |
(FEET)| (FEET)| 4 | 6 | 9 | 12 | 15 | (FEET)
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 4X4 | 4X4 | 4X4 | 4X4 | 4X6 | 4
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | UP TO | | | | | |
| 8 | 4X4 | 4X4 | 4X4 | 4X6 | 4X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 10 | 4X6 | 4X6 | 4X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 12 | 4X6 | 4X6 | 4X6 | 6X6 | 6X6 | 4
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 4X4 | 4X4 | 4X4 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 8 | 4X6 | 4X6 | 4X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| UP TO | | | | | |
| 10 | 6X6 | 6X6 | 6X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| UP TO | | | | | |
| 12 | 6X6 | 6X6 | 6X6 | 6X6 | 6X6 | 4
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X6 | 6X6 | 6X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| UP TO | | | | | |
| 8 | 6X6 | 6X6 | 6X6 | 6X6 | 6X6 | 4
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| UP TO | | | | | |
| 10 | 6X6 | 6X6 | 6X6 | 6X6 | 6X8 | 4
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| UP TO | | | | | |
| 12 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 4
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
TABLE C-2.1
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE A P(a) = 25 X H + 72 psf (2 ft Surcharge)
[Continued]
____________________________________________________________________
|
| SIZE (S4S) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH | |
| WALES | UPRIGHTS
OF |_______________|_____________________________________________
| | |
TRENCH| | VERT. | MAXIMUM ALLOWABLE HORIZONTAL SPACING
| |SPACING| (FEET)
| SIZE | |_____________________________________________
| | | | | | |
(FEET)| (IN) |(FEET) | CLOSE | 4 | 5 | 6 | 8
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| Not | Not | | | | |
| Req'd | Req'd | | | | 4X6 |
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | Not | Not | | | | |
| Req'd | Req'd | | | | | 4X8
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 8X8 | 4 | | | 4X6 | |
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 8X8 | 4 | | | | 4X6 |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| Not | Not | | | | |
| Req'd | Req'd | | | | 4X10 |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 6X8 | 4 | | 4X6 | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| 8X8 | 4 | | | 4X8 | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| 8X10 | 4 | | 4X6 | | 4X10 |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 6X8 | 4 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| 8X8 | 4 | 3X6 | 4x12 | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| 8X10 | 4 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| | | | | | |
| 8X12 | 4 | 3X6 | 4x12 | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
* Douglas fir or equivalent with a bending strength not less than
1500 psi.
** Manufactured members of equivalent strength may be substituted for
wood.
TABLE C-2.2
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE B P(a) = 45 X H + 72 psf (2 ft Surcharge)
____________________________________________________________________
|
| SIZE (S4S) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH |
| CROSS BRACES
OF |_____________________________________________________________
| | |
| HORIZ.| WIDTH OF TRENCH (FEET) | VERT.
TRENCH|SPACING|_______________________________________| SPACING
| | | | | | |
| | UP TO | UP TO | UP TO | UP TO | UP TO |
(FEET)| (FEET)| 4 | 6 | 9 | 12 | 15 | (FEET)
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 4X6 | 4X6 | 4X6 | 6X6 | 6X6 | 5
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | UP TO | | | | | |
| 8 | 4X6 | 4X6 | 6X6 | 6X6 | 6X6 | 5
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 10 | 4X6 | 4X6 | 6X6 | 6X6 | 6X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X6 | 6X6 | 6X6 | 6X8 | 6X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 8 | 6X8 | 6X8 | 6X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| UP TO | | | | | |
| 10 | 6X8 | 6X8 | 8X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X8 | 6X8 | 6X8 | 6X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| UP TO | | | | | |
| 8 | 6X8 | 6X8 | 6X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| UP TO | | | | | |
| 10 | 8X8 | 8X8 | 8X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
TABLE C-2.2
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE B P(a) = 45 X H + 72 psf (2 ft Surcharge)
[Continued]
____________________________________________________________________
|
| SIZE (S4S) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH | |
| WALES | UPRIGHTS
OF |_______________|_____________________________________________
| | |
TRENCH| | VERT. | MAXIMUM ALLOWABLE HORIZONTAL SPACING
| |SPACING| (FEET)
| SIZE | |_____________________________________________
| | | | | | |
(FEET)| (IN) |(FEET) | CLOSE | 2 | 3 | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | 3X12 | |
| 6X8 | 5 | | | 4X8 | | 4X12
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | | | | | | |
| 8X8 | 5 | | 3X8 | | 4X8 |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 8X10 | 5 | | | 4X8 | |
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 8X8 | 5 | 3X6 | 4X10 | | |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 10X10 | 5 | 3X6 | 4X10 | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| 10X12 | 5 | 3X6 | 4X10 | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 8X10 | 5 | 4X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| 10X12 | 5 | 4X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| 12X12 | 5 | 4X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
* Douglas fir or equivalent with a bending strength not less than
1500 psi.
** Manufactured members of equivalent strength may be substituted for
wood.
TABLE C-2.3
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE C P(a) = 80 X H + 72 psf (2 ft Surcharge)
____________________________________________________________________
|
| SIZE (S4S) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH |
| CROSS BRACES
OF |_____________________________________________________________
| | |
| HORIZ.| WIDTH OF TRENCH (FEET) | VERT.
TRENCH|SPACING|_______________________________________| SPACING
| | | | | | |
| | UP TO | UP TO | UP TO | UP TO | UP TO |
(FEET)| (FEET)| 4 | 6 | 9 | 12 | 15 | (FEET)
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X6 | 6X6 | 6X6 | 6X6 | 8X8 | 5
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | UP TO | | | | | |
| 8 | 6X6 | 6X6 | 6X6 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 10 | 6X6 | 6X6 | 8X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 6X8 | 6X8 | 6X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| UP TO | | | | | |
| 8 | 8X8 | 8X8 | 8X8 | 8X8 | 8X8 | 5
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| See | | | | | |
| Note 1| | | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| UP TO | | | | | |
| 6 | 8X8 | 8X8 | 8X8 | 8X10 | 8X10 | 5
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| See | | | | | |
| Note 1| | | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| See | | | | | |
| Note 1| | | | | |
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| See | | | | | |
| Note 1| | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
TABLE C-2.3
TIMBER TRENCH SHORING -- MINIMUM TIMBER REQUIREMENTS *
SOIL TYPE C P(a) = 80 X H + 72 psf (2 ft Surcharge)
[Continued]
____________________________________________________________________
|
| SIZE (S4S) AND SPACING OF MEMBERS **
|_____________________________________________________________
DEPTH | |
| WALES | UPRIGHTS
OF |_______________|_____________________________________________
| | |
TRENCH| | VERT. | MAXIMUM ALLOWABLE HORIZONTAL SPACING
| |SPACING| (FEET)
| SIZE | |_____________________________________________
| | | | | | |
(FEET)| (IN) |(FEET) | CLOSE | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 8X8 | 5 | 3X6 | | | |
5 |_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
TO | | | | | | |
| 10X10 | 5 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 10X12 | 5 | 3X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 10X10 | 5 | 4X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
10 | | | | | | |
| | | | | | |
| 12X12 | 5 | 4X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| | | | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
| | | | | | |
| | | | | | |
| 10X12 | 5 | 4X6 | | | |
|_______|_______|_______|_______|_______|_______|_____________
15 | | | | | | |
| | | | | | |
| | | | | | |
|_______|_______|_______|_______|_______|_______|_____________
TO | | | | | | |
| | | | | | |
| | | | | | |
|_______|_______|_______|_______|_______|_______|_____________
20 | | | | | | |
| | | | | | |
| | | | | | |
______|_______|_______|_______|_______|_______|_______|_____________
|
OVER | SEE NOTE 1
20 |
______|_____________________________________________________________
* Douglas fir or equivalent with a bending strength not less than
1500 psi.
** Manufactured members of equivalent strength may be substituted for
wood.
UNITED STATES
DEPARTMENT OF LABOR
Occupational Safety & Health Administration
200 Constitution Ave NW
Washington, DC 20210
800-321-6742 (OSHA)
TTY
www.OSHA.gov
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OCCUPATIONAL NOISE EXPOSURE
OCCUPATIONAL NOISE EXPOSURE 02.07.2023
Page 1 of 3
1.00 POLICY
The Occupational Noise Exposure policy has been developed to establish a program and
procedures for hearing conservation. This policy applies to Public Works employees during
operations that produce employee noise exposures in excess of 85 dBA Time-Weighted Average
over 8 hours and meets the requirements of OSHA Standard 29 CFR § 1910.95 (k) and (l).
1.05 DEFINITIONS
A Scale: The setting on a sound level meter that most closely resembles the way the human ear
hears.
Audiogram: A test of an individual's hearing threshold level as a function of frequency.
Baseline Audiogram: The audiogram against which future audiograms are compared.
dBA: The decibel level using the A Scale.
Decibel (Db): The unit of measurement of sound level.
Hertz (Hz): The unit of measurement of frequency; numerically equal to cycles of a sound wave
per second.
Time-Weighted Average (TWA) Sound Level: A weighted average sound level over a given
amount of time, usually 8 hours.
1.10 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary equipment that meets current standards.
Safety Director:
1. Issuing and administering this program and making sure that the program satisfies
the requirements of all applicable federal, state and local hearing conservation
requirements.
2. Administering the audiometric testing program.
3. Providing, upon request, to affected employees, previous employees, or their
representatives, copies of the standard and this policy, and records of audiometric
examinations.
4. Ensure OSHA standard is posted in the workplace of affected employees.
5. Enforcing administrative and engineering controls within the department to limit
employee noise exposure.
6. Administer initial and annual employee training.
7. Administer Noise surveys.
8. Ensure “Caution – Hearing Protection Required” signage is posted in appropriate areas.
Supervisor:
1. Enforcing the wearing of hearing protectors by employees required to wear them.
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Employee:
1. Wearing hearing protection when in areas labeled “Caution – Hearing Protection
Required”, and as directed.
2. Participate in initial and annual training.
1.15 NOISE EXPOSURE MONITORING
At the discretion of the Safety Director, noise surveys to identify excessive noise areas will be
conducted periodically and whenever a process change occurs that may result in a possible noise-
level change. If the noise survey indicates that any exposure may equal or exceed an eight (8)
hour TWA of 85 decibels, the Noise Monitoring Program will be implemented. Regardless of
decibel levels, written results of exposure tests and audiograms are provided to all tested
employees.
1.20 NOISE MONITORING PROGRAM
1. An employee from each such area of suspected hazard noise level will wear a dosimeter
for eight (8) hours or a dosimeter eight (8) hours TWA shall be taken in said area.
2. Dosimeter findings shall be read and TWA determined.
3. Employees shall be notified of monitored TWA in their area.
4. All employees with an eight (8) hour TWA of 85 decibels or above shall have audiometric
testing by a certified technician who is responsible to a physician. This baseline shall be
established within six (6) months of an employee’s first exposure to noise over 85
decibels.
5. All audiograms will be taken after fourteen (14) hours free from workplace noise. This
requirement shall be communicated to the employee before the test is scheduled. This
fourteen (14) hour requirement can be satisfied with hearing protection worn during work
hours.
6. All instruments used to determine an eight (8) hour TWA will be calibrated.
7. A new audiogram will be taken of all employees annually and compared to their baseline
audiogram.
8. Employees shall be informed of necessity of an ontological examination and referred for
an evaluation of the employer suspect’s pathology of the ear or believes that additional
testing is necessary.
9. If an employee has experienced a threshold shift of ten (10) decibels, personal protection
equipment must attenuate said employee to an eight (8) hour TWA of 85 decibels.
10. All tests and records will be kept for two (2) years, plus the time of employment for each
employee.
1.25 HEARING PROTECTION PROGRAM
1. Hearing protection is required in all areas where noise exposures are equal to or greater
than 85 dBA for 8 hours, if necessary.
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2. Employees who are exposed to noise levels at or above 85 dBA for 8 hours will be
included in a hearing conservation program.
3. The hearing conservation program will include baseline and annual audiograms.
Employees will be provided with hearing protection in various types and styles, and
they will be trained annually on the effects of noise and how to protect themselves.
1.30 SOUND LEVEL SURVEYS
1. Employees will receive audiometric testing when the sound level in an area equals or
exceed an 8-hour Time-Weighted Average of 85 dB
2. When changes in the work environment have occurred, a sound level survey will be
conducted.
3. Sound level equipment will be used and calibrated according to manufacturers'
specifications.
1.35 TRAINING
1. Employees will be trained on the effects of noise on hearing.
2. Employees will be trained on the purpose of hearing protection, including the
advantages and disadvantages of various hearing protection and instructions on the
selection, fitting, use and care of hearing protection.
3. Employees will be trained on the purpose of audiometric testing and how tests will be
administered.
1.40 AUDIOMETRIC TESTING
1. Employees who are to receive an audiogram during the workday must wear hearing
protection prior to their test.
2. Employees will be encouraged to refrain from any noisy non-work-related activities
during the 14 hours prior to the test.
3. Each employee's audiogram will be examined to determine a standard threshold shift
relative to the baseline has occurred.
4. If a shift in the employee's hearing has occurred, the employee will be required to wear
hearing protection while working in high-noise areas and will be fitted and trained in
their use and care.
5. Employees already wearing hearing protection will be retrained and/or refitted in their
use and provided with hearing protection offering greater protection if necessary.
6. The employee will be informed if future audiometric tests indicate that a standard shift
threshold has occurred.
7. Employee's standard threshold shift is not permanent.
8. The employee may discontinue the mandatory wearing of hearing protection if an
audiometric test indicates threshold shift was temporary.
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1.00 POLICY
The Fall Protection policy has been developed to eliminate, prevent, and control fall hazards.
This policy applies to Public Works employees and meets the requirements of OSHA Standard
29 CFR § 1926, Subpart M.
1.05 DEFINITIONS
Anchorage: a secure point of attachment for equipment such as lifelines, lanyards, deceleration
devices, and rope descent systems.
Competent person: a person who is capable of identifying existing and predictable hazards in
the surroundings or working conditions which are unsanitary, hazardous, or dangerous to
employees, and who has authorization to take prompt corrective measures to eliminate them.
Designated area: a distinct portion of a walking-working surface delineated by a warning line in
which employees may perform work without additional fall protection.
Fall protection: any equipment, device, or system that prevents an employee from falling from
an elevation or mitigates the effect of such a fall.
Fixed ladder: a ladder with rails or individual rungs that is permanently attached to a structure,
building, or equipment.
Guardrail system: a barrier erected along an unprotected edge or exposed side, edge, or other
area of a walking-working surface to prevent employees from falling to a lower level.
Hole: a gap or open space in a floor, roof, horizontal walking-working surface, or similar surface
that is at least 2 inches in its least dimension.
Ladder safety system: a system designed to eliminate or reduce the possibility of falling from a
ladder. Ladder safety systems usually consist of a carrier, safety sleeve, lanyard, connectors, and
body harness. Cages and wells are not ladder safety systems.
Mobile Elevating Work Platform (MEWP): Machine/device intended for moving persons,
tools and material to working positions, consisting of at least a work platform with controls, an
extending structure and a chassis.
Opening: a gap or open space in a wall, partition, vertical walking-working surface, or similar
surface that is at least 30 inches high and at least 18 inches wide, through which an employee can
fall to a lower level.
Personal fall arrest system: a system used to arrest an employee in a fall from a walking-
working surface. It consists of a body harness, anchorage, and connector. The means of
connection include a lanyard, deceleration device, lifeline, or a suitable combination of these.
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Platform: a walking-working surface that is elevated above the surrounding area.
Positioning system: a system of equipment and connectors that, when used with a body harness
or body belt, allows an employee to be supported on an elevated vertical surface, such as a wall
or windowsill, and work with both hands free. Positioning systems are also called “positioning
system devices” and “work-positioning equipment.”
Qualified Person: a person who, by possession of a recognized degree, certificate, or
professional standing, or who by extensive knowledge, training, and experience, has successfully
demonstrated the ability to solve or resolve problems relating to the subject matter, the work, or
the project.
Scaffold: any temporary elevated or suspended platform and its supporting structure, including
anchorage points, used to support employees, equipment, materials, and other items.
Toeboard: a low protective barrier that is designed to prevent materials, tools, and equipment
from falling to a lower level, and protect employees from falling.
Travel restraint system: a combination of an anchorage, anchorage connector, lanyard (or other
means of connection), and body support that Medina Public Works uses to eliminate the
possibility of an employee going over the edge of a walking-working surface.
Unprotected sides and edges: any side or edge of a walking-working surface (except at
entrances and other points of access) where there is no wall, guardrail system, or stair rail system
to protect an employee from falling to a lower level.
Walking-working surface: any horizontal or vertical surface on or through which an employee
walks works, or gains access to a work area or workplace location.
Warning line: a barrier erected to warn employees that they are approaching an unprotected side
or edge, and which designates an area in which work may take place without the use of other
means of fall protection.
1.10 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Develop and administer the Fall Protection Program.
2. Conduct risk assessments that identify locations and tasks that require fall protection.
3. Maintain an inventory of fixed ladders (see section 1.20) that are more than 24 feet to add
ladder safety devices for OSHA requirements by the year 2036.
4. Ensure appropriate caution signs are posted for areas requiring personal fall protection
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systems.
5. Ensure that appropriate personal fall protection systems and compatible equipment are
available to employees.
6. Ensure contractors have proper training and equipment for fall protection, when needed.
7. Ensure that fall protection devices are inspected as required by a competent or qualified
person.
8. Ensure that MEWP are inspected on an annual basis.
9. Ensure employees are trained on the policy and procedures included in this section.
Supervisor:
1. Ensure that personal fall protection systems are used properly where it is required.
2. Ensure that MEWP are inspected before use.
3. Assure that safe work practices are utilized and prohibit the use of poor of forbidden
practices.
Employee:
1. Follow supervisory direction and abide by the prescribed work practices.
2. Use personal fall protection systems in accordance with instructions and training
received.
3. Care and inspect personal fall protection systems properly and guard against damage and
contamination.
4. Report personal fall protection system malfunctions, failed inspections, or other problems
to supervisor.
5. Participate in safety training.
1.15 PROCEDURE
OSHA compels employers to provide appropriate fall protection to employees who may be
exposed to unprotected sides or edges that are 4 feet or more above a lower level for general
industry work (e.g., maintenance) and 6 feet or more above a lower level for construction
work. Fall protection must be used to protect personnel against hazards capable of causing
injury, impairment, or death.
General
Eliminate or reduce locations where fall protection is required when feasible. This may
include modifying a structure, isolating the employee from the fall hazard, changing a process,
substituting equipment, or using work procedures organized in such a manner that the
employee is not exposed to the fall hazard.
An unprotected side or edge that is 4 feet or more above a lower level shall be protected by a
guardrail system or personal fall protection system, such as personal fall arrest, travel restraint,
or positioning system. Other areas or tasks that require fall protection are listed below:
1) If at any time a portion of a guardrail system, gate, or chains are removed, and an
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employee must lean over the edge of the access opening to facilitate hoisting, the
employee must be protected by a personal fall arrest system.
2) Holes or openings, such as pits or roof hatches, require fall protection including one or
more of the following: covers, guardrail systems, travel restraint systems, or personal fall
arrest systems.
Medina Public Works employees who are not utilizing personal fall protection systems are
prohibited from working within 15 feet of an unprotected edge of a roof, without a proper
guardrail system, unless the only task performed is inspecting, investigating, or assessing
workplace conditions. If further work is deemed necessary as a result of the inspection, then
proper guardrail systems, personal fall protections systems, or designated areas must be in place
before work begins.
Medina Contractors performing work on roofs or other fall protection areas must be trained and
equipped by their employer to conduct the work safely according to OSHA regulations.
Fall Protection Systems
Fall protection systems will be used in the following circumstances:
1) When appropriate guardrail systems are not in place at unprotected sides or edges at a
height of 4 feet or more.
a. When work is performed 15 feet or less from a roof’s edge with no appropriate
guardrail system, then a travel restraint system or personal fall arrest system must
be used unless there is a designated area.
2) When ascending or descending fixed ladders that extend more than 24 feet above a lower
level.
Guardrail Systems
Guardrail systems must meet the following requirements:
1) Top edge height of top rails are 42 inches, plus or minus 3 inches, above the walking-
working surface.
2) Midrails, screens, mesh, intermediate vertical members, or solid panels are installed
between the walking-working surface and the top edge of the guardrail system when
there is not a wall or parapet that is at least 21 inches high.
3) Guardrail systems are capable of withstanding, without failure, a force of at least 200
pounds applied in a downward or outward direction of the top edge.
4) Midrails, screen, mesh, intermediate vertical members, and solid panels are capable of
withstanding, without failure, a force of at least 150 pounds applied in any downward or
outward direction at any point along the intermediate member.
5) Guardrail systems must be smooth-surfaced.
6) Steel banding and plastic banding are not used for top rails or midrails.
7) A removable guardrail section (consisting of a top rail and midrail) can be placed across
access openings between guardrail sections for hoisting operations.
a. Chains or gates can be used instead of a removable guardrail section, only for
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hoisting operations and when it is demonstrated that the chains or gates provide a
level of safety equivalent to guardrails.
8) When guardrail systems are used around holes that serve as points of access, such as
ladderways, there must be a self-closing gate that slides or swings away from the hole,
and is equipped with a top rail and midrail (or equivalent intermediate member); or have
an offset to prevent from walking or falling into the hole. Chains are not acceptable.
Designated Areas
If a guardrail system or personal fall protection system is not available, then a designated
area is possible. If work is both temporary and infrequent, a designated area can be erected at
least 6 feet 5 from the roof edge. If the work is not temporary or infrequent, then a designated
area can be erected at least 15 feet from the roof edge. Designated area means a distinct
portion of walking-working surface is delineated by a warning line consisting of rope, wire,
tape, or chain in which employees may perform work without additional fall protection.
Fixed Ladders
1) All fixed ladders must be equipped with a personal fall arrest system or a ladder safety
system.
Scaffolds or Mobile Elevated Work Platforms
Work can sometimes be conducted from the ground with proper safety equipment, such as a
scaffold or a mobile elevated work platform.
A. Scaffolds:
a. Each employee more than 10 feet above a lower level shall be protected from falls
by guardrails or a fall arrest system, except those on single-point and two-point
adjustable suspension scaffolds which will be protected by both a personal fall
arrest system and a guardrail.
b. Guardrail height of the toprail for scaffolds must be between 38 inches and 45
inches.
i. When the crosspoint of crossbracing is used as a toprail, it must be
between 38 inches and 48 inches above the work platform.
ii. Guardrail height of the midrails must be installed approximately between
the toprail and the platform surface.
iii. When a crosspoint of crossbracing is used as a midrail, it must be between
20 inches and 30 inches above the work platform.
c. Support scaffold footings shall be level and capable of supporting the loaded
scaffold.
d. Supported scaffold platforms shall be fully planked or decked.
e. Supported scaffolds with a height-to-base of more than 4:1 shall be restrained
from tipping by guying, tying, bracing, or the equivalent.
f. Scaffolds and scaffold components must support at least four times the maximum
intended load. Suspension scaffold rigging must support at least six times the
intended load.
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B. Mobile Elevated Work Platforms (MEWP)
a. Only trained and authorized Medina Public Works personnel are allowed to
operate and/or occupy the MEWP.
b. The operator shall read and understand the manufacturer’s operator’s manual or
have it explained to him/her prior to use.
c. Preventive maintenance shall be established in accordance with the
manufacturer’s recommendations.
d. Inspections shall be conducted at least before use or before start of shift, and on
an annual basis.
e. Operators shall comply with the requirements to install and position guardrails,
and that access gates or openings shall be properly closed or in appropriate
positions per the manufacturer’s instructions.
f. When guardrails are not available then employees must use personal fall
protection, either travel restraint or fall arrest, and operators shall comply with the
instructions provided by the manufacturer regarding anchorage(s).
i. A rescue plan is required when using fall arrest systems to determine how
the affected worker will return safely to the platform or ground, as well as
prevention of suspension trauma (e.g., trauma strap).
g. When working in the area of energized conductors, the operator shall stay at least
10 feet away from power lines with any part of their body, conductive object or
any part of the MEWP.
h. An aerial lift requires a body harness and a lanyard attached to the boom or basket
when working. The use of a body belt on an aerial lift is only acceptable with a
tether anchored to the boom or basket (fall restraint system).
i. MEWPs are not specifically designed to transfer personnel from one level to
another or for leaving the work platform. Exiting, or entering, a MEWP at height
shall only be permitted through a procedure provided by the manufacturer and
approval from OESO for appropriate fall protection during the procedure.
C. Specific equipment training is required when a scaffold or MEWP is used.
D. Where used, toeboards shall be:
a. Capable of withstanding a force of at least 50 pounds applied to any downward or
horizontal direction at any point along the toeboard.
b. At least 3 ½ inches high from the top edge of the toeboard to the level of the
walking/working surface.
Personal Fall Protection Systems
A. Personal Fall Arrest System:
a. Attachment of the body harness must be located in the center of the wearer’s
back, near the shoulder level, or above the head.
i. Body belts are not acceptable as part of the personal fall arrest system.
b. Anchorages used for attachment of personal fall arrest equipment must be:
i. independent of any anchorage being used to suspend employees or
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platforms on which employees work, and either
ii. capable of supporting at least 5,000 pounds per employee attached, or
iii. designed and used as part of a complete personal fall arrest system which
maintains a safety factor of at least two.
c. A competent person must inspect systems before each use for wear, damage, and
other deterioration, and remove defective components from service.
d. The use of a personal fall arrest system requires a rescue plan to determine how
the affected worker will return safely to a lower platform or the ground, as well as
prevention of suspension trauma (e.g., trauma strap).
B. Travel Restraint System:
a. A travel restraint system must be limited to a walking-working surface that is flat.
b. Travel restraint lines must be capable of sustaining a tensile load of at least 5,000
pounds.
c. Anchorages selected for restraint systems must have a strength capable of
sustaining static loads applied in the directions permitted by the system:
i. No less than 1,000 pounds for non-certified anchorages; or
ii. At least two times the foreseeable force for certified anchorages; or
iii. As determined for personal fall arrest systems.
d. A competent person must inspect the system before use each day to determine
that the equipment is in safe working condition
C. Positioning systems (Work-Positioning Systems):
a. Anchorages used for attachment of positioning systems must be:
i. Capable of supporting at least twice the potential impact load of an
employee’s fall, or 3,000 pounds of force, whichever is greater.
b. Must be rigged so that an employee can free fall no more than two feet.
c. A competent person must inspect the system before use each day to determine
that the equipment is in safe working condition.
1.20 INVENTORY SUMMARY
FIXED LADDER INVENTORY
LOCATIONS
LADDER SAFETY
DEVICE INSTALLED?
(1) Water Tower Yes
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1.00 POLICY
The Personal Protective Equipment (PPE) policy has been developed to protect employees from
the potential hazards of the workplace through the proper selection, use, and maintenance of
personal protective equipment. This policy applies to Public Works employees and meets the
requirements of OSHA Standard 29 CFR § 1910.132.
1.05 RESPONSIBILITIES
Safety Director:
1. Issue and administer this program and make sure that it satisfies all applicable federal,
state, and local PPE requirements.
2. Conduct a Job Hazard Assessment for all work areas within the facility to identify
hazards to the eyes, head, hands, and feet.
3. Select, provide, and distribute appropriate PPE to all affected employees.
4. Assure the adequacy of employee owned PPE.
5. Ensuring that all affected employees receive initial and annual training on PPE use.
6. Enforce all PPE requirements within the facility.
7. Maintaining training records for all employees.
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Supervisor:
1. Monitor employees for the use of correct PPE within their work area. Misuse or non-use
of PPE by an employee in any work area may result in disciplinary action.
2. Report infractions to the Safety Director.
3. Determine the need for re-training for any employee who shows the lack of knowledge or
understanding of assigned PPE.
Employee:
1. Understand the purpose of PPE.
2. Understand the hazards of improper use of PPE.
3. Wear appropriate PPE according to the results of the Job Hazard Assessment that has
been conducted for their work area.
4. Using PPE for its intended use.
5. The proper care, maintenance, and storage of PPE.
6. Obtain Safety Director authorization prior to use of any employee owned PPE.
7. Immediately notify the Supervisor or Safety Director if a piece of PPE is in need of repair
(defective or damaged).
8. Attend all prescribed training classes.
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1.10 JOB HAZARD ASSESSMENT PROCEDURE
1. Controlling Hazards:
The City of Medina realizes that PPE devices alone will not be relied on to provide full
protection against hazard(s). Personal Protective Equipment will be used in conjunction with,
administrative controls, engineering controls, guards and sound manufacturing practices.
2. Assessment and Selection:
The City of Medina feels that it is necessary to consider certain general guidelines for assessing
hazardous situations that exist in our occupational environment and to match the protective
devices to the particular hazard. The Safety Director will conduct a job hazard assessment (job
hazard assessment) in all departments to determine if any hazards are present in the workplace,
or likely to be present, which necessitate the use of PPE. If such hazards are present, or likely to
be present, the Safety Director will select, and require each affected employee to use the types of
PPE that will protect against the identified hazards.
3. Job Hazard Assessment:
The Job Hazard Assessment performed will be verified through written certification of each
workplace evaluated, documented on the Job Hazard Assessment Form1, and will include:
1.The area being assessed
2.The written results of the assessment
3.The date of the assessment
4.The person(s) completing the assessment
5.The Safety Director signature of approval
4. Assessment Guidelines:
In order to assess the need for PPE, the following steps will be taken:
Survey:
The purpose of the survey is to identify sources of hazards to workers. Special
consideration will be given to the basic hazard categories:
1. Impact
2. Penetration
3. Compression (rolling objects)
4. Chemicals
5. Temperature
6. Harmful dust
7. Electrical
8. Noise
9. Radiation
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Sources:
During the walk-through survey, the following sources of hazards will be identified:
1. Sources of motion; i.e., machinery or processes where any movement of tools,
machine elements or particles could exist.
2. Sources of high temperatures that could result in burns, eye injury or ignition of
protective equipment
3. Temperature extremes (hot/humid climates, cold climates)
4. Types of chemical exposures
5. Sources of harmful dust
6. Sources of light radiation; i.e., welding, brazing, cutting, etc.
7. Sources of falling objects or potential for dropping objects
8. Sources of sharp objects, which might pierce the feet or cut the hands
9. Sources of rolling or pinching objects which could crush the feet
10. Any electrical hazards
11. Sources of high decibels
Organize/Analyze Data:
Upon completion of the walk-through survey, an analysis of the hazards or potential
hazards found in the occupational environment will be completed to enable proper
selection of protective equipment.
5. Selection Guidelines:
The general procedure for selection of protective equipment will be as follows:
1. Individuals who are familiar with the hazards present in the specific occupational
environment will review the Job Hazard Assessment.
2. Recommendations will be made on the selection of the personal protective equipment,
which ensures a level of protection; equal to or greater than the minimum required to
protect employees from the hazards identified.
3. Personal protective equipment will be selected for each specific occupational
environment and will be required to be worn by all employees who may be exposed to
hazards in those areas.
6. Reassessment of Hazards:
The supervisor and appropriate individual(s) will reassess the workplace hazard situation as
necessary by: identifying and evaluating new equipment and processes, reviewing accident
records, and reevaluating the suitability of previously selected PPE(s).
Eyewear:
1. Nonprescription eyewear will be obtained from the City of Medina.
2. Eyewear will be replaced when damaged or worn out.
3. All safety glasses will be equipped with sideshields.
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4. Employees who wear prescription glasses will wear safety goggles over their own
personal eyewear.
a. The city has a prescription plan available that allows employees to order
prescription safety glasses at greatly reduced prices. See the Safety
Director for more information.
Protective Clothing
1. Protective clothing shall be worn while handling caustic or dangerous chemicals,
while welding, tree trimming, and handling batteries and while changing mercury
vapor lights.
2. Safety shoes shall be worn on all jobs involving handling or moving heavy
material, and during moving operations.
3. The following city personnel shall wear protective shoes:
a. Engineering personnel while on public streets, during construction or maintenance
job sites.
b. Street department personnel while doing street maintenance.
c. Park department personnel during grounds maintenance activities.
4. Employees shall not wear loose, flowing or ragged clothing on or near moving
machinery or equipment, or during tree trimming.
5. During winter outdoor work layers of loose, lightweight clothing is
recommended.
6. Employees shall wear shirts and full-length pants for jobs involving construction
or maintenance projects. This includes but is not limited to street repair, sewer
and water, grounds maintenance, parks, cemetery work, etc.
Gloves:
1. Employees who work in areas that may contain hand hazards are required to wear
appropriate gloves.
2. Only gloves that are designated for the particular task will be worn.
3. To prevent employees from getting caught on equipment, gloves will not be worn
in operations around moving machinery.
Hard Hats:
1. Employees who are performing duties where overhead objects/equipment may
cause a hazard will wear hard hats. This includes falling objects, drench work,
confined space, etc.
2. Hardhats shall be kept in good repair and in proper adjustment and shall be worn
only by the individual to who they are assigned
Visibility Clothing:
1. Employees in high traffic areas (i.e. working on or near roadways,
flagging/directing traffic, etc.) and around equipment operation must be worn at
all times.
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1.15 TRAINING
All employees who are exposed to hazards or potential hazards in their occupational
environment will be required to use Personal Protective Equipment. All employees who
are required to use Personal Protective Equipment will participate in City of Medina PPE
training program.
The City of Medina will provide all affected employees with the proper PPE for their
occupational environment. The City of Medina will conduct PPE training for all equipment used
in specific work areas for all employees at the time of initial assignment and annually thereafter,
and whenever a change in the work area occurs that requires the use of new PPE.
Training will include at a minimum:
1. When PPE is necessary - Results of the Job Hazard Assessment
2. What types of PPE are necessary for each work area
3. How to properly wear, adjust, fit and test PPE
4. The limitations of PPE
5. The proper care, maintenance, and storage of PPE
6. The useful life of PPE
7. Demonstration of employees understanding of the training and employees ability to don
and use PPE correctly.
Training will be verified through documentation that includes the name of each employee
involved in the training, the date of the training session and the subject of the training being
verified. By signing the training sign-off sheet employees acknowledge they have received and
understand the training.
Retraining will be given when necessary if it is determined that any employee does not have the
proper understanding or skill to use the PPE that he/she is required to use, or if any process
changes require the use of new types of PPE. Jobs performed less than once a year shall have
retraining before work is done.
1.20 FORMS
1Refer to the Safety Manual Appendix for all forms.
F002 – Job Hazard Assessment Form
EMERGENCY EYE WASH AND
SAFETY SHOWER PROCEDURE
Emergency Eye Wash & Shower 02.07.2023
Page 1 of 4
1.00 POLICY
The Emergency Eye Wash and Safety Shower policy has been developed to ensure a suitable
means for flushing and quick drenching of the eyes and body is provided near areas where
corrosive materials are used in an effort to reduce serious or permanent damage to skin or eyes.
This policy applies to Public Works employees and meets the requirements of OSHA Standard
29 CFR § 1910.151.
1.05 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Develop and administer the Eye Wash and Safety Shower Program.
2. Maintain an inventory summary of locations and types of all emergency eyewash/shower
stations.
3. Inspect and flush units per the inspection and testing protocol identified in this policy.
4. Ensure problems identified during inspection are corrected immediately.
5. Provide and ensure units are tagged annually with a new inspection tag.
6. Perform, maintain, and retain the monthly, quarterly, and annual Eyewash/Shower
Inspection Checklist(s)1.
7. Ensure employees are trained on the policy and procedures included in this section.
Supervisors:
1. Assure that safe work practices are utilized and prohibit the use of poor of forbidden
practices.
Employees:
1. Follow supervisory direction and abide by the prescribed work practices.
2. Wear proper PPE when working with hazardous chemicals.
3. Participate in safety training.
1.10 PROCEDURE
In most cases, the initial first aid treatment for a chemical splash is to rinse the affected area
with water for at least 15 minutes prior to seeking any other medical treatment. It is often
critical that the eyes be flushed during the first few seconds following a chemical splash with
contaminant free water if injury is to be minimized. That’s why it’s critical that eyewash
stations and showers are kept in proper working order and inspected with a documented
program.
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SAFETY SHOWER PROCEDURE
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1) Chemical burns can continue to burn and cause serious tissue damage without
significant pain after exposure due to a delayed effect. Chemical exposure to
corrosive materials shall be flushed immediately – a lag time of 2 - 3 minutes can
cause substantially more severe injuries. Ocular burns can result in cornea damage,
cataracts, and/or complete loss of vision. Flushing shall be initiated within the first
few seconds of exposure.
2) Hydrofluoric acid is a particularly hazardous caustic agent. Exposure to hydrofluoric
acid must be immediately flushed with water for 30 minutes, followed by an
application of a topical ointment, such as a calcium gluconate solution. Seek medical
attention immediately.
3) Proper eye protection (and an additional face shield as well for particularly
strong/concentrated corrosive chemicals) shall always be worn when working with
hazardous chemicals.
4) Eyewash/shower stations shall be available for immediate use and located within 10
seconds of the hazardous operations (approximately 50 feet), on the same level, and have
a pathway that is always clear of obstructions and slip/trip hazards.
5) Highly visible signs shall be posted at/near the station and the area shall be well lighted.
6) The activating valves/levers shall be highly visible and easy to use, requiring no more
than a one-handed operation. Once the lever has been activated, no hands shall be needed
to maintain water flow.
7) Nozzles must be protected with auto-opening dust covers.
8) The eyewash/shower station shall provide a “minimum” of a 15 minute uninterrupted
flush of lukewarm water (80 – 90 deg is preferred) provided by a temperature-mixing
valve.
1.15 INSPECTION AND TESTING PROTOCOL
Eyewashes shall be activated monthly for a period long enough to verify operation and ensure
that flushing fluid is available and clean. This flushing helps clean out any rust, scale deposits, or
bacteria that may accumulate and cause additional eye injury. The monthly inspections shall
include the following:
1) Ensure that access to the eyewash is unobstructed.
2) Visually inspect the eyewash to ensure that there are no broken parts, leakage, etc.
3) Verify that protective eyewash covers are properly positioned, clean, intact, and operate
properly when activated.
4) Activate eyewash unit - flush pipes: check that the spouts are clean and that the water
flow is effective and continuous. Operate the eyewash for 1 minute.
EMERGENCY EYE WASH AND
SAFETY SHOWER PROCEDURE
Emergency Eye Wash & Shower 02.07.2023
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5) The unit must deliver low-pressure “soft” flow to both eyes so it does not injure the open
eyes.
6) Check that the unit’s valve activator remains open without the use of the operator’s
hands.
7) Ensure each station has a highly visible emergency sign.
8) For portable (non-plumbed units), verify that the expiration date has not been exceeded
and fluid levels are full. Follow manufacturer’s instructions.
9) Ensure that problems identified during the monthly inspection are documented
and corrected immediately.
10) Maintain the inspection tag for this monthly testing.
11) Maintain and file the Monthly Eyewash/Shower Inspection Checklist1 for all testing.
Annual Eyewash Test
1) Verify flow rate of the device annually. Let the water run for exactly one minute to verify
collection of at least 1.5 liters (0.4 gallon) of water for eyewash alone or 11.4 liters (3.0
gallons) for an eye/face wash unit with a minimum water pressure of 30 PSI.
2) Check for tepid water temperature (80 – 90 deg preferred)
3) Maintain the inspection tag for this annual testing.
4) Maintain and file the Annual Eyewash/Shower Inspection Checklist1 for all testing.
Showers shall be activated on a quarterly basis. The quarterly inspections shall include the
following:
1) Ensure that access to the shower is unobstructed.
2) Visually inspect the shower to ensure that there are no broken parts, leakage, etc.
3) Check that the flow is effective and continuous.
4) Check that the unit remains activated without the use of the operator’s hands.
5) Maintain an inspection tag for this testing.
6) Ensure that problems identified during the inspection are corrected immediately.
7) Maintain and file the Quarterly Eyewash/Shower Inspection Checklist1 for all testing.
Annual Shower Test
1) Flow rate of the device shall be conducted annually. Verify collection of at least 75.7
liters (20 gallons) of water at a minimum water pressure of 30 PSI. Run for a 15 second
increment to fill a five-gallon bucket.
2) Maintain an inspection tag for this testing.
3) Ensure that problems identified during the inspection are corrected immediately.
4) Maintain and file the Annual Eyewash/Shower Inspection Checklist1 for all testing.
Inspection Information
For eyewash/showers that are not equipped with a proper drain, you can use a bucket to collect
drain water and drain in nearby sink OR use the 5 gallon bucket with sump pump and hose
EMERGENCY EYE WASH AND
SAFETY SHOWER PROCEDURE
Emergency Eye Wash & Shower 02.07.2023
Page 4 of 4
connection, and drain into a nearby sink. For testing of shower units, you can use a shower tester
tent and bucket OR use the special stainless steel hose adapter and hose and drain to a nearby
sink. This is most effectively conducted by two people.
For the annual inspection, flow meters or buckets with known volumes (5 gallons for shower
test, 1.5 liters for eyewash test) and a watch can be used to make sure the units are in proper
working order with the correct amount of flow. A thermometer shall be used to determine tepid water temperature
until the tester is confident of water temperature.
Departments are responsible to store & secure testing equipment and ensure they are
maintained in good condition.
1.20 TRAINING
All employees who might be exposed to a chemical splash shall be trained on the following
topics:
1) The specific location of the units serving that area.
2) How to properly activate & use the specific type of system.
3) Eyewash – eye injury - Individuals shall be instructed to hold the eyelids “open” and roll
the eyeballs continuously so fluid will flow on all surfaces of the eye and under the
eyelid, and then seek medical attention. Bring a copy of the SDS to medical facility.
4) Shower – skin/body injury – Remove all contaminated clothing, flush body for a
minimum of 15 minutes, then seek medical attention. Bring a copy of the SDS to medical
facility.
1.25 INVENTORY SUMMARY
UNIT QUANTITY / LOCATION
Eyewash Station(s)
(1) Public Works Shop
(1) Hamel Water Treatment Plant
(1) Wellhouse - Independent Beach
(1) Wellhouse – Morningside
(1) Hamel Wellhouse 3
Shower Station(s) (1) Public Works Shop
(3) Water Treatment Plant
1.30 FORMS
1Refer to the Safety Manual Appendix for all forms.
F015 Emergency Eyewash/Shower Inspection Checklist Form
WELDING AND CUTTING (HOT WORK)
Welding and Cutting 02.07.2023
Page 1 of 10
1.00 POLICY
The Welding and Cutting policy has been developed to protect life and property from fire,
atmospheric contaminants, and other associated hazards that may occur during these operations.
This policy applies to Public Works employees and meets the requirements of OSHA Standard
29 CFR § 1910.252.
1.05 DEFINITIONS
Welding/Hot Work Procedures – Any activity which results in sparks, fire, molten slag, or hot
material that has the potential to cause fires or explosions.
Designated Area – Permanent location designed or approved for hot work operations to be
performed regularly.
Examples of Hot Work – Cutting, brazing, soldering, torch applied roofing, grinding and
welding.
Fire Watch – Selected employee posted in the hot work area to monitor the safety of hot work
operations and watch for fires.
Hot Work Operator – Is an employee who performs hot work operations.
Hot Work Permit1 – A document issued by the Permit Authorizing Individual.
Permit Authorizing Individual (PAI) – Individuals designated by management to authorize hot
work.
Special Hazard Occupancies – Any area containing flammable liquids, dust accumulation, gases,
plastics, rubber and paper products.
1.10 RESPONSIBILITIES
Administration:
1. Allocate resources for all necessary safety equipment that meets current standards.
Safety Director:
1. Ensure that all individuals involved in the hot work operations are trained in the safe
operation of their equipment and the safe use of the process. They shall also have an
awareness of the inherent risks involved and understand the emergency procedures in the
event of a fire.
2. Advise all contractors about site-specific flammable materials, hazardous processes and
conditions, or other potential fire hazards.
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Supervisor:
1. Responsible for the safe operations of hot work activity and shall establish permissible areas
for hot work.
2. Designate a permit authorizing individual (PAI).
3. Ensure that only approved apparatus, such as torches, manifolds, regulators or pressure
reducing valves, and acetylene generators, are used.
Permit Authorizing Individual (PAI):
1. In conjunction with management, the PAI shall be responsible for the safe operation of hot
work activities. The PAI shall determine site-specific flammable materials, hazardous
processes, or other potential hazards. The PAI shall ensure the protection of combustibles
from ignition by the following means:
a. Ensure the work is moved to a location free from combustibles.
b. If the work cannot be moved, ensure the combustibles are moved to a safe distance or
are properly shielded against ignition.
c. Ensure hot work is scheduled such that operations that could expose combustibles to
ignition are not started during hot work operations.
i. If a, b, or c cannot be met, then hot work shall not be performed.
ii. The PAI shall determine that fire protection and extinguishing equipment are
properly located at the site.
iii. Where a fire watch is required, the PAI shall see that the fire watch is available at
the site.
iv. Where a fire watch is not required, the PAI shall make a final checkup ½ hour after
the completion of hot work operations to detect and extinguish possible smoldering
fires.
Hot Work Operator (Employee):
1. The hot work operator shall handle the equipment safely and use it so as not to endanger
lives and property.
2. When the operator is not a designated PAI, the operator shall have the PAI’s approval before
starting hot work operations.
3. When the operator is not a designated PAI, the operator shall cease hot work operations if
unsafe conditions develop and shall notify management, the supervisor, or the PAI for
reassessment of the situation.
Fire Watch:
1. The fire watch shall be aware of the inherent hazards of the work site and of the hot work.
2. The fire watch shall ensure that safe conditions are maintained during hot work operations.
3. The fire watch shall have the authority to stop the hot work operations if unsafe conditions
develop.
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4. The fire watch shall have fire extinguishing equipment readily available and shall be trained
in its use.
5. The fire watch shall be familiar with the facilities and procedures for sounding an alarm in
the event of a fire.
6. The fire watch shall watch for fires in all exposed areas and try to extinguish them only when
the fires are obviously within the capacity of the equipment available. If the fire watch
determines that the fire is not within the capacity of the equipment, he or she shall sound the
alarm immediately.
1.15 WELDING AND HOT WORK FIRE PREVENTION MEASURES
Permissible Areas
1. Hot work shall be allowed only in areas that are or have been made fire safe. Hot work shall
be performed in either designated areas or permit-required areas.
Designated Area
1. A designated area shall be a specific area designed or approved for such work, such as a
maintenance shop or a detached outside location that is of noncombustible or fire-resistive
construction, essentially free of combustible and flammable contents, and suitably segregated
from adjacent areas.
City of Medina Designated Areas
Public Works Shop
Permit-Required Areas
1. A permit-required area shall be an area that is made fire safe by removing or protecting
combustibles from ignition sources.
Non-Permissible Areas
1. Hot work shall not be allowed in the following areas:
a. In areas not authorized by management.
b. In sprinklered buildings while such protection is impaired.
c. In explosive atmospheres that can develop inside uncleaned or improperly prepared
drums, tanks, or other containers and equipment that have previously contained such
materials.
d. In explosive atmospheres that can develop in areas with an accumulation of combustible
dusts.
Hot Work Permit
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1. Before hot work operations begin in a non-designated area, a written hot work permit by
the permit authorizing individual (PAI) shall be required.
2. Before a hot work permit is issued, the following conditions shall be verified, by the PAI.
a. Hot work equipment to be used shall be in satisfactory operating condition and in good
repair.
b. Where combustible materials, such as paper clippings, wood shavings, or textile fibers
are on the floor, the floor shall be swept clean for a radius of 35 feet. Combustible floors
(except wood or concrete) shall be kept wet, be covered with damp sand, or be protected
by noncombustible or fire-retardant shields. Where floors have been wet down, personnel
operating arc welding or cutting equipment shall be protected from possible shock.
c. All combustibles shall be relocated at least 35 feet from the work site. If relocation is
impractical, combustibles shall be protected with fire-retardant covers or otherwise
shielded with metal or fire-retardant guards or curtains. Edges of covers at the floor shall
be tight to prevent sparks from going under them, including where several covers overlap
when protecting a large pile.
d. Opening or cracks in walls, floors, or ducts within 35 feet of the site shall be tightly
covered with fire-retardant or noncombustible material to prevent the passage of sparks to
adjacent areas.
e. Conveyor systems that might carry sparks to distant combustibles shall be shielded.
f. If hot work is to be done on a wall, partition, ceilings, or roof, precautions shall be taken
to prevent ignition of combustibles on the other side by relocating combustibles. If it is
impractical to relocate combustibles, a fire watch on the opposite side from the work
shall be provided.
g. Hot work shall not be attempted on a partition, wall, ceiling, or roof that has a
combustible covering or insulation, or on walls or partitions of combustible sandwich-
type panel construction.
h. Hot work that is performed on pipes or other metal that is in contact with combustible
walls, partitions, ceilings, roofs, or other combustibles shall not be undertaken if the work
is close enough to cause ignition by conduction.
i. Fully charged and operable fire extinguishers that are appropriate for the type of possible
fire shall be available immediately at the work area. If existing hose lines are located
within the hot work area defined by the permit, they shall be connected and ready for
service, but shall not be required to be unrolled or charged.
j. If hot work is done in close proximity to a sprinkler head, a wet rag shall be laid over the
head and then removed at the conclusion of the welding or cutting operation. During hot
work, special precautions shall be taken to avoid accidental operation of automatic fire
detection or suppression systems.
k. Nearby personnel shall be suitably protected against heat, sparks, slag, and so on.
3. Based on local conditions, the PAI shall determine the length of the period for which the hot
work permit is valid, but in no case more than a single shift.
4. The area shall be inspected by the PAI at least once per shift while the hot work permit is in
effect to ensure that it is a fire-safe area.
Fire Watch
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1. A fire watch shall be required by the PAI when hot work is performed in a location where
other than a minor fire might develop, or where the following conditions exist:
a. Combustible materials in building construction or contents are closer than 35 feet to the
point of operation.
b. Combustible materials are more than 35 feet away but are easily ignited by sparks.
c. Wall or floor openings within a 35 foot radius expose combustible materials in adjacent
areas, including concealed spaces in walls or floors.
d. Combustible materials are adjacent to the opposite side of partitions, walls, ceilings, or
roofs and are likely to be ignited.
2. A fire watch shall be maintained for at least ½ hour after completion of hot work operations
in order to detect and extinguish smoldering fires.
3. More than one fire watch shall be required if combustible materials that could be ignited by
the hot work operation cannot be directly observed by the initial fire watch.
1.20 WELDING STANDARD OPERATING PROCEDURES
The following lists Welding Standard Operating Procedures and are applicable for all electric
and gas welding. These operating procedures shall be posted at each designated welding and hot
work area for quick reference and review.
Electric Welding
1. Perform safety check on all equipment.
2. Ensure fire extinguisher is charged and available.
3. Ensure electrical cord, electrode holder and cables are free from defects (no cable splices are
allowed within 10 feet of the electrode holder). Cables with damaged insulation or exposed
conductors shall be replaced.
4. Ensure PPE (welding hood, gloves, safety shoes, and aprons) are available and have no
defects.
5. Ensure the welding unit is properly grounded.
6. All defective equipment must be repaired or replaced before use.
7. Remove flammables and combustibles.
8. No welding is permitted on or near containers of flammable material, combustible material or
unprotected flammable structures.
9. Place welding screen or suitable barricade around work area to provide a fire safety zone and
prevent injuries to passersby (do not block emergency exits or restrict ventilation).
10. Ensure adequate ventilation and lighting.
11. Execute Hot Work Permit procedures.
12. Set Voltage Regulator no higher than the following for:
a. Manual Alternating Current Welders – 80 volts.
b. Automatic Alternating Current Welders – 100 volts.
c. Manual or automatic Direct Current Welders – 100 volts.
13. Uncoil and spread out welding cable.
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14. To avoid overheating, ensure proper contact of work leads and connections, remove any
metal fragments from magnetic work clamps (to avoid electric shock do not wrap welding
cables around a body part and avoid welding in wet conditions).
15. Fire watch for ½ hour after welding and until all welds have cooled.
16. Perform final watch and terminate permit.
Gas Welding
1. Perform safety check on all equipment.
2. Ensure tanks have gas and fittings are tight.
3. Ensure fire extinguishers are charged and available.
4. Inspect hoses for defects.
5. Ensure PPE (welding hood, gloves, safety shoes and aprons) are available and have no
defects.
6. All defective equipment must be repaired or replaced before use!
7. Remove flammables and combustibles.
8. No welding is permitted on or near containers of flammable material, combustible material,
or unprotected flammable structures.
9. Place welding screen or suitable barricade around work area to provide a fire safety zone and
prevent injuries to passersby (do not block emergency exits or restrict ventilation).
10. Use a NIOSH approved respirator, if necessary.
11. Ensure adequate ventilation and lighting.
12. Execute Hot Work Permit procedures.
13. Open valves on oxygen and gas tanks to desire flow.
14. Shut tank valves and relieve hose pressure. Store hoses.
15. Fire watch for ½ hour after welding and until all welds have cooled.
16. Perform final fire watch and terminate permit.
1.25 COMPRESSED GAS
Care, Transporting, Moving and Storage
1. Valve caps on cylinders must be in place and secured. Valve caps must not be used for
lifting. Do not pry cylinder caps while frozen. Loosen caps with warm water.
2. Cylinders must be transported on a secured cradle only, and by tilting or rolling them.
3. Cylinders must be moved by tilting and rolling them on the bottom edges. Avoid dropping
cylinder or striking other cylinders.
4. Cylinders transported by powered vehicles must be secured in a vertical position.
5. Regulators must be removed, and caps put in place prior to moving cylinders, unless
cylinders are secured on a special carrier.
6. Cylinders shall be stored chained to the wall so they cannot be accidently knocked over.
7. Proper steadying devices must be used to keep cylinders from falling over while in use.
8. Cylinder valves must be closed when cylinders are empty or when cylinders are moved.
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Welding and Cutting 02.07.2023
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9. Oxygen cylinders must be stored separated from fuel gas cylinders or combustible materials
a minimum distance of 20 feet or by a 5 foot high noncombustible barrier with a fire-
resistance rating of one-half hour
10. Cylinders stored inside a building must be stored 20 feet from combustible materials where
they were well protected, well ventilated, and dry. Cylinders must not be stored near
elevators, stairs, or gangways. Assigned storage locations must prevent cylinders from being
knocked over or damaged.
11. Cylinders must be kept away from welding or cutting operations to prevent sparks, hot slag,
or flames from reaching them. Fire resistant shields must be used when this is impractical.
12. Cylinders must be placed away from electrical circuits. Do not strike electrode against a
cylinder to strike an arc.
13. Cylinders containing oxygen, acetylene or other fuel gas must not be used in confined spaces.
14. Cylinders must not be used as rollers or supports.
15. Only the gas supplier is authorized to mix gases in a cylinder.
16. No damaged or defective cylinder may be used.
Use of Fuel Gas
1. Valves must be opened slightly and closed immediately before a regulator is connected to the
cylinder. This is called “cracking” which clears the valve of dust and dirt. The employee
must stand to the side of the outlet, not in front. Valves must be cracked away from welding
work, sparks, flames, or other sources of ignition.
2. Valves must be opened slowly to prevent damage to the regulator. Valves must not be
opened more than 1 ½ turns. If a wrench is required, it must stay in position in case of
emergency for a quick shut off. Manifold or coupled cylinders must have a wrench available
for immediate use. Do not place objects on top of cylinders, or damage may occur to the
safety device or interfere with the quick closing of the valve.
3. Cylinders must be closed, and the gas released from the regulator before removing the
regulator. If cylinders, valves, regulators, plug, or other safety devices are damaged, they
must be tagged out of service and removed from the work area.
Manifolds
1. Fuel gas and oxygen manifolds must bear the name of the substance they contain.
2. Fuel gas and oxygen manifolds must be placed in safe, well ventilated, and accessible
locations.
3. Hose connections must be made so that they cannot be interchanged between fuel gas and
oxygen manifolds and supply header connections. Keep hose connections free of grease and
oil, and do not use adapters to interchange hoses.
4. Manifold and header hose connections must be capped when not in use.
5. Nothing may be placed on manifolds that will damage the manifold or interfere with the
quick closing of the valves.
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Hoses
1. Fuel gas hose and oxygen hose must be distinguishable from each other, and not be
interchangeable. Contrast may be made by different colors or by surface characteristics.
2. Employees will inspect all hoses in use at the beginning of each work shift. Defective hoses
will be tagged and removed from service.
3. Hose subjected to flashback, or which show severe wear or damage must be tested at twice
the normal pressure from the hose, but not less than 300 p.s.i. If defective, the hose must not
be used.
4. Hose couplings must be disconnected by rotary motion only.
5. Hoses stored in boxes must be well ventilated.
6. Hoses, cables, and other equipment must be kept clear of passageways, ladders and stairs.
Torches
1. Torches must be inspected at the beginning of each working shift for open/closed shutoff
valves, hose coupling, and tip connections. Defective torches may not be used.
2. Clogged torch tip openings must be cleaned.
3. Torches may be lit by friction lighters or other approved devices only.
Regulators and Gauges
1. Pressure and regulators and related gauges must work properly while in use.
Oil and Grease Hazards
1. Oxygen cylinders and fittings must be kept away from oil or grease. Cylinders and fittings
must be kept from oil or greasy substances and may not be handled with oily hands or gloves.
2. Oxygen must not be directed at oily surfaces, greasy clothes, or within a fuel oil or other
storage tank or vessel.
Gas supplies to welding equipment must be shut off during lunch breaks, overnight, or during
shift breaks. Hoses and torches must be removed from confined spaces.
1.30 TRAINING
Training shall be provided to all Public Works personnel assigned to use welders. The training
shall include:
1. Safe performance of work tasks
2. Safe use, operation and maintenance of welders and other tools used
3. Review of the manufacturer’s operating and maintenance instructions, warnings, and
precautions
4. Recognition, prevention and control of other safety and health hazards that may be
encountered during typical work tasks
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5. Review of the requirements of the City of Medina’s policies pertaining to the required tasks
6. Use of Hot Work Permit System
Each new employee and each employee who is required to be trained shall work under the close
supervision until the employee demonstrates to the supervisor the ability to safely perform their
new duties independently.
1.35 PROTECTIVE EQUIPMENT
1. When working on platforms, scaffolds, or runways, welders and their helpers shall be
protected against falling by use of railings, safety belts, life lines, or other effective
safeguards. Specifics on fall protection can be found under the Fall Protection section of this
Safety Manual.
2. Helmets or hand shields shall be used during all arc welding/cutting operations, excluding
submerged arc welding. All helpers & attendants shall be provided with proper eye
protection. Goggles or other suitable eye protection shall be used during all gas welding or
oxygen cutting operations. Spectacles with side shields and suitable filter lenses are required
during gas welding operations on light work, torch brazing, and for inspections. Operators
and attendants of resistance welding or brazing shall use transparent face shields or goggles,
depending on the particular job.
Specifications for eye protection:
Helmets and hand shields shall be made of material which is an insulator for heat and electricity.
Helmets, shields and goggles shall not be readily flammable and shall be capable of withstanding
sterilization. Helmets and hand shields shall be arranged to protect face, neck, and ears from
direct radiant energy from the arc. Helmets shall be provided with filter plates designed for easy
removal. Parts shall be constructed of material which will not readily corrode or discolor the
skin. Goggles shall be ventilated to prevent fogging of lens as much as possible. All glass lenses
shall be tempered and free from flaws. The front and rear surfaces of lenses shall be smooth and
parallel, except prescription lenses for optical correction. Lenses shall bear permanent distinctive
markings which denote source and shade for easy identification. All filter lenses and plates must
meet the test for transmission of radiant energy set forth in 29 CFR 1910.133(b)(1), Eye and
Face Protection.
3. Special protection for arc welding rays shall be used. Where the work permits, the welder
should be enclosed in an individual booth constructed of non-combustible, non-reflective
material. All booths shall allow for either natural or mechanical ventilation to protect against
the build-up of hazardous atmospheres.
4. Protective clothing shall be worn in accordance with 29 CFR 1910.132. The degree of
protective clothing will vary with size, nature, and location of work to be performed.
5. Additional details on protective equipment can be found under the Personal Protection
Equipment section of this Safety Manual.
WELDING AND CUTTING (HOT WORK)
Welding and Cutting 02.07.2023
Page 10 of 10
1.40 APPENDIX REFERENCES
2Appendix to § 1910.133(b)(1)
1.45 FORMS
1Refer to the Safety Manual Appendix for all forms.
F025 Hot Work Permit
By Standard Number / 1910.133 - Eye and face protection.
Part Number:1910
Part Number Title:Occupational Safety and Health Standards
Subpart:1910 Subpart I
Subpart Title:Personal Protective Equipment
Standard Number:1910.133
Title:Eye and face protection.
GPO Source:e-CFR
1910.133(a)
General requirements.
1910.133(a)(1)
The employer shall ensure that each affected employee uses appropriate eye or face protection when exposed
to eye or face hazards from flying particles, molten metal, liquid chemicals, acids or caustic liquids, chemical
gases or vapors, or potentially injurious light radiation.
1910.133(a)(2)
The employer shall ensure that each affected employee uses eye protection that provides side protection when
there is a hazard from flying objects. Detachable side protectors (e.g. clip-on or slide-on side shields) meeting
the pertinent requirements of this section are acceptable.
1910.133(a)(3)
The employer shall ensure that each affected employee who wears prescription lenses while engaged in
operations that involve eye hazards wears eye protection that incorporates the prescription in its design, or
wears eye protection that can be worn over the prescription lenses without disturbing the proper position of the
prescription lenses or the protective lenses.
1910.133(a)(4)
Eye and face PPE shall be distinctly marked to facilitate identification of the manufacturer.
1910.133(a)(5)
The employer shall ensure that each affected employee uses equipment with filter lenses that have a shade
number appropriate for the work being performed for protection from injurious light radiation. The following is a
listing of appropriate shade numbers for various operations.
Filter Lenses for Protection Against Radiant Energy
Operations
Electrode Size ¹⁄
in.
Arc
Current
Minimum* Protective
Shade
Shielded metal arc welding Less than 3 Less than
60
7
3-5 60-160 8
Filter Lenses for Protection Against Radiant Energy
Operations
Electrode Size ¹⁄
in.
Arc
Current
Minimum* Protective
Shade
5-8 160-250 10
More than 8 250-550 11
Gas metal arc welding and flux cored arc
welding
less than 60 7
60-160 10
160-250 10
250-500 10
Gas Tungsten arc welding less than 50 8
50-150 8
150-500 10
Air carbon (Light)less than
500
10
Arc cutting (Heavy)500-1000 11
Plasma arc welding less than 20 6
20-100 8
100-400 10
400-800 11
Plasma arc cutting (light)**less than
300
8
(medium)**300-400 9
(heavy)**400-800 10
Torch brazing 3
Torch soldering 2
Carbon arc welding 14
Filter Lenses for Protection Against Radiant Energy
Operations Plate thickness - inches Plate thickness - mm Minimum* Protective Shade
Gas Welding:
Light Under 1/8 Under 3.2 4
Medium 1/8 to 1/2 3.2 to 12.7 5
Filter Lenses for Protection Against Radiant Energy
Operations Plate thickness - inches Plate thickness - mm Minimum* Protective Shade
Heavy Over 1/2 Over 12.7 6
Oxygen cutting:
Light Under 1 Under 25 3
Medium 1 to 6 25 to 150 4
Heavy Over 6 Over 150 5
* As a rule of thumb, start with a shade that is too dark to see the weld zone. Then go to a lighter shade which
gives sufficient view of the weld zone without going below the minimum. In oxyfuel gas welding or cutting where
the torch produces a high yellow light, it is desirable to use a filter lens that absorbs the yellow or sodium line in
the visible light of the (spectrum) operation.
** These values apply where the actual arc is clearly seen. Experience has shown that lighter filters may be
used when the arc is hidden by the workpiece.
1910.133(b)
Criteria for protective eye and face protection.
1910.133(b)(1)
Protective eye and face protection devices must comply with any of the following consensus standards:
1910.133(b)(1)(i)
ANSI/ISEA Z87.1-2010, Occupational and Educational Personal Eye and Face Protection Devices, incorporated
by reference in § 1910.6;
1910.133(b)(1)(ii)
ANSI Z87.1-2003, Occupational and Educational Personal Eye and Face Protection Devices, incorporated by
reference in § 1910.6; or
1910.133(b)(1)(iii)
ANSI Z87.1-1989 (R-1998), Practice for Occupational and Educational Eye and Face Protection, incorporated
by reference in § 1910.6;
1910.133(b)(2)
Protective eye and face protection devices that the employer demonstrates are at least as effective as protective
eye and face protection devices that are constructed in accordance with one of the above consensus standards
will be deemed to be in compliance with the requirements of this section.
[59 FR 16360, April 6, 1994; 59 FR 33910, July 1, 1994; 61 FR 9227, March 7, 1996; 61 FR 19547, May 2, 1996;
74 FR 46356, Sept. 9, 2009; 81 FR 16090, March 25, 2016]
UNITED STATES
DEPARTMENT OF LABOR
Occupational Safety & Health Administration
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Washington, DC 20210
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F001 02.07.2023
Safety Acknowledgment Form
The law says that an employer must have a policy for managing health and safety. OSHA
requires an employer to have a written safety manual in place that covers all aspects of OSHA
standards. Fines may result if they are incomplete or outdated.
Compliance with the safety manual and personnel policy are a condition of employment. To
ensure cooperation, please complete and sign this form.
By signing, I ________________________________________acknowledge:
I have reviewed and understand the City of Medina Safety and Personnel Policies adopted
by the City Council.
I understand the Safety Manual is available on SharePoint at:
City Admin Files/General Administration/Safety/Safety Manual
I understand the Personnel Policy is available on SharePoint at:
City Admin Files/General Administration/Personnel/Personnel Policy
I understand a printed copy of the Safety Manual and Personnel Policy are available in
Human Resources, Planning, Public Works, and Police Department.
I understand all revisions to the Safety Manual and Personnel Policy will be communicated
via email distribution, that I am required to review and understand all revisions in a timely
manner, and that all revisions are adopted into policy, and are a condition of employment.
I understand that my employment with the City of Medina is dependent upon returning this
completed form in a timely manner and understanding and following the Safety Manual
and Personnel Policy.
Employee Signature: _________________________________ Date: _______________
Original – HR
Copy – Employee
F002 02.07.2023
Job Hazard Assessment Form
Job Description: ___________________________________________________________
Date of Assessment: ___________ New ___ Revised ___
Identify Hazards
1______________________________________
2______________________________________
3______________________________________
4______________________________________
5______________________________________
6______________________________________
Control of Hazards
1______________________________________
2______________________________________
3______________________________________
4______________________________________
5______________________________________
6______________________________________
Necessary PPE or Safety Equipment
1______________________________________
2______________________________________
3______________________________________
4______________________________________
5______________________________________
6______________________________________
Assessment Team Members: _________________________ _________________________
_________________________ _________________________ _________________________
__________________________________
(Safety Director Signature of Approval)
Original – Safety Director
Copy – Employee, Supervisor
F003 02.07.2023
Supervisor’s Accident Report
Date of Accident: ___________ Did You Witness the Incident? ___________
Location of Accident: ___________ Time of Accident: ___________
Was the accident reported to you immediately? ___________
Employee Name: ________________ Name of First Aid Attendant: ________________
Explanation of accident: _________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Did horseplay contribute to the accident? _________
Did an unsafe act contribute to this accident? _________
Has a similar accident occurred? _________ When? ___________________
Was personal protection equipment appropriate for job task? _________
Does the employee need further or repeat personal protection equipment? _________
Did poor housekeeping contribute to this accident? _________
Was the employee previously trained as to safe procedures for this task? _________
What action did you take after the accident? __________________________________________
______________________________________________________________________________
______________________________________________________________________________
Was the employee wearing personal protection equipment? _________ What? ____________
______________________________________________________________________________
______________________________________________________________________________
Suggestions to stop repeat accidents: ________________________________________________
______________________________________________________________________________
______________________________________________________________________________
How could accident have been avoided? Were all guards in place? _______________________
______________________________________________________________________________
______________________________________________________________________________
__________________________________
(Supervisor’s Signature)
**This form must be given to the Safety Director within twenty-four (24) hours of incident
and is to be attached to the Safety Committee Accident Report)**
F004 02.07.2023
Safety Committee Accident Report
Date of Accident: __________________ Date of Safety Meeting: __________________
Summary of Accident: ___________________________________________________________
______________________________________________________________________________
Names of Investigators Job Title Names of Investigators Job Title
___________________ ___________ ___________________ ___________
___________________ ___________ ___________________ ___________
Names of Injured Personnel Job Title
_________________________ ______________
Does present training cover this type of accident? __________
Does injury include back or point injuries? __________ (if YES, include Ergonomic Report For
Job Task Form)
Consensus of root cause of accident:
______________________________________________________________________________
______________________________________________________________________________
Recommendation for corrective action and prevention of similar accident/injury:
______________________________________________________________________________
______________________________________________________________________________
**Attach the Supervisors Accident Report and return to the Safety Director no later than
ten (10) days from the date of the safety meeting**
Date Form Returned: _____________
Has the root cause been identified? ___Yes ___No
Is the corrective action appropriate? ___Yes ___No
___________________________
Safety Director Signature
Original – HR
Copy – Employee, Supervisor
F005 02.07.2023
Ergonomic Report For Job Task
IF INJURIES INCLUDE BACK OR POINT INJURIES, INCLUDE THIS FORM IN
INVESTIGATION BY SAFETY COMMITTEE
Employee: __________________________________ Job Title: _______________________________
Supervisor: __________________________________ Date: _____________________________
During the employee’s eight (8) hour day he or she:
Sits ______ hours
Stands ______ hours
Walks ______ hours
The employee’s task requires:
Bending/stooping Seldom Occasional Frequently None
Squatting Seldom Occasional Frequently None
Reaching over shoulders Seldom Occasional Frequently None
Twisting Seldom Occasional Frequently None
Kneeling Seldom Occasional Frequently None
Balancing Seldom Occasional Frequently None
Climbing (height: ______) Seldom Occasional Frequently None
Pushing (lbs: ______) Seldom Occasional Frequently None
Pulling (lbs: ______) Seldom Occasional Frequently None
The employee’s job requires lifting of ______ maximum pounds.
The employee’s job requires:
Working on heights
Driving motor vehicles
Chemical exposure
Dust fumes or gas exposure
Exposure to extreme temperature changes
_____________________________________________
(Supervisor Signature)
**Attach to the Safety Committee Accident Report, when applicable**
F006 02.07.2023
_____ First Violation
_____ Second Violation
_____ Third Violation
_____ Fourth Violation
Safety Violation Form
Employee: __________________________________________
Date of Violation: ____________________________________
Supervisor: _________________________________________
The employee cited above violated the City Safety Policy as stated below:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The employee was instructed in the following safety working practices with regard to this
violation:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Performance improvement / corrective action plan discussed:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Employee Statement:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_________________________ _____________
Employee Signature Date
_________________________ ______________
Supervisor Signature Date
Original – HR
Copy – Employee, Supervisor
F007 02.07.2023
Respirator Training and Issuance Form
Date: ______________ Trainer: __________________________________
____ Annual Training ____ New Employee Training ____ Present Employee Training
Respirator Issued: Model Number: ___________
Manufacturer: ______________
Mask Type: _________
Filter and NIOSH Number: _________
Are there any physical limitations such as beard, glasses, or dentures? ______________
Fit Test Results: _____________________________________
I ______________________________, understand the need and purpose for this respirator. I
understand that I will be responsible for its use, care, and maintenance. I will inspect the
respirator and filter each time I use it and report any damages to my supervisor. I have been
examined by a doctor and I have been trained in the use of the respirator. I have been fit tested
and I have had the opportunity to ask questions in my training session.
Date: ______________ _____________________________
(Employee Signature)
Date: ______________ _____________________________
(Trainer Signature)
Original – Safety Director
Copy – Employee
F008 02.07.2023
Personnel Certified in CPR / First Aid / AED
City Hall: Deb Dion x239, Brenda Ruth x604, Jennifer Altendorf x238
(Expire September 2024)
Public Works: Steve Scherer x223, Derek Reinking x256, Joe Ende 612-290-3789,
John (Jack) Gleason 612-290-2224, Greg Leuer 612-290-1746
(Expire February 2023)
Police: All Licensed Police Officers 763-473-9209
Crisis Management Team
Safety Director: Greg Leuer 612-290-1746
City Hall: Scott Johnson x225, Dusty Finke x224
Public Works: Steve Scherer x223, Derek Reinking x256
Police: Jason Nelson x243
Hospital and Urgent Care Facilities
North Memorial Hospital – 3300 Oakdale Avenue North, Robbinsdale 55422
(763) 520-5200
Methodist Hospital – 6500 Excelsior Blvd., St. Louis Park 55426
(952) 993-5000
Methodist Hospital – 9555 Upland Ln N. Maple Grove 55369
(952) 993-7672
Park Nicollet Urgent Care – 4155 County Road 101 N. Plymouth 55446
952-993-8900
West Health Urgent Care – 2855 & 2805 Campus Drive, Plymouth 55441
(763) 577-7160
F009 02.07.2023
Fire Drill Report Form
Date: ______________ Emergency: Fire __Weather __ Other (explain): ______________
Manager: _________________ Number of Employees: ________ Time: ___________
Did all employees report to the evacuation command center location? _________
Was the SDS book brought to the evacuation command center location? _________
Was head count taken? _________
Were shut off procedures followed? _________
Rate the orderliness of evacuation: Poor _____ Average _____ Good _____
Suggestions for improving performance? ____________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________ ______________________________
(Supervisor’s Signature) (Safety Director’s Signature)
F010 02.07.2023
Lockout Tagout Tag Examples
F011 02.07.2023
Lockout/Tagout Device Use Log
DATE DEVICE
TIME
EMPLOYEE
SIGNATURE
DATE
RETURNED TIME
F012 02.07.2023
Energy Source Log
This form is used to identify equipment / machinery / systems that require lockout procedures.
At a minimum, inventory must be reviewed annually. Reference Page 2 for periodic inspection
standard language.
Energy Types: Identify which type of energy is present and requires LOTO prior to performing
work for each piece of equipment or machine listed.
1 - Electrical 6 - Thermal
2 - Compressed Air 7 - Chemical
3 - Hydraulic 8 - High Pressure
4 - Gravity 9 - Other: (describe) ________________________
5 – Kinetic
EQUIPMENT / MACHINE LOCATION ENERGY
TYPE(S)
PROCEDURE
(Y/N)
Date Inventory Completed:
Authorized Employee Signature:
F012 02.07.2023
Lockout/Tagout Periodic Inspection
The lockout/tagout – 1910.147 regulations were put in place by OSHA to help reduce the number of
accidents and injuries in the workplace. Many people were being hurt while working on heavy machinery,
because they did not properly disengage the power source before entering hazardous areas. Utilize below
language to perform adequate inspections:
Periodic inspection.
1910.147(c)(6)(i)
The employer shall conduct a periodic inspection of the energy control procedure at least annually to
ensure that the procedure and the requirements of this standard are being followed.
1910.147(c)(6)(i)(A)
The periodic inspection shall be perfomed by an authorized employee other than the ones(s) utilizing
the energy control procedure being inspected.
1910.147(c)(6)(i)(B)
The periodic inspection shall be conducted to correct any deviations or inadequacies identified.
1910.147(c)(6)(i)(C)
Where lockout is used for energy control, the periodic inspection shall include a review, between the
inspector and each authorized employee, of that employee's responsibilities under the energy
control procedure being inspected.
1910.147(c)(6)(i)(D)
Where tagout is used for energy control, the periodic inspection shall include a review, between the
inspector and each authorized and affected employee, of that employee's responsibilities under the
energy control procedure being inspected, and the elements set forth in paragraph (c)(7)(ii) of this
section.
1910.147(c)(6)(ii)
The employer shall certify that the periodic inspections have been performed. The certification shall
identify the machine or equipment on which the energy control procedure was being utilized, the
date of the inspection, the employees included in the inspection, and the person performing the
inspection.
F013 02.07.2023
Specific Energy Control Procedure
Complete one form for each type of equipment requiring LOTO. Place a copy on or near
the equipment to which it applies and keep a master copy on SharePoint.
Facility: ___________________________ Date: _______________
Authorized Person: _______________________ Job Title: __________________________
Equipment Description: ________________________________________________________
Manufacturer / Model No. / Serial No.: ____________________________________________
CONTROLS: (start/stop button, toggle switches, emergency button, shut-off valves, etc.)
CONTROL LOCATION ON EQUIPMENT
ISOLATION DEVICES:
Types of energy: ____Electric ____Chemical ____Steam ____Potential
____Pneumatic ____ Other: _______________________________
TYPE OF ENERGY LOCATION LOTO DEVICE USED
Type of Stored Energy: ___________________ Method to Dissipate: _________________
Type of Stored Energy: ___________________ Method to Dissipate: _________________
Type of Stored Energy: ___________________ Method to Dissipate: _________________
PROCEDURE:
1. Notify nearby workers (affected employees)
2. Review procedure and collect correct LOTO devices
3. Neutralize all energy sources including stored energy
4. Test to assure isolation of all energy sources
NOTES:
F014 02.07.2023
Lockout/Tagout Lock Assignment Log
LOCK NUMBER ASSIGNED TO DATE
F024 02.07.2023
Directions:
(1) Post this checklist on/near eyewash/shower station to use as a guideline while performing
monthly/quarterly/annual inspection/test (see below).
(2) Make corrections/repairs immediately, document them on the Safety Inspection Form.
(3) Date and initial the inspection tag on eyewash/shower unit.
EMERGENCY EYEWASH & SAFETY SHOWER INSPECTION CHECKLIST
DATE OF INSPECTION: ________________
Eyewash Monthly Yes No
Eyewash activated & flushed of contaminants (1 minute)
Activator lever remains open without holding it down (open & close lever 5 times)
Eyewash covers are present, clean, open & close properly
Water flow is soft/even and flowing properly from both eyepieces/nozzles
Emergency sign is posted
Area is well lighted
Access is unobstructed
Inspection tag is signed & dated
Shower Quarterly Yes No
Shower activated & flow is effective & continuous
Access is unobstructed
Activator lever/chain remains open without holding it down
Emergency sign is posted
Area is well lighted
Inspection tag is signed and dated
Eyewash Annual Yes No
Flow rate tested & exceeds 0.4 gpm or 1.5 lpm for eyewash only
Flow rate tested & exceeds 3.0 gpm or 11.4 lpm for eyewash/face combo unit
Tepid water temperature tested. Results =
Passed eyewash gauge test
Inspection tag signed & dated – (mark annual test)
Shower Annual Yes No
Flow rate tested & exceeds 20 gpm or 75.7 lpm
Tepid water temperature tested. Results = (combo units need only eyewash temp.)
Inspection tag signed & dated
F016 02.07.2023
F016 02.07.2023
F017 02.07.2023
Safety Inspection Form
LOCATION DATE CHECK LIST ITEMS
Public Works Proper Chemicals Storage AED
Police Department Eye Wash/Shower Unit(s) SDS Labels
City Hall Clear Electrical Panels Lighting
Log Cabin Fire Extinguishers Clear Walkways
Community Center No Blocked Doors / Halls First Aid Station(s)
Field House / Garage Solicit Employee Input(s) Floor Condition
Treatment Plant Ergonomic Observation(s) Carpet Condition
Wellhouse #1 General Housekeeping Slip/Trip/Fall Hazard(s)
Wellhouse #2 Sharps Container Guardrail(s)/Handrail(s)
Wellhouse #3 New Job Hazard Uncovered Elevator (Phase I & II)
MM Wellhouse Stairways / Ladder(s) 1st Aid Kit Disinfect & Stock
IB Wellhouse Lockout Tagout Observations
Notes / Other Items:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Inspection performed by: ___________________________
Original – Safety Director
F018 02.07.2023
Hepatitis B Consent Form
I __________________________________, have been informed of my right to receive three (3)
injections of Hepatitis B vaccine to prevent Hepatitis B infection. I have received bloodborne
pathogen training and understand the dangers of bloodborne pathogens.
I __________________________ this vaccination and accept all responsibilities of my decision.
(accept / decline*)
Dated: ____________ Employee Signature: _____________________________
Dated: ____________ Witness Signature: _______________________________
*employees who decline hepatitis B vaccination but at a later date while still covered under this
policy decide to accept the vaccination, the City shall make available, at no cost to the employee,
hepatitis B vaccination at that time.
Original – HR
Copy – Employee, Supervisor
F019 02.07.2023
Sharps Injury Log
Date Type, Brand, Model of Device Department Describe How the Incident
Occurred
F020 02.07.2023
Bloodborne Exposure Incident Form
Date: _____________ Time: _____________
______________________________ ______________________________
(Employee Name) (Potentially Hazardous Substance)
______________________________
(Witness)
______________________________
(Witness)
______________________________
(Witness)
Incident Location: ______________________________________________________________
Personal Protection Equipment Used: ______________________________________________
_____________________________________________________________________________
Circumstances: ________________________________________________________________
_____________________________________________________________________________
Action Taken: _________________________________________________________________
_____________________________________________________________________________
Recommendation for Prevention: __________________________________________________
______________________________________________________________________________
Date: _____________
Original – HR
Copy – Employee, Supervisor
F021 02.07.2023
Post-Exposure Evaluation Report for BBP Accident
Employee furnished with exposure information and documentation: Date: _____________
Source individual identification: Date: _____________
_____________________________________
(Name)
_____________________________________
(Street Address)
_____________________________________
City, State, Zip)
Source individual’s blood test results given to employee: Date: _____________
OR
Consent was not given __________________
Employee’s blood tested: Date: _____________
Employee given appointment with doctor: Date: _____________
______________________________ ______________________________
(Doctor’s Name) (Clinic or Hospital)
Documentation forwarded to doctor:
1. Copy of OSHA Bloodborne Standard _________
2. Employee’s job description _________
3. Incident description _________
4. Blood test results _________
5. Any pertinent medical records _________
Original – HR
Copy – Employee
F022 02.07.2023
Page 1 of 2
Workstation Ergonomics Request for Assessment
Complete and submit this form to Greg Leuer and Caitlyn Walker (the Assessment Team)
to help us evaluate any workstation problem areas and needed modifications. Submission
of this form is voluntary, and any information provided will be kept confidential.
Name: ______________________________________ Date: _________________
Department: ________________________ Supervisor: _______________________
Job Title: ___________________________ Total hours worked per week: __________
Do you regularly use a computer or telephone as part of your daily duties: ________________
Explain any discomfort you are currently experiencing: _________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Workstations: An individual workstation should provide the operator with a comfortable sitting
position sufficiently flexible to reach, use, and observe the screen, keyboard and any paper
document referred to while keying.
Posture Support: The seat and backrest of the chair should support a comfortable posture
permitting occasional variations in the sitting position. Chair height and backrest angle should be
easily adjustable. A footrest may be necessary to obtain the proper posture.
Arms: When using the keyboard, the upper arm and forearm should form a right angle. The
hands should be in a reasonably straight line with the forearm, using a wrist rest. Long or
unnaturally high reaches should be avoided. Armrest should also be avoided while keying.
Legs & Feet: The chair height is correct when the entire sole of the foot can rest on the floor or
on a footrest and the knee is level with or slightly higher than the hip. This allows blood to
circulate freely in the legs and feet.
Workstation Surface: The table or workstation should suit the task to be done. It should be
large enough for reference materials, files, telephone, calculator, or other necessary items and
also permit different positions of the screen and keyboard. An adjustable surface height is an
advantage.
F022 02.07.2023
Page 2 of 2
Workstation Ergonomics Request for Assessment
THIS PAGE TO BE COMPLETED BY ASSESSMENT COMMITTEE
Chair adjusted for good posture, back, neck & lumber support: __________________________
Head, neck, and torso comfortable and upright (not twisted): ____________________________
Front edge of chair does not touch behind knee: ______________________________________
Arms do not touch armrest while keyboarding: _______________________________________
Feet are flat on floor or footrest: ___________________________________________________
Thighs do not touch under desk or keyboard tray: _____________________________________
Adequate desk room for necessary work and items: ___________________________________
Adequate space for knees and legs under desk: _______________________________________
Trained in proper lifting procedures: _______________________________________________
Adequate lighting on and around desk: _____________________________________________
Lunch breaks of at least 30 minutes, preferably away from desk: _________________________
Personal AM and PM breaks of at least 10 minutes: ____________________________________
Additional Notes: _______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Committee Recommendation: _____________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
________________________________ ____________
Safety Director Signature Date
________________________________ ____________
Human Resources Signature Date Original – HR
Copy – Employee, Supervisor
Confined Space Entry Permit
F023 02.07.2023
Space Name: ______________________________________________________________________ Entry #: ____________________________________
Purpose of Entry: __________________________________________________________________ Permit Expires: ______________________________
Entry Date(s): ____________________________ Entry Time(s) : ____________________________ Rescue Information: ___________________________
Attendant(s): _____________________________ Entrants: _________________________________ Phone #: ____________________________________
_____________________________ _________________________________
Yes No Yes No
Oxygen deficiency (less than 19.5% at sea level)1. Respiratory Protection:1. Isolate the space
Toxic gases or vapors (greater than 10% of the
lower flammable limit or greater than 23.5%
oxygen at sea level
2. Protective Clothing/Equipment:2. Lockout
Toxic gases or vapors (greater than the
Permissible Exposure Limit)
3. Communication Equipment:3. Clean/Purge
Mechanical hazards
Electrical shock
Materials harmful to the skin
Engulfment
Configuration
Air Monitoring Results Air Monitoring Equipment Used ________________________________________________________________________________________
Check
when
provided
4. Rescue Equipment:
5. Ventilation:
6. Electrical Equipment:
4. Rescue Equipment
5. Ventilation
6. Other
Required Required
Hazard Controls (specify)Hazard Identification Yes No Equipment (specify)
Check
when
provided
Time AM
PM Time AM
PM Time AM
PM Time AM
PM Time AM
PM Time AM
PM Time AM
PM Time AM
PM
Oxygen Level min 19.50%
max 23.50%
Flammability 10% LEL
H2S 10 ppm
CO 25 ppm
SO2 2 ppm
Other (specify)_______
Authorization of Entry Supervisor Additional Instructions?Additional Permits?
Yes ___ No ___
If yes, list on back
Yes ___ No ___
If yes, list on back
Name: __________________________________ Date: _________ Phone#: ________________
F024 02.07.2023
Directions:
(1) Post this checklist on/near ladder storage area(s) to use as a guideline while performing
periodic inspections.
(2) Make corrections/repairs immediately, document them on the Safety Inspection Form.
(3) Date and initial the inspection tag on the ladder.
F025 02.07.2023
Training Sign-in Record
Course Name: __________________________________________________________
Date of Training: ____________________ Course Length: ____________________
Instructor(s): ___________________________________________________________
Print Name Signature Department
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Hot Work Permit
Seek an alternative/safer method if possible!
F025 02.07.2023
Before initiating hot work, ensure precautions are in place as required by OSHA Standard 29 CFR § 1910.146 (g) (k) and
Minn Rules 5207.0300-0304. Make sure an appropriate fire extinguisher is readily available.
This Hot Work Permit is required for any operation involving open flame or producing heat and/or sparks performed
outside of the Designated Area (Public Works Shop). This work includes, but is not limited to, welding, brazing, cutting,
grinding, soldering, thawing pipe, torch-applied roofing, or chemical welding.
Date: Time Started:
Time Completed:
Location/Building:
Work To Be Done: Name (print) and Signature of Permit Authorizing
Individual:
I verify that the above location has been examined, the precautions listed below have been taken, and permission is
granted for this work.
THIS PERMIT IS GOOD FOR ONE DAY ONLY
PRECAUTIONS:
Available sprinklers, hose streams, and extinguishers are in service and operable
Hot work equipment is in good working condition in accordance with manufacturer’s specifications.
Special permission obtained to conduct hot work on metal vessels or piping lined with rubber or plastic.
Requirements within 35 ft (11 m) of hot work
Flammable liquid, dust, lint, and oily deposits removed.
Explosive atmosphere in area eliminated.
Floors swept clean and trash removed.
Combustible floors wet down or covered with damp sand or fire-resistive/noncombustible materials or equivalent.
Personnel protected from electrical shock when floors are wet.
Other combustible storage material removed or covered with listed or approved materials (welding pads, blankets, or
curtains; fire-resistive tarpaulins), metal shields, or noncombustible materials.
All wall and floor openings covered.
Ducts and conveyors that might carry sparks to distant combustible material covered, protected, or shut down.
Requirements for hot work on walls, ceilings, or roofs
Construction is noncombustible and without combustible coverings or insulation.
Combustible material on other side of walls, ceilings, or roofs is moved away.
Requirements for hot work on enclosed equipment
Enclosed equipment is cleaned of all combustibles.
Containers are purged of flammable liquid/vapor.
Pressurized vessels, piping, and equipment removed from service, isolated, and vented.
Requirements for hot work fire watch and fire monitoring
Fire watch is provided during and for a minimum of 1 hour after hot work, including any break activity.
Fire watch is provided with suitable extinguishers and, where practical, a charged small hose.
Fire watch is trained in use of equipment and in sounding alarm.
Fire watch can be required in adjoining areas, above and below.
Respirator Fit Test Form
For additional record-keeping purposes, feel free to duplicate these forms.
4078
Employee Employee Number Title Date Issued
RESPIRATOR
Brand and Model Number Type NIOSH Approval Number
❐
❐
APPLICATION
LIMITATIONS ___ Beard ___ Denture ___Glasses ___None
Explain
FITTING ___ Satisfactory Qualitative Saccharin/Bitter Fit Test Instructions For Use—Reviewed:
___ Satisfactory Positive Pressure Fit Check Test ___ Donning and Removal
___ Satisfactory Negative Pressure Fit Check Test ___ Storage—Replacement Indicators
Employee Signature Date
Approval Signature Date
For additional record-keeping purposes, feel free to duplicate these forms.
Employee Employee Number Title Date Issued
RESPIRATOR
Brand and Model Number Type NIOSH Approval Number
❐
❐
APPLICATION
LIMITATIONS ___ Beard ___ Denture ___Glasses ___None
Explain
FITTING ___ Satisfactory Qualitative Saccharin/Bitter Fit Test Instructions For Use—Reviewed:
___ Satisfactory Positive Pressure Fit Check Test ___ Donning and Removal
___ Satisfactory Negative Pressure Fit Check Test ___ Storage—Replacement Indicators
Employee Signature Date
Approval Signature Date
MN FR01 (12/13) Employer: Send copies to Insurer (or Workers’ Compensation Division if no insurer), employee, and employee’s union (if applicable)
MN Department of Labor and Industry
Workers’ Compensation Division
PO Box 64221
St. Paul, MN 55164-0221
(651)284-5032 or 1-800-342-5354
Fax: (651) 284-5731
First Report of Injury
See Instructions on Reverse Side.
PRINT IN INK or TYPE
ENTER DATES IN MM/DD/YYYY FORMAT DO NOT USE THIS SPACE
1.EMPLOYEE SOCIAL SECURITY #2.OSHA Case #3.Time employee began
work on date of injury am
pm
4.DATE OF CLAIMED INJURY 5.Time
of injury
am
pm
6.Date of death # of dependents (if death
is related to injury)
7.EMPLOYEE Name (last, suffix, first, middle) 8.Gender
M F
9.Marital
status Married
Unmarried
10.Home address 11.Home phone #12.Date of birth 13. Date hired
City State Zip Code 14.Occupation 15.Regular department 16.Apprentice
Yes No
17.Average weekly wage 18.Rate per
hour
19.Hours per
day
20.Days per
week
Normal work schedule Sun – Sat
S M T W T F S
21.Employment
status (check all
that apply)
Full time
Seasonal
Part time
Volunteer
22.Tell us how the injury/illness occurred, what the employee was doing before the incident (give details), and what the injury/illness was. Examples: "Worker was driving
lift truck with a pallet of boxes when the truck tipped, pinning worker's left leg under drive shaft." "Worker developed soreness in left wrist over time from daily computer key entry."
23.What was the injury or illness (include the part(s) of body)? Examples:
chemical burn left hand, broken left leg, carpal tunnel syndrome in left wrist.
24.What tools, equipment, machines, objects, or substances were involved?
Examples: chlorine, hand sprayer, pallet lift truck, computer keyboard.
25.Did injury occur on employer’s premises?
Yes No
Name and address of the place of the occurrence
26.First date of any lost time 27. Employer paid for lost time on day of injury (DOI)
Yes No No lost time on DOI
28.Date employer notified of injury 29.Date employer notified of lost time
30.Return to work date 31.RTW same employer 32.RTW with restrictions
Yes No Yes No
33.Treating physician(name)34. Extent of medical treatment (check all that apply)
None Minor on-site by employer’s medical staff Minor clinic/hospital
Emergency room Hospitalization more than 24 hours
Future major medical anticipated
35.Certified Managed Care Organization (if any)
36.EMPLOYER Legal name 37.EMPLOYER DBA name (if different)
38.Mailing address 39.Employer FEIN 40.Unemployment ID #
City State Zip Code 41.Employer’s contact name and phone #
42.Physical address (if different)43. Witness (name and phone) – if more than 1 attach a separate sheet
City State Zip Code 44.NAICS code 45.Date form completed
46.INSURER name 51.CLAIMS ADMIN COMPANY (CA) name (check one) Insurer
TPA League of Minnesota Cities Insurance Trust Berkley Risk Administrators Company, LLC
47.Insured legal name and FEIN 52.CA Address
145 University Avenue West
48.Policy # (including effective dates) or self-insured certificate #City State Zip Code
St. Paul MN 55103-2044
49.Insurer FEIN 50.Date insurer received notice 53.CA FEIN 54.CA Claim #
41-6007047 0698639002
55.To be completed
by the CA:
Claim type code: Type of loss code: Late reason code: Salary paid in lieu of comp? Death result of injury?
LM 2510 (1/17)
GENERAL INSTRUCTIONS TO THE EMPLOYER
Employers, not employees, are responsible for completing this form. The information is needed to determine liability and entitlement to
benefits. You must file this form with your insurer, and give a copy to the employee and the employee’s local union office. You are required
to provide the employee with a copy of the Employee Information Sheet, which is available on the Department of Lab or and Industry’s
web site at www.dli.mn.gov.
Filing this form is not an admission of liability. You must report a claim to your insurer whenever anyone believes that a work-related
injury or illness that requires medical care or where lost time from work has occurred. If the claimed injury wholly or partially incapacitates
the employee for more than three calendar days, the claim must be made on this form and reported to your insurer within ten days. Your
insurer may require you to file it sooner. Failure to file within the ten days may result in penalties. It is important to file this form quickly to
allow your insurer time to investigate the claim. Your insurer will report the injury to the Department of Labor and Industry (Department),
when necessary. Self-insured employers have 14 days to report the injury to the Department, when necessary.
If the claim involves death or serious injury (including injuries that later result in death), you must notify the Department and your insurer
within 48 hours of the occurrence. The claim can be reported initially to the Department by telephone (651-284-5041), fax (651-284-
5731), or personal notice. The initial notice must be followed by the filing of this form with the Department within seven days of the
occurrence.
SEND THIS FORM TO YOUR INSURER IMMEDIATELY – DO NOT WAIT FOR THE DOCTOR’S REPORT
SPECIFIC INSTRUCTIONS TO THE EMPLOYER ON COMPLETING THIS FORM
x Item 2: OSHA case #. Fill in the case number from the OSHA 300 log. This form contains all items required by the OSHA form 301.
x Items 17-21: Fill in all the wage information. If the employee does not work a regularly scheduled work week, attach a 26 week wage
statement so your insurer can calculate the appropriate average weekly wage. Attach a separate sheet giving the weekly value of any
meals, lodging, or 2nd income paid to the employee.
x Item 20: Fill in the average number of days per week that the employee works. Also include their normal work schedule, Sunday -
Saturday, by checking the appropriate boxes. If the employee’s work schedule fluctuates from week-to-week, leave the boxes blank.
x Items 22-24: Be as specific as possible in describing: the events causing the injury; the nature of the injury (cut, sprain, burn, etc .),
and the part(s) of body injured (back, arm, etc.); and the tools, equipment, machines, objects or substances involved.
x Item 26: Fill in the first day the employee lost any time from work (including time lost for medical treatment), even if you paid the
employee for the lost time.
x Item 27: Check the appropriate box to indicate if there was lost time on the date of injury and whether you paid for that lost time.
x Item 28: Fill in the date you first became aware of the injury or illness.
x Item 29: Fill in the date you became aware that the lost time indicated in Item 26 was related to the claimed injury.
x Item 30: Leave the box blank if the employee has not returned to work by the time you file this form. If the employee has returned to
work, fill in the date and answer the questions in Items 31 and 32. Notify your insurer if the employee misses time due to this injury
after that date.
x Item 34: Check all the boxes that apply AT the time you file this form.
x Item 39: Fill in your Federal Employer Identification Number (FEIN). For information, see www.usa.gov/Business/Business-
Gateway.shtml and click on “Get an Employer ID Number”.
x Items 40 and 44: Fill in your Unemployment ID number and North American Industry Classification System (NAICS) code, which are
both assigned by the Minnesota Unemployment Insurance Program (651-296-6141).
x Items 46-54: Your insurer or claims administrator will complete this information if you do not have it available.
INSTRUCTIONS TO THE INSURER/CLAIMS ADMINISTRATOR
(For first reports of injury filed on or after Jan. 1, 2014)
Pursuant to Minnesota Statutes, section 176.231, and Minnesota Rules, part 5220.2530, insurers and self-insured employers must file with
the Department’s Workers’ Compensation Division an electronic first report of injury, according to the requirements set out in sections 2 to
4 of the Minnesota implementation guide, in all cases where a first report of injury is required to be filed under Minnesota Statutes, chapter
176. The Minnesota implementation guide can be found on the Department’s website at www.dli.mn.gov/WC/Edi.asp.
A first report of injury submitted by the insurer or self-insured employer in any other manner or format is not considered filed with the
division, except for a written first report of injury on a paper form filed by a self-insured employer within seven days of death or serious
injury.
If the claim does not involve lost time beyond the waiting period or potential permanent partial disability (PPD), or has not been requested
to be filed by the Department, a first report of injury does not need to be filed.
This material can be made available in different forms, such as large print, Braille or audio. To request, call (651) 284-5032 or 1-
800-342-5354 Voice or TDD (651) 297-4198.
ANY PERSON WHO, WITH INTENT TO DEFRAUD, RECEIVES WORKERS’ COMPENSATION BENEFITS TO WHICH THE PERSON
IS NOT ENTITLED BY KNOWINGLY MISREPRESENTING, MISSTATING, OR FAILING TO DISCLOSE ANY MATERIAL FACT IS
GUILTY OF THEFT AND SHALL BE SENTENCED PURSUANT TO SECTION 609.52, SUBDIVISION 3.
OSHA INFOSHEET
Respirator Medical Evaluation Questionnaire
Respirators must be used in workplaces in which employees are exposed to hazardous
airborne contaminants. When respiratory protection is required employers must have a
respirator protection program as specifed in OSHA’s Respiratory Protection standard
(29 CFR 1910.134). Before wearing a respirator, workers must frst be medically evaluated
using the mandatory medical questionnaire or an equivalent method. To facilitate these
medical evaluations, this INFOSHEET includes the mandatory medical questionnaire to be
used for these evaluations.
Medical Evaluation and
Questionnaire Requirements
The requirements of the medical evaluation and for
using the questionnaire are provided below:
• The employer must identify a physician or
other licensed health care professional (PLHCP)
to perform all medical evaluations using the
medical questionnaire in Appendix C of the
Respiratory Protection standard or a medical
examination that obtains the same information.
(See Paragraph (e)(2)(i).)
• The medical evaluation must obtain the
information requested in Sections 1 and 2, Part
A of Appendix C. The questions in Part B of
Appendix C may be added at the discretion of the
health care professional. (See Paragraph (e)(2)(ii).)
• The employer must ensure that a follow-
up medical examination is provided for any
employee who gives a positive response to
any question among questions 1 through 8 in
Part A Section 2, of Appendix C, or whose initial
medical examination demonstrates the need for
a follow-up medical examination. The employer
must provide the employee with an opportunity
to discuss the questionnaire and examination
results with the PLHCP. (See Paragraph (e)(3)(i).)
• The medical questionnaire and examinations
must be administered confdentially during the
employee’s normal working hours or at a time
and place convenient to the employee and in a
manner that ensures that he or she understands
its content. The employer must not review the
employee’s responses, and the questionnaire
must be provided directly to the PLHCP. (See
Paragraph (e)(4)(i).)
Excerpt from Appendix C of 29 CFR 1910.134:
OSHA Respirator Medical Evaluation Questionnaire
To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A, do not require a
medical examination.
To the employee: Your employer must allow you to answer this questionnaire during normal working hours, or
at a time and place that is convenient to you. To maintain your confdentiality, your employer or supervisor must
not look at or review your answers, and your employer must tell you how to deliver or send this questionnaire to
the health care professional who will review it.
Once flled out, this form must be given to the PLHCP. This form should not be submitted to OSHA.
1
YES NO
Part A Section 1. (Mandatory) The following information must be provided by every employee who has
been selected to use any type of respirator (please print).
1. Today's date:
2. Your name:
3. Your age (to nearest year):
4. Sex (circle one): Male/Female
5. Your height: ft. in.
6. Your weight: lbs.
7. Your job title:
8. A phone number where you can be reached by the health care professional who reviews this
questionnaire (include the Area Code):
9. The best time to phone you at this number:
10. Has your employer told you how to contact the health care professional who will review this
questionnaire (circle one): Yes/No
11. Check the type of respirator you will use (you can check more than one category):
a. ___ N, R, or P disposable respirator (filter-mask, non-cartridge type only).
b. ___ Other type (for example, half- or full-facepiece type, powered-air purifying, supplied-air,
self-contained breathing apparatus).
12. Have you worn a respirator (circle one): Yes/No If “yes,” what type(s):
Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who
has been selected to use any type of respirator (please circle “yes” or “no”).
1. Do you currently smoke tobacco, or have you smoked tobacco in the last month?
2. Have you ever had any of the following conditions?
a. Seizures
b. Diabetes (sugar disease)
c. Allergic reactions that interfere with your breathing
d. Claustrophobia (fear of closed-in places)
e. Trouble smelling odors
3. Have you ever had any of the following pulmonary or lung problems?
a. Asbestosis
b. Asthma
2
YES NO
YES NO
e.Swelling in your legs or feet (not caused by walking)
f.Heart arrhythmia (heart beating irregularly)
g.High blood pressure
h.Any other heart problem that you've been told about
6.Have you ever had any of the following cardiovascular or heart symptoms?
a.Frequent pain or tightness in your chest
b.Pain or tightness in your chest during physical activity
c.Pain or tightness in your chest that interferes with your job
d.In the past two years, have you noticed your heart skipping or missing a beat
e.Heartburn or indigestion that is not related to eating
f.Any other symptoms that you think may be related to heart or circulation problems
7.Do you currently take medication for any of the following problems?
a.Breathing or lung problems
b.Heart trouble
YES NO
c. Chronic bronchitis
d. Emphysema
e. Pneumonia
f. Tuberculosis
g. Silicosis
h. Pneumothorax (collapsed lung)
i. Lung cancer
j. Broken ribs
k. Any chest injuries or surgeries
l. Any other lung problem that you've been told about
4. Do you currently have any of the following symptoms of pulmonary or lung illness?
a. Shortness of breath
b. Shortness of breath when walking fast on level ground or walking up a slight hill
or incline
c. Shortness of breath when walking with other people at an ordinary pace on
level ground
d. Have to stop for breath when walking at your own pace on level ground
e. Shortness of breath when washing or dressing yourself
f. Shortness of breath that interferes with your job
g. Coughing that produces phlegm (thick sputum)
h. Coughing that wakes you early in the morning
i. Coughing that occurs mostly when you are lying down
j. Coughing up blood in the last month
k. Wheezing
l. Wheezing that interferes with your job
m. Chest pain when you breathe deeply
n. Any other symptoms that you think may be related to lung problems
5. Have you ever had any of the following cardiovascular or heart problems?
a. Heart attack
b. Stroke
c. Angina
d. Heart failure
3
YES NOf.Shortness of breath that interferes with your job g.Coughing that produces phlegm (thick sputum)h.Coughing that wakes you early in the morning i.Coughing that occurs mostly when you are lying down j.Coughing up blood in the last month k.Wheezing l.Wheezing that interferes with your job m.Chest pain when you breathe deeply n.Any other symptoms that you think may be related to lung problems 5.Have you ever had any of the following cardiovascular or heart problems?a.Heart attack b.Stroke
c.Angina
YES NO
YES NO
e. Swelling in your legs or feet (not caused by walking)
f. Heart arrhythmia (heart beating irregularly)
g. High blood pressure
h. Any other heart problem that you've been told about
6. Have you ever had any of the following cardiovascular or heart symptoms?
a. Frequent pain or tightness in your chest
b. Pain or tightness in your chest during physical activity
c. Pain or tightness in your chest that interferes with your job
d. In the past two years, have you noticed your heart skipping or missing a beat
e. Heartburn or indigestion that is not related to eating
f. Any other symptoms that you think may be related to heart or circulation problems
7. Do you currently take medication for any of the following problems?
a. Breathing or lung problems
b. Heart trouble
c. Blood pressure
d. Seizures
8. If you've used a respirator, have you ever had any of the following problems?
(If you've never used a respirator, check the following space and go to question 9.) £
a. Eye irritation
b. Skin allergies or rashes
c. Anxiety
d. General weakness or fatigue
e. Any other problem that interferes with your use of a respirator
9. Would you like to talk to the health care professional who will review this questionnaire
about your answers to this questionnaire?
Questions 10 to 15 below must be answered by every employee who has been selected to use either a
full-facepiece respirator or a self-contained breathing apparatus (SCBA). For employees who have been
selected to use other types of respirators, answering these questions is voluntary.
10. Have you ever lost vision in either eye (temporarily or permanently)?
11. Do you currently have any of the following vision problems?
a. Wear contact lenses
b. Wear glasses
c. Color blind
d. Any other eye or vision problem
4
YES NOc.Blood pressure d.Seizures
YES NO
YES NO
1.In your present job, are you working at high altitudes (over 5,000 feet) or in a place
that has lower than normal amounts of oxygen
If “yes,” do you have feelings of dizziness, shortness of breath, pounding in your
chest, or other symptoms when you're working under these conditions
2.At work or at home, have you ever been exposed to hazardous solvents, hazardous
airborne chemicals (e.g., gases, fumes, or dust), or have you come into skin contact
with hazardous chemicals
If “yes,” name the chemicals if you know them:____________, _______________, ______________.
3.Have you ever worked with any of the materials, or under any of the conditions, listed below:
a.Asbestos
b.Silica (e.g., in sandblasting)
c.Tungsten/cobalt (e.g., grinding or welding this material)
d.Beryllium
e.Aluminum
f.Coal (for example, mining)
g.Iron
h.Tin
i.Dusty environments
j.Any other hazardous exposures
If “yes,” describe these exposures: _____________________________________
4.List any second jobs or side businesses you have:
YES NO
12. Have you ever had an injury to your ears, including a broken eardrum?
13. Do you currently have any of the following hearing problems?
a. Difficulty hearing
b. Wear a hearing aid
c. Any other hearing or ear problem
14. Have you ever had a back injury?
15. Do you currently have any of the following musculoskeletal problems?
a. Weakness in any of your arms, hands, legs, or feet
b. Back pain
c. Difficulty fully moving your arms and legs
d. Pain and stiffness when you lean forward or backward at the waist
e. Difficulty fully moving your head up or down
f. Difficulty fully moving your head side to side
g. Difficulty bending at your knees
h. Difficulty squatting to the ground
i. Climbing a flight of stairs or a ladder carrying more than 25 lbs .
j. Any other muscle or skeletal problem that interferes with using a respirator
This infosheet does not include the questions in
Part B because they are not mandatory; rather, they
may be added to the questionnaire at the discretion
of the health care professional who will review the
questionnaire.
Labor, 200 Constitution Avenue, N.W., N-3101,
Washington, DC 20210. Telephone (202) 693-1888
or fax to (202) 693-2498.
Contacting OSHA
To report an emergency, fle a complaint or
seek OSHA advice, assistance or products, call
(800) 321-OSHA (6742) or contact your nearest
OSHA regional, area, or State Plan offce; TTY:
1-877-889-5627.
OSHA Educational Materials
OSHA has an extensive publications program.
For a listing of free items, visit OSHA’s web site
at www.osha.gov/publications or contact the
OSHA Publications Offce, U.S. Department of
This InfoSheet is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well
as descriptions of mandatory safety and health standards. The recommendations are advisory in nature, informational in
content, and are intended to assist employers in providing a safe and healthful workplace. The Occupational Safety and
Health Act requires employers to comply with safety and health standards and regulations promulgated by OSHA or by a
state with an OSHA-approved state plan. In addition, the Act’s General Duty Clause, Section 5(a)(1), requires employers to
provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm.
U.S. Department of Labor DT
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Resolution No. 2023-XX
February 7, 2023
Member ____ introduced the following resolution and moved its adoption:
CITY OF MEDINA
RESOLUTION NO. 2023-XX
RECOGNIZING ERIN BARNHART FOR FIFTEEN YEARS
OF SERVICE TO THE CITY OF MEDINA
WHEREAS, Erin Barnhart has been a valued full time City of Medina employee in the
Finance Department of the City since February 1, 2008; and
WHEREAS, Erin has served as the Accountant and Assistant Finance Director at the City
of Medina and has served as the Finance Director since January 1, 2015; and
WHEREAS, Erin has created financial management policies/procedures and helped to
implement modern technological tools to improve the City’s financial stability, accountability,
quality control, and customer service; and
WHEREAS, Erin procured a Aa1 rating for the City and through strategic bond planning
has enabled the City to qualify for Conduit Bond financing on three occasions; and
WHEREAS, Erin oversees the City’s Capital Improvement Plan, bonding, debt service, the
Financial Management Plan, project assessments, and other effective strategies for long-term fiscal
planning; and
WHEREAS, Erin produces all quarterly, semi-annual and annual reports required by
Hennepin County, the State of Minnesota, Office of the State Auditor, Department of the
Treasury, Department of Justice and Internal Revenue Service; and
WHEREAS, Erin manages funding for road reconstructions/overlays, numerous utility
upgrades, and managed over $700,000 in CARES Act funds due to the COVID-19 pandemic; and
WHEREAS, Erin implemented an inventory of electronic equipment for remote working
during COVID-19 shutdowns and an inventory of safety supplies at each facility, which was
essential for staff and returning to work safely; and
WHEREAS, Erin’s exceptional work with the annual budget/creating base budget
information and audit preparation/completion has resulted in multiple years of general fund
surpluses; and
WHEREAS, the City of Medina expresses sincere gratitude for Erin’s dedication and
continued service to the Medina community.
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Medina
acknowledges and thanks Erin Barnhart for fifteen years of service to the community.
Dated: February 7, 2023.
Agenda Item # 7A
Resolution No. 2023-XX
February 7, 2023 2
Kathy Martin, Mayor
ATTEST:
Caitlyn Walker, City Clerk
The motion for the adoption of the foregoing resolution was duly seconded by member ______
and upon vote being taken thereon, the following voted in favor thereof:
And the following voted against same:
Whereupon said resolution was declared duly passed and adopted.
Loram/Scannell Page 1 of 1 February 7, 2023
Pre Plat and Site Plan Review City Council Meeting
TO: Mayor Martin and Members of the City Council
FROM: Dusty Finke, Planning Director
DATE: February 2, 2023
MEETING: February 7, 2023 City Council
SUBJECT: Loram/Scannell Properties – Preliminary Plat, Site Plan Review, CUP -
PIDs 1111823230001, 1111823220003, and 1111823210005
Background
At the January 17, 2023 meeting, the City Council reviewed the
proposed preliminary plat and site plan review for the Loram/Scannell
warehouse project east of Arrowhead Drive, south of Loram’s existing
facility.
The City Council discussed what should be required in terms of land or
cash-in-lieu at some length during review. The primary point of
discussion was whether to require dedication of property over a portion
of the eastern lot for a potential location for the Diamond Lake Regional Trail.
Following review, the Council directed staff to prepare approval documents and to discuss
potential park dedication options with the Applicant and Three Rivers Park District.
Staff has begun to engage with Three Rivers and reached out to Loram, but anticipates
discussions may take some time. The City does not need to make a final determination on park
dedication until the time of final plat review.
As such, staff recommends that the City Council act on the preliminary plat application and site
plan review/CUP at this time. Staff will continue to analyze options related to park dedication
and report back to the Council at the time of final plat.
Recommended Actions
1. Motion to adopt the resolution granting preliminary plat approval for Loram Industrial
Addition.
2. Motion to adopt the resolution granting site plan review and conditional use permit for
Loram Industrial Addition.
MEMORANDUM
Proposed construction:
3 buildings, 396,000 s.f.
Subdivision: Four lots
Area: 43 acres
Future Land Use: Business
Staging: 2018
Zoning: Industrial Park (IP)
Agenda Item #8A
Resolution No. 2023-##
February 7, 2023
ME230-776-854329.v1
Member _________ introduced the following resolution and moved its adoption:
CITY OF MEDINA
RESOLUTION NO. 2023-##
RESOLUTION GRANTING PRELIMINARY PLAT APPROVAL FOR
LORAM INDUSTRIAL ADDITION
WHEREAS, the city of Medina (the “City”) is a municipal corporation, organized and
existing under the laws of Minnesota; and
WHEREAS, Loram Maintenance of Way, Inc. (the “Owner”) owns certain property
located east of Arrowhead Drive and south of Highway 55 (the “Property”), which is legally
described in Exhibit A, attached hereto; and
WHEREAS, Scannell Properties (the “Applicant”) has requested preliminary approval of
a plat to subdivide the Property into four lots for industrial/commercial development and two
outlots to contain common improvements and space; and
WHEREAS, the preliminary plat is tentatively proposed to be called Loram Industrial
Addition; and
WHEREAS, on October 11, 2023, the Planning Commission held a duly noticed public
hearing, reviewed the information provided by the Applicant and City staff, heard testimony from
interested parties, and recommended approval of the preliminary plat subject to a series of terms
and conditions; and
WHEREAS, on January 17, 2023, the City Council reviewed the proposed preliminary
plat, considered the recommendation of the Planning Commission and heard additional testimony;
and
WHEREAS, subject to the fulfillment of the conditions noted below, the City Council
makes the following findings of fact regarding the preliminary plat based on the requirements of
the Subdivision Ordinance:
a. The proposed preliminary plat is not in conflict with the Comprehensive Plan and is not
premature for consideration.
b. The subdivision is appropriate for the physical conditions on the site including the
topography, storm water, natural resources, and soils.
c. That the site is physically suitable for the proposed density of development and meets
minimum lot size standards.
d. The proposed subdivision is not likely to cause substantial environmental damage.
e. The proposed subdivision is not likely to be injurious to public health.
f. The proposed subdivision and its improvements will not conflict with public or private
streets, easements, or right-of-ways.
Resolution No. 2023-## 2
February 7, 2023
NOW, THEREFORE BE IT RESOLVED, that the City Council of Medina, Minnesota
hereby grants preliminary plat approval for Loram Industrial Addition, subject to the following
terms and conditions:
1) The Applicant shall enter into a development agreement with the City, which shall include
the conditions described below as well as other requirements by City ordinance or policy.
2) The Applicant shall install all improvements shown on the plans dated 11/21/2022 and
landscaping plans dated 12/27/2022, except as may be modified herein. The design of all
improvements shall be subject to review and approval by the City Engineer prior to
construction.
3) The Applicant shall satisfy park dedication requirements as determined by the City
Council at the time of final plat application and in accordance with relevant regulations.
Park dedication may, at the discretion of the City Council, include dedication of land for
park and trail or other permissible purposes, cash-in-lieu of land dedication, or a
combination of land and cash as authorized in the City’s subdivision ordinance and fee
schedule.
4) The plat shall dedicate drainage and utility easements as recommended by the City
Engineer, including but not limited to, adjacent to the perimeter of the lots, over all water
mains and hydrants, over stormwater improvements, and over all wetland areas.
5) The plat shall be subject to the City’s wetland protection ordinance, including provision of
minimum required upland buffers adjacent to wetlands on the site and vegetation
establishment, and the Developer shall execute and record a Wetland Buffer Easement
Agreement in a form and of substance acceptable to the City Attorney.
6) The Applicant shall execute and record access easements or other instruments in a form
and of substance acceptable to the City Attorney to provide adequate access and
circulation between the lots to accommodate the Applicant’s proposed integrated
development.
7) The Applicant shall execute and record a Stormwater Maintenance Agreement in a form
and of substance acceptable to the City Attorney to describe the responsibility of the
property owners to maintain the private stormwater improvements.
8) Sewer and watermain improvements within the lots shall be privately maintained. The
mains along the southern property line shall be dedicated as public improvements upon
completion.
9) The Applicant shall address the comments of the City Engineer and the Applicant shall
submit updated plans prior to or at the time of final plat application which address the
comments.
10) The Applicant shall update plans and construct turn lane improvements on Arrowhead
Drive, as recommended by Hennepin County Transportation, as part of the subdivision
improvements.
11) The plat shall be updated to dedicate right-of-way with a width of 70’ along the east of Lot
1, Block 2.
12) No development or construction is proposed or approved upon Lot 1, Block 2 at this time.
Development or construction upon Lot 1, Block 2 shall be expressly conditioned upon
construction of roadway improvements to the satisfaction of the City which provide access
to the parcel.
13) The Applicant shall submit a letter of credit in an amount of 150% of the cost of site
improvements prior to commencing construction in order to ensure completion.
Resolution No. 2023-## 3
February 7, 2023
14) The Applicant shall provide title documentation at the time of final plat application and
abide by the recommendations of the City Attorney with regard to title matters.
15) The Applicant shall obtain all permits required by Elm Creek Watershed District, Minnesota
Department of Transportation, the Minnesota Department of Health, the Minnesota
Pollution Control Agency, the Metropolitan Council and any other relevant agencies.
16) The final plat application shall be filed within 180 days of the date of the resolution
granting preliminary approval or the approval shall be considered void unless a written
request for time extension is submitted by the applicant and approved by the City Council.
17) The Applicant shall pay to the City a fee in an amount sufficient to reimburse the City for
the cost of reviewing the preliminary plat, construction plans, and other relevant
documents.
Dated: February 7, 2023.
By: ______________________
Kathleen Martin, Mayor
Attest:
By: ___________________________
Caitlyn Walker, City Clerk
The motion for the adoption of the foregoing resolution was duly seconded by member ________
and upon vote being taken thereon, the following voted in favor thereof:
And the following voted against same:
Whereupon said resolution was declared duly passed and adopted.
Resolution No. 2023-## 4
February 7, 2023
EXHIBIT A
Legal Description of the Property
Resolution No. 2023-##
February 7, 2023
Member _________ introduced the following resolution and moved its adoption:
CITY OF MEDINA
RESOLUTION NO. 2023-##
RESOLUTION GRANTING SITE PLAN REVIEW AND CONDITIONAL USE PERMIT
APPROVAL FOR LORAM INDUSTRIAL ADDITION
WHEREAS, the city of Medina (the “City”) is a municipal corporation, organized and
existing under the laws of Minnesota; and
WHEREAS, Loram Maintenance of Way, Inc. (the “Owner”) owns certain property
located east of Arrowhead Drive and south of Highway 55 (the “Property”), which is legally
described in Exhibit A, attached hereto; and
WHEREAS, Scannell Properties (the “Applicant”) has requested site plan review and a
conditional use permit for an integrated development of three buildings totaling approximately
396,000 square feet of warehouse/office space on the Property; and
WHEREAS, a conditional use permit is required due to the proposed warehousing
within the City’s IP zoning district; and
WHEREAS, on October 11, 2023, the Planning Commission held a duly noticed public
hearing, reviewed the information provided by the Applicant and City staff, heard testimony from
interested parties, and recommended approval of the site plan review and conditional use permit
subject to a series of terms and conditions; and
WHEREAS, on January 17, 2023, the City Council reviewed the proposed site plan review
and conditional use permit, considered the recommendation of the Planning Commission and heard
additional testimony; and
WHEREAS, on February 7, 2023, the City Council granted preliminary approval of the
Loram Industrial Addition plat, which would create the lots on which the proposed site plan review
and conditional use permit are proposed; and
WHEREAS, subject to the fulfillment of the conditions noted below, the City Council has
determined that the proposed development is consistent with relevant City requirements and finds
that the use meets the requirements for conditional use permits as described in Sections 825.39
and 833.07 Subd. 3(l) of the City Code.
Resolution No. 2023-## 2
February 7, 2023
NOW, THEREFORE BE IT RESOLVED, that the City Council of Medina, Minnesota
hereby grants site plan review and conditional use permit approval, subject to the following
terms and conditions:
1) This site plan review and conditional use permit approval shall be contingent upon final
approval and recordation of the Loram Industrial Addition plat.
2) The Applicant shall implement the Wetland Replacement Plan related to the proposed
wetland impacts.
3) The Applicant shall install all improvements shown on the plans dated 11/22/2022 and
landscaping plans dated 12/27/2022 except as may be modified herein. The design of all
improvements shall be reviewed and approved by the City Engineer prior to commencing
construction.
4) The Applicant shall abide by the requirements of the wetland protection ordinance,
including installation of vegetative buffers, recordation of easements, and installation of
signage, and the Developer shall execute and record a Wetland Buffer Easement Agreement
in a form and of substance acceptable to the City Attorney.
5) It is acknowledged that proposed parking is intended to accommodate warehousing as the
principal and predominant use. Other uses shall not exceed 15% of Lot 1, Block 1, 20% of
Lot 2, Block 1, or 10% of Lot 3, Block 1 unless the applicant has provided evidence
satisfactory to City staff, that adequate parking exists for the use.
6) It is acknowledged that the amount of parking, anticipated site layout, and projected uses on
the site result from direct action of the Applicant and Owner for the sake of any future
variance request.
7) No loading docks shall be permitted within 300 feet of the eastern property line of Lot 3,
Block 1 of the preliminary plat. Based upon the footprint of the building shown on the plans
dated 11/22/2022, no loading dock shall be permitted on the eastern 50 feet of the building.
8) The Applicant shall increase landscaping adjacent to the buildings, including through
reducing sidewalk width to the extent possible.
9) All parking lot and landscape lighting shall be downcast and shielded.
10) The Applicant shall provide information on transformer, meter, and HVAC equipment and
provide screening measures for review and approval. Any rooftop equipment shall be
screened with elements which are compatible with the architectural design of the building,
to the satisfaction of City staff.
11) All comments from the Elm Creek Watershed District shall be addressed.
12) All comments from the City Engineer shall be addressed.
13) All trash and recycling shall be stored within the buildings. If storage is proposed outside
the building, location and enclosure shall be submitted for review and approved by staff for
consistency with IP standards prior to storing outside.
14) Outside storage shall be limited to the areas identified on the site plan within the loading
dock area of Lot 2, Block 1 of the preliminary plat. No outdoor storage shall be permitted
on Lots 1 or 3, Block 1 unless specifically proposed and approved by the City as part of a
Site Plan Review. The height of the storage shall not exceed 10 feet.
15) The Applicant shall update plans to identify bicycle storage areas.
16) The Applicant shall install signage to be approved by City staff and take other measures to
encourage trucks and most vehicles to utilize the northern shared access.
Resolution No. 2023-## 3
February 7, 2023
17) The site plan review approval for buildings on Lots 1 and 2, Block 1 shall be effective for
one year and thereafter shall be considered null and void. Site plan approval for building on
Lot 3, Block 1 shall be effective for three years and thereafter shall be considered null and
void.
18) The Applicant shall obtain necessary permits from the City, Hennepin County, Elm Creek
Watershed, Minnesota Department of Health, Minnesota Pollution Control Agency,
Metropolitan Council, and any other relevant agency prior to commencing construction
activity on the Property.
19) The Applicant shall pay to the City a fee in an amount sufficient to reimburse the City for
the cost of reviewing the preliminary plat, site plan review, and related documents.
Dated: .
By: ______________________
Kathleen Martin, Mayor
Attest:
By: ___________________________
Caitlyn Walker, City Clerk
The motion for the adoption of the foregoing resolution was duly seconded by member ________
and upon vote being taken thereon, the following voted in favor thereof:
And the following voted against same:
Whereupon said resolution was declared duly passed and adopted.
Resolution No. 2023-## 4
February 7, 2023
EXHIBIT A
Legal Description of the Property
Lots 1-3, Block 1, Loram Industrial Addition, Hennepin County, Minnesota
Resolution No. 2023-##
DATE
Member _________ introduced the following resolution and moved its adoption:
CITY OF MEDINA
RESOLUTION NO. 2023-##
RESOLUTION GRANTING EXTENSION OF TIME TO RECORD
HAMEL TOWNHOMES PLAT; AMENDING RESOLUTION NO. 2022-64
WHEREAS, on August 16, 2022, the city of Medina adopted Resolution 2022-64, granting
final approval to Hamel Townhomes, LLC (the “Applicant”) of the plat of Hamel Townhomes; and
WHEREAS, under the terms of said resolution, the plat was required to be recorded within
180 days of adoption of the resolution or the approval was to be considered void, unless a written
request for time extension is submitted by the Applicant and approved by the City Council; and
WHEREAS, the Applicant has requested an extension of time to record the plat.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Medina,
Minnesota, as follows:
1. The plat shall be recorded by August 11, 2023 or the approval shall be considered
void, unless a written request for time extension is submitted by the applicant and
approved by the City Council.
2. The Applicant shall provide updated title documentation to the satisfaction of the City
Attorney and abide by any updated comments and recommendations of the City
Attorney related to the plat opinion, title issues and recording procedures.
3. Except as explicitly stated above, all terms and conditions of Resolution 2022-64 are
hereby reaffirmed.
Dated:
Kathleen Martin, Mayor
ATTEST:
Caitlyn Walker, City Clerk
Agenda Item #9A
Resolution No. 2023-##
DATE
2
The motion for the adoption of the foregoing resolution was duly seconded by member _____
upon vote being taken thereon, the following voted in favor thereof:
And the following voted against same:
Whereupon said resolution was declared duly passed and adopted.
Planning Department Update Page 1 of 2 February 7, 2023
City Council Meeting
TO: Mayor Martin and Members of the City Council
FROM: Dusty Finke, Planning Director
DATE: February 2, 2023
MEETING: February 7, 2023 City Council
SUBJECT: Planning Department Updates
Land Use Application Review
A) Loram/Scannell Medina Industrial – Loram and Scannell have submitted materials for the City
to prepare an EAW for a warehouse/industrial development east of Arrowhead Drive, south of
Highway 55, to the south of Loram’s existing facility. The council approved the findings of fact
and made a negative declaration on the need for an EIS at the April 5 meeting. Staff will route
the record of decision as required. The applicant has now also applied for preliminary plat and
site plan review approval for construction of approximately 398,000 s.f. of office warehouse on
three lots. The Planning Commission held a public hearing at their August 10 and October 11
meetings and recommended approval on a 4-2 vote. The City Council reviewed at the January 17
meeting and directed staff to prepare resolutions of approval, which will be presented at the
February 7 meeting.
B) Pioneer Highlands Final Plat – Onyx Investments has requested final plat approval of a four-lot
rural subdivision located south of Pioneer, east of Willow Drive. Staff intended to present to City
Council on January 17, 2023, but the applicant has requested delay. Staff will present to Council
when the applicant is prepared, tentatively at the February 21 meeting.
C) 562 Hwy 55 lot combination – Arul Jothi Ramalingam has requested to combine property at 562
Hwy 55 with an adjacent separate 16.5’ wide strip of property they own to the east.
D) Meander Park and Boardwalk – Meander Rd, east of Arrowhead Dr – Medina Ventures had
requested PUD General Plan and Preliminary Plat approval for a development to include four
residential units north of Meander Rd, and commercial uses south of Meander Rd including a
venue, restaurant, daycare, and speculative retail space. The City Council granted PUD general
plan and preliminary plat approval on January 17. Staff will await final plat application.
E) Cates Ranch/Willow Drive Warehouse Industrial – Comprehensive Plan Amendment– Oppidan
has submitted a concept plan review for a 310,000 square foot warehouse/office development
east of Willow Drive, north of Chippewa Road. The applicant is requesting feedback prior to
proceeding with full design of their project. The Planning Commission reviewed and provided
comments on October 11 and Council reviewed on October 18. Staff will await formal
application.
F) BAPS Site Plan Review – 1400 Hamel Road – BAPS Minneapolis Medina has requested an
amendment to their approved site plan review. The applicant has submitted updated architectural
information based on the City’s updated regulations pertaining to architectural elements. The
applicant has also proposed minor adjustments to the site layout previously approved. The
Council reviewed at the November 9 meeting and recommended approval. The Council
approved the amended Site Plan Review at the December 6 meeting. The applicant has indicated
that they intend to start construction during the spring of 2023.
G) Adam’s Pest Control Final Plat – Jan Har LLC has requested final plat approval for a two lot
subdivision for development of an office north of Hwy 55 and west of Willow Drive. The
property owner to the east of the site has not agreed to provide right-of-way, so the applicant
MEMORANDUM
Planning Department Update Page 2 of 2 February 7, 2023
City Council Meeting
proposes access directly to Highway 55. Council granted final approval at the September 20
meeting. Construction is underway.
H) 500 Hamel Road Apartment Concept Plan – Medina Apartments LLC has requested review of a
concept plan review for development of a 97-unit apartment building at 500 Hamel Rd. The
Planning Commission held a public hearing at their August 10 meeting and Council provided
comments on August 16. The developer met with neighbors on September 12 and the parties
have indicated that they will meet again to discuss the project.
I) Hamel Townhomes Final Plat – 342 Hamel Rd – Hamel Townhomes, LLC has requested final
plat approval for a 30-unit townhome development. The Council granted final plat approval on
August 16. Staff will work with the applicant to finalize documents prior to beginning of
construction.
J) Ditter Heating and Cooling Site Plan Review – 820 Tower Drive – Ditter Heating and Cooling
has requested a Site Plan Review for an approximately 5,000 square foot addition to its building.
The application is incomplete for review and will be scheduled for a hearing when complete.
K) Pioneer Trail Preserve – This project has been preliminarily approved and the City is awaiting
final plat application.
L) Johnson ADU CUP, St. Peter and Paul Cemetery – The City Council has adopted resolutions
approving these projects, and staff is assisting the applicants with the conditions of approval in
order to complete the projects.
Other Projects
A) Permit/Planning Technician hiring – staff conducted interviews with applicants and is happy
to recommend hiring Maria Rucke to join the team. Staff will request Council approval at the
February 7 meeting.
B) Permit software implementation – staff continues to work with OpenGov to set up the system.
C) Hackamore Road – Staff will present information on easement acquisition to the Council at a
closed session at the February 7 meeting.
D) Uptown Hamel – staff met with property owners and WSB staff to discuss conceptual
development sketches that are part of the project.
TO: Honorable Mayor and City Council
FROM: Jason Nelson, Director of Public Safety
DATE: February 2, 2023
RE: Police Department Updates
Our office has been busy wrapping up mandated annual reporting to various agencies. All training is
tracked to ensure that officers have the mandated classes taken for their professional licenses. We are
mandated to take 48 hours of continuing education every three years to renew police officer licenses.
We have received all nine (9) Automated External Defibrillators (AEDs) from the Minnesota Center
for Resuscitation Medicine on a grant which allowed us to partner with the University of Minnesota.
With the grant, we have replaced all the police department AEDs and moved some of the replaced
units to city hall and the community center. The benefits of the new AEDs are that they are connected
to our squad car WIFI, which ensures that the units are always ready, and provide an easy upload for
training and development. As a second piece to this, the U of M will roll out a first of its kind
Extracorporeal Membrane Oxygenation truck (ECMO). This ECMO truck is basically a mobile
emergency room that assists patients who are not receptive to electric shocks from defibrillators or
CPR. The ECMO truck has the capabilities to pump a patient’s blood out, oxygenate it and pump it
back into the body, essentially doing the work of the heart and lungs. Statistics show that patients with
out-of-hospital cardiac arrest have a very low survival rate and the vision is that by utilizing the
ECMO truck those survival rates will go up. The ECMO truck was recently featured in an article in
the Crow River News.
This past Saturday, we conducted our annual basic first aid refresher at the police department. North
Memorial comes out to our agency and provides this annual training so that our officers can keep up
their Basic First Aid certificates. In our agency, our Reserves and CSOs, along with officers, are all
certified in Basic First Aid. We also have several others who are certified Emergency Medical
Technicians which is the next level up from the Basic First Aid. The role of the first responders is to
provide that initial care when responding to calls until our area ambulance services arrive. Our police
and fire do a great job providing that initial care and relay information to Dispatch so that the
ambulance is kept up to date as to what is going on real time prior to their arrival.
Investigator Scharf and Officer Hall went to Alexandria Technical College on February 2nd for their
annual job fair. This is the first time our agency has ever participated in a job fair, and the hope is to
get our agency’s information directly in front of future police officer candidates who will be
graduating soon.
Patrol:
The following are updates of Patrol Officers between January 10, 2023, and January 31, 2023:
Citations – 48 Warnings – 93 PD Accidents – 4
Medicals – 24 Suspicion Calls – 5 Traffic Complaints – 5
Assist Other Agencies – 10 Alarms – 13 Welfare Checks - 7
On 01/11/2023 at 0915 hours an Officer was dispatched to a theft report at Holiday, 200 Highway 55.
The officer learned from management that they suspect an employee had stolen $350 by placing funds
on a gift card and not depositing any money into the register. The case was forwarded to
Investigations for follow up.
On 01/11/2023 at 1641 hours officer was dispatched to a report of an unconscious person at Oaklee of
Medina. Upon arrival it was learned an employee had become dizzy while leaving and had passed out
in the parking lot and believed to hit their head. When responders arrived, the patient was conscious.
North Ambulance arrived and officers were cleared. Assisted by Hamel Fire Rescue. Unknown if
transported.
On 01/12/2023 at 1613 hours officers were dispatched to a welfare check at the Hillcrest Apartments
in Loretto. A business owner reported an employee had not shown up for work for the past week and
was believed to live in an apartment at that address. Upon arrival officers learned from other tenants
that the person in question no longer lived there and possibly moved to Wright County. Wright
County Sheriff’s Office was advised.
On 01/12/2023 at 2153 hours officers were called to a suspicious vehicle/person in the 600 block of
Shawnee Woods Road. A resident reported that someone’s vehicle became stuck at the end of their
driveway. When they went out to see if the person needed assistance and the person refused. Upon
arrival by officers the vehicle was found unoccupied but blocking the driveway of the resident. An
officer made contact with the registered owner by phone who sounded intoxicated and insinuated the
vehicle may have been stolen. Officers later made contact with the spouse of the registered owner
who said her husband had called her saying his vehicle got stuck and he was on his way home in an
Uber. The vehicle was impounded.
On 01/18/2023 at 2256 hours officer was dispatched to a runaway in the 500 block of Clydesdale
Circle. Upon arrival the officer learned that a 14-year-old had left the residence after a disagreement
with parents. Parents and officers were unable to make contact with the juvenile by phone who was
believed to have gone to an unknown friend’s house. The juvenile was entered as a runaway. Around
0351 hours the officer was notified by the parent that they had made contact with their son and were
on their way to pick him up.
On 01/19/2023 at 1600 hours officer was dispatched to a theft report at Target. An employee of the
School of Rock reported their wallet was lost and discovered fraudulent charges at businesses in
Minneapolis. He believed he forgot his wallet inside Target but was unsure. All fraudulent charges
were reversed by the credit card companies.
On 01/21/2023 at 1400 hours officers were dispatched to a report of one unconscious person at the
Choo Choo Bar in Loretto. It was later updated that they believed the 80-year-old patient was possibly
having a stroke. The patient was having lunch with friends when he suddenly collapsed at the table.
The patient was conscious when first responders arrived but unable to communicate. Assisted by
Loretto Fire Rescue. He was transported to the hospital by North Ambulance.
On 01/21/2023 at 2230 hours officers were dispatched to an apartment fire at the Hillcrest Apartments
in Loretto. A tenant had been about to deep fry some chicken when the pot caught on fire. Upon
arrival heavy smoke was coming out the front doors of the apartment complex. All residents were
evacuated, and the fire was contained and quickly extinguished by Loretto Fire Department. Several
residents were transported to the Loretto Fire Department to wait due to cold temperatures at the time
and after several hours were allowed back to their apartments.
On 01/27/2023 at 0624 hours officer was dispatched to Oaklee of Medina on a report of a deceased
resident. Upon arrival the officer learned that a resident in the memory care was not breathing and had
recently been diagnosed with COVID. The patient had a DNR order in place, so no lifesaving
measures were attempted. The Hennepin County Medical Examiner was notified.
On 01/27/2023 at 2250 hours an officer stopped a speeding vehicle on County Road 101. Upon
making contact with the driver, the officer could smell the odor of alcohol coming from inside the car
although the driver denied having anything to drink. The officer requested the driver to submit to field
sobriety tests which they failed and were placed under arrest for DWI. The driver submitted to a
breath test which showed a BAC of .17.
Investigations:
Murder investigation tentatively completed, and the case has been completely submitted to the
Hennepin County Attorney’s Office.
Completed an investigation into $4,500 theft of cigarettes at a convenience store. One suspect
identified. Forwarded for charges.
Received a child protection report. Investigation on-going.
Received a fraud report involving stolen checks. Investigation on-going.
Completed the setup and issuance of the new AEDs to all squad cars.
Attended a job fair on behalf of the police department at the Alexandra Technical & Community
College.
There are currently 9 cases assigned to investigations.
1
TO: Mayor and City Council Members
FROM: Steve Scherer, Public Works Director
DATE: February 1, 2023
MEETING: February 7, 2023
SUBJECT: Public Works Update
STREETS
• Staff held an open house this week on the Clydesdale Trail street project. Although
we reached out to all stake holders, very few participants showed up. The
preliminary assessment was shared with the stake holders who came to the open
house, and it is Staff’s recommendation not to exceed these numbers. We are calling
for the improvement hearing at the February 7th City Council meeting to move
forward in the process. If Staff or Council decide the benefit appraisal is necessary,
we will still have time prior to the assessment hearing to complete the appraisal.
• The material bids are in your packet for approval with minimal increase in paving
costs. I can now work through the cost estimates for several feasibility reports I’ve
had in process for the 2023 street overlay projects.
WATER/SEWER/STORMWATER
• The filter rehab project is moving forward. The test results for radium and arsenic for
the media disposal are back. Staff is reviewing options for its disposal.
• Trevor Ratke successfully completed school to upgrade his water certification level,
which is beneficial for cross-training in this area. Trevor has proven to be a fantastic
addition and as other staff start thinking about retirement, water treatment might be an
avenue he would like to pursue.
• As a requirement of our Ms4 permit, Jack and I successfully renewed our erosion
control certifications through the U of M.
• We dealt with a sewer force main break in the Independence system along County
Road 19 last week. Public Works was notified, and the line was shut down
immediately. Burschville Construction, our emergency excavator, was mobilized and
with the assistance of Public Works, the repair was completed and traffic back to
normal in a five-hour timeframe.
PARKS/TRAILS
• The ice rinks are in good shape and with some warmer weather we are hoping for a
few weeks of good skating prior to the first big thaw.
• I am in the process of re-quoting court surfacing for the Legion Park tennis court and
the new courts at Hunter Park. My goal is to present these to Council in the next
packet.
MEMORANDUM
2
• Lisa and I ordered the new no parking signs to direct ballfield spectators to the
overflow parking available off Mill Street. Dusty is working to update google maps
to show the same.
• Dusty and I are preparing to work through the HAC contract in the next few weeks,
so we are prepared for the 2023 ball season.
MISC
• The redesigned Safety Manual is in your packet. Lisa spent many hours putting this
together and cross checking our existing policies with OSHA requirements. We are
lucky to have her skill in this area.
• Road material bids were opened (publicly) on January 31, results are in your packet.
• Lisa is in the process of reviewing regulations to ensure the City remains compliant
with the Minnesota Pollution Control Agency updates to the hazardous material
generator documentation.
ORDER CHECKS JANUARY 17, 2023 – FEBRUARY 7, 2023
053914 ENCLAVE PATRIOT HOA ......................................................... $250.00
053915 KNUDSON, BRIAN .................................................................... $250.00
053916 US HOME CORP .................................................................. $10,000.00
053917 STATE OF MINNESOTA ............................................................. $50.00
053918 SADASIVAN, SAMJITH ............................................................. $500.00
053919 BOND TRUST SERVICES CORP .............................................. $950.00
053920 KANDALA, SRIVANI .................................................................. $500.00
053921 PFANNENSTIEL, STEPHANIE .................................................. $500.00
053922 WILD MEADOWS HOMEOWNERS ........................................... $250.00
053923 COMPASS MINERALS AMERICA INC ................................... $1,880.26
053924 CONTEMPORARY IMAGES ........................................................ $29.43
053925 DPC INDUSTRIES INC ................................................................ $10.00
053926 HENN COUNTY TAXPAYER SVCS DEPT ............................. $2,238.20
053927 HENN COUNTY TREASURER ............................................... $1,251.88
053928 KELLY'S WRECKER SERVICE INC ....................................... $1,279.55
053929 KENNEDY & GRAVEN CHARTERED .................................. $10,505.47
053930 METRO WEST INSPECTION ............................................... $16,000.14
053931 NAPA OF CORCORAN INC ...................................................... $430.54
053932 TOWMASTER ............................................................................. $45.00
053933 SSI MN TRANCHE 1 #10322006 ............................................ $1,278.18
053934 SSI MN TRANCHE 3 #10327096 ............................................ $1,435.15
053935 WSB & ASSOCIATES ........................................................... $52,330.25
053936 HUNT, GREG ....................................................................... $19,400.00
053937 ABDO ..................................................................................... $7,250.00
053938 ACME TOOLS ........................................................................... $163.26
053939 ADAMS PEST CONTROL INC .................................................. $285.11
053940 ASPEN MILLS INC ................................................................. $4,629.71
053941 BEAUDRY OIL & PROPANE .................................................. $8,637.64
053942 BLUE CROSS BLUE SHIELD OF MN ................................... $39,132.38
053943 BOYER FORD TRUCKS INC ..................................................... $116.50
053944 CONTEMPORARY IMAGES ................................................... $1,099.55
053945 CORE & MAIN LP ...................................................................... $398.80
053946 DITTER COOLING & HEATING................................................. $383.04
053947 ECM PUBLISHERS INC ............................................................ $386.58
053948 FINANCE AND COMMERCE ....................................................... $64.35
053949 GOPHER STATE ONE CALL ...................................................... $50.00
053950 HAMEL LIONS CLUB ................................................................ $525.00
053951 HAMEL VOLUNTEER FIRE DEPT ....................................... $93,600.00
053952 HAWKINS INC. ....................................................................... $3,489.39
053953 HENN COUNTY HUMAN SERV & PH .................................... $8,600.00
053954 JAN-HAR LIMITED LIABILITY ..................................................... $47.98
053955 JIMMY'S JOHNNYS INC ............................................................ $130.00
053956 KELLY'S WRECKER SERVICE INC ....................................... $1,419.32
053957 KOTHRADE SEWER, WATER & ............................................ $2,306.25
053958 LAW ENFORCEMENT LABOR .................................................. $607.50
053959 LEAGUE OF MINNESOTA CITIES ............................................ $990.00
053960 CITY OF LONG LAKE ............................................................. $8,443.75
053961 LORETTO VOL FIRE DEPT INC .......................................... $27,978.09
053962 MARK OF EXCELLENCE HOMES ............................................ $862.34
053963 MN DEPARTMENT OF HEALTH ................................................. $23.00
053964 NAPA- LONG LAKE ................................................................... $541.47
053965 NAPA OF CORCORAN INC ........................................................ $76.97
053966 ODP BUSINESS SOLUTION LLC .............................................. $627.94
053967 PACE ANALYTICAL .................................................................. $640.00
053968 PREMIUM WATERS INC ............................................................. $19.49
053969 RATNALA, NAGA SAMEERA .................................................... $975.00
053970 ROBERTS, JOHN/JENNIFER ...................................................... $44.04
053971 ROLF ERICKSON ENTERPRISES INC ................................ $10,909.73
053972 RYAN COMPANIES ............................................................. $52,222.00
053973 SOLUTION BUILDERS INC .................................................... $4,931.36
053974 SS 567 UNIVERSITY LLC ......................................................... $250.00
053975 STANDARD INSURANCE COMPANY .................................... $1,142.00
053976 STREICHER'S ........................................................................... $387.78
053977 SUBURBAN TIRE WHOLESALE INC ........................................ $539.96
053978 TARGET CORPORATION .................................................... $84,234.76
053979 TEGRETE CORP .................................................................... $1,355.00
053980 THE DOCK DOCTORS ........................................................... $1,740.72
053981 TIMESAVER OFFSITE .............................................................. $223.50
053982 TIMECLOCK PLUS LLC ......................................................... $1,200.00
053983 TITLE LLC ESCROW ACCOUNT .............................................. $102.08
053984 WATERMARK TITLE AGENCY ................................................... $28.64
053985 WESTSIDE WHOLESALE TIRE ................................................ $116.00 Total Checks $495,292.03
ELECTRONIC PAYMENTS JANUARY 17, 2023 – FEBRUARY 7, 2023
006687E ELAN FINANCIAL SERVICE .................................................. $9,410.81
006688E AFLAC ....................................................................................... $491.08
006689E MEDIACOM OF MN LLC ........................................................... $990.08
006690E FARMERS STATE BANK OF HAMEL ......................................... $44.00
006691E PR PERA .............................................................................. $21,200.28
006692E PR FED/FICA ....................................................................... $21,218.46
006693E PR MN Deferred Comp ........................................................... $3,157.00
006694E PR STATE OF MINNESOTA .................................................. $4,735.82
006695E CITY OF MEDINA ........................................................................ $23.00
006696E FURTHER .............................................................................. $2,177.39
006697E FARMERS STATE BANK OF HAMEL ......................................... $12.00
006698E FURTHER ................................................................................... $77.49
006699E MINNESOTA, STATE OF ....................................................... $3,824.00
006700E BOND TRUST SERVICES CORP ....................................... $998,690.00
006701E FP MAILING SOL POSTAGE BY PHON ................................. $1,000.00
006702E PR PERA .............................................................................. $21,140.63
006703E PR FED/FICA ....................................................................... $21,083.14
006704E PR MN Deferred Comp ........................................................... $3,157.00
006705E PR STATE OF MINNESOTA .................................................. $4,680.83
006706E CITY OF MEDINA ........................................................................ $23.00
006707E FURTHER .............................................................................. $2,177.39
006708E MN CHILD SUPPORT PAYMENT ............................................. $724.20
006709E MINNESOTA, STATE OF .......................................................... $193.38
006710E FURTHER ................................................................................. $938.82
006711E CIPHER LABORATORIES INC. .............................................. $1,407.00
006712E CENTERPOINT ENERGY ...................................................... $7,547.94
006713E FARMERS STATE BANK OF HAMEL ....................................... $150.00
006714E FP MAILING SOL POSTAGE BY PHON ................................. $1,000.00
006715E GREAT AMERICA FINANCIAL SERVI ...................................... $178.95
006716E MARCO (LEASE) .................................................................... $1,592.83
006717E THE VALVOLINE COMPANY 68 ................................................. $56.74
006718E WRIGHT HENN COOP ELEC ASSN ...................................... $2,711.69
006719E FARMERS STATE BANK OF HAMEL ......................................... $10.00
006720E DELTA DENTAL ..................................................................... $2,693.88
Total Electronic Checks $1,138,518.83
PAYROLL DIRECT DEPOSIT JANUARY 18, 2023 & FEBRUARY 1, 2023
0512441 MILINKOVICH, JACOB .............................................................. $836.25
0512442 WIESE, TANNER L .................................................................... $485.95
0512443 ALTENDORF, JENNIFER L. ................................................... $1,387.18
0512444 BARNHART, ERIN A. ............................................................. $2,984.89
0512445 BOECKER, KEVIN D. ............................................................. $3,167.93
0512446 CONVERSE, KEITH A. ........................................................... $2,578.02
0512447 DEMARS, LISA ....................................................................... $1,683.00
0512448 DION, DEBRA A. .................................................................... $2,160.61
0512449 ENDE, JOSEPH...................................................................... $2,102.73
0512450 FINKE, DUSTIN D. ................................................................. $3,085.65
0512451 GLEASON, JOHN M. .............................................................. $2,386.34
0512452 GREGORY, THOMAS ............................................................ $2,273.55
0512453 HALL, DAVID M. ..................................................................... $2,277.54
0512454 HANSON, JUSTIN .................................................................. $2,772.34
0512455 JACOBSON, NICOLE ................................................................ $978.88
0512456 JOHNSON, SCOTT T. ............................................................ $2,983.41
0512457 KLAERS, ANNE M. ................................................................. $1,821.50
0512458 LEUER, GREGORY J. ............................................................ $2,553.13
0512459 MCGILL, CHRISTOPHER R. .................................................. $1,801.80
0512460 MCKINLEY, JOSHUA D .......................................................... $2,417.83
0512461 MYHRE, JORDAN J ............................................................... $2,617.06
0512462 NELSON, JASON ................................................................... $5,013.17
0512463 RATKE, TREVOR J ................................................................ $2,215.81
0512464 REINKING, DEREK M ............................................................ $2,927.77
0512465 SCHARF, ANDREW ............................................................... $5,024.63
0512466 SCHERER, STEVEN T. .......................................................... $2,700.79
0512467 VINCK, JOHN J ...................................................................... $2,142.35
0512468 VOGEL, NICHOLE .................................................................. $1,051.81
0512469 WALKER, CAITLYN M. ........................................................... $2,034.66
0512470 BURSCH, JEFFREY ............................................................... $1,160.51
0512471 MILINKOVICH, JACOB ............................................................. $836.25
0512472 WIESE, TANNER L ................................................................... $777.75
0512473 ALBERS, TODD M. ................................................................... $230.87
0512474 ALTENDORF, JENNIFER L. .................................................. $1,164.22
0512475 BARNHART, ERIN A. ............................................................ $2,984.89
0512476 BOECKER, KEVIN D. ............................................................ $3,176.95
0512477 CAVANAUGH, JOSEPH ........................................................... $230.87
0512478 CONVERSE, KEITH A. .......................................................... $2,498.65
0512479 DEMARS, LISA ...................................................................... $1,682.99
0512480 DESLAURIERS, DEAN ............................................................. $230.87
0512481 DION, DEBRA A. ................................................................... $2,177.34
0512482 ENDE, JOSEPH..................................................................... $2,515.61
0512483 FINKE, DUSTIN D. ................................................................ $3,085.65
0512484 GLEASON, JOHN M. ............................................................. $2,059.05
0512485 GREGORY, THOMAS ........................................................... $2,273.54
0512486 HALL, DAVID M. .................................................................... $2,327.37
0512487 HANSON, JUSTIN ................................................................. $2,772.33
0512488 JACOBSON, NICOLE ............................................................... $978.88
0512489 JOHNSON, SCOTT T. ........................................................... $2,980.12
0512490 KLAERS, ANNE M. ................................................................ $1,729.56
0512491 LEUER, GREGORY J. ........................................................... $2,098.64
0512492 MARTIN, KATHLEEN M ........................................................... $327.07
0512493 MCGILL, CHRISTOPHER R. ................................................. $1,934.06
0512494 MCKINLEY, JOSHUA D ......................................................... $2,397.98
0512495 MYHRE, JORDAN J .............................................................. $2,556.54
0512496 NELSON, JASON .................................................................. $3,013.15
0512497 RATKE, TREVOR J ............................................................... $2,144.58
0512498 REID, ROBIN ............................................................................ $230.87
0512499 REINKING, DEREK M ........................................................... $2,563.28
0512500 SCHARF, ANDREW .............................................................. $1,856.85
0512501 SCHERER, STEVEN T. ......................................................... $2,700.78
0512502 VINCK, JOHN J ..................................................................... $2,390.13
0512503 VOGEL, NICHOLE ................................................................. $1,051.80
0512504 WALKER, CAITLYN M. .......................................................... $2,034.66
0512505 BURSCH, JEFFREY .............................................................. $1,802.66
Total Payroll Direct Deposit $135,443.90