HAZARD ALERT FORM. Department: DEPARTMENTS OF PLANT PATHOLOGY AND NEMATOLOGY. Location of Hazard: Building: Floor: Room:

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1 HAZARD ALERT FORM Department: DEPARTMENTS OF PLANT PATHOLOGY AND NEMATOLOGY I. Unsafe Condition or Hazard Name: (optional) Job: Title: (optional) Location of Hazard: Building: Floor: Room: Date and time the condition or hazard was observed: Description of unsafe condition or hazard: What changes would you recommend to correct the condition or hazard? Employee Signature: (optional) Date: II. Management/Safety Committee Investigation Name of person investigating unsafe condition or hazard: Results of investigation (What was found? Was condition unsafe or a hazard?): (Attach additional sheets if necessary.) Proposed action to be taken to correct hazard or unsafe condition: (Complete and attach a Hazard Correction Report, IIPP Appendix E) Signature of Investigating Party: Date: IIPP-Appendix A Completed copies of this form should be routed to the appropriate supervisor and department January 2008 Safety Coordinator, and must be maintained in department files for at least three years.

2 9/1/2015 PPE Assessment IIPP Hazard Assessment - Part I Dept.: Plant Pathology/Entomology and Nematology Completed by: Andrew Ross Date 10/13/2014 ACTIVITY HAZARD CONTROL Personal Protective Equipment Describe Job Hazard: Impact, penetration, rolling, pinching, slip, trip or fall, compression, ergonomic or body positioning, fall from elevated surface, pierce, cut, abrasion Describe present hazard control or penetration, struck by or against object, caught in between, stress or strain, material handling, lifting, pushing, pulling, reaching, electrical (shock/arc), repetitive practice (Note: Control Hierarchy): 1. Engineering style controls (i.e. machine guarding), 2. Job Hazard Activity; Describe motion, chemical, biological, infectious disease, optical, or Administrative controls (i.e. SOP's), Is Personal Protective Equipment task, procedure, equipment or radiation exposure, thermal/heat/burns, respiratory 3. Work practices (i.e. training), or required? If Yes, tool use, etc. chemicals, fumes, dust 4. Personal Protective Equipment complete Part II Computer use Ergonomic injuries, carpel tunnel, eye strain, arthritis, other wrist/neck/back injuries Ergonomics for computer users safety training and evaluation strongly recommended, ergonomic key boards/chairs/etc. provided upon individual requests No Filing, stapling, writing, etc. Repetitive motion injuries Ergonomics training and evaluation strongly recommended, ergonomic equipment provide upon request No General office work Slips, trips, falls, falling objects Never under any circumstance stand on a chair or other piece of furniture. Always use a step stool of ladder to retrieve items from high locations. Keep floors clear of debris and liquid spills. If a spill can t be cleaned immediately, use the "wet floor" sign to warn others of the potential hazard. Keep furniture boxes, etc. from blocking doorways, halls and walking space. Do not store heavy objects overhead. Do not top-load filing cabinets, fill from bottom to top. Do not open more than one file drawer at a time. Brace tall bookcases and tall file cabinets to walls. Refer to EH&S SafetyNet # 46 and 83. No ENT IIPP Appendix B 1 JSA office 1 of 9

3 9/1/2015 Describe Job Hazard: Impact, penetration, rolling, PPE Assessment pinching, slip, trip or fall, compression, ergonomic or body positioning, fall from elevated surface, pierce, cut, abrasion or penetration, struck by or against object, caught in between, stress or strain, material handling, lifting, pushing, pulling, reaching, electrical (shock/arc), repetitive motion, chemical, biological, infectious disease, optical, or radiation exposure, thermal/heat/burns, respiratory chemicals, fumes, dust Job Hazard Activity; Describe task, procedure, equipment or tool use, etc. General office work Electrical hazards Describe present hazard control practice (Note: Control Hierarchy): 1. Engineering style controls (i.e. machine guarding), 2. Administrative controls (i.e. SOP's), 3. Work practices (i.e. training), or 4. Personal Protective Equipment Never use 2 to 3 prong adapters in electrical outlets, all large appliances (refrigerators, microwaves ovens, etc.) are plugged directly into an outlet, Never overload outlets or daisy chain extension cords/power strips, keep electrical cords away from walk paths, UCD facilities department or MCB shop technicians address all electrcal problems (replacing light bulbs, replacing ballasts, cracked or frayed wires, etc.), annual inspections preformed by the fire marshal or lab safety professional with EH&S, refer to safety nets # 20 & 109 Is Personal Protective Equipment required? If Yes, complete Part II No Handling/moving heavy items Back/lifting injuries Use lift cart or ask for assistance whenever possible, proper lifting procedures followed as per safety net #46, Back injury prevention training required for anyone who lifts heavy objects regularly, No General workplace Physical injuries due to fires, earthquakes, workplace violence, etc. Annual training on Departmental Emergency Action Plan (EAP), EAP followed by all employees, copy of EAP available for all employees in mailroom on 3rd floor of Hutchison Hall, worplace violence training available from UCD police department No DATE: IIPP Hazard Assessment Training Dept.: This Hazard Assessment was conducted by on The assessment was conducted using all the day shift Custodians and 2 supervisors knowledge of the existing equipment and handling procedures, knowledge of Cal OSHA 8 CCR IIPP 3203 hazard assessment requirements and techniques. Employee are provided all training for protection against the hazards as established and noted above. Employees are trained (below) on when and what control is necessary (as listed above). EMPLOYEE PRINTED NAME EMPLOYEE SIGNATURE ENT IIPP Appendix B 1 JSA office 2 of 9

4 9/1/2015 Describe Job Hazard: Impact, penetration, rolling, PPE Assessment pinching, slip, trip or fall, compression, ergonomic or body positioning, fall from elevated surface, pierce, cut, abrasion or penetration, struck by or against object, caught in between, stress or strain, material handling, lifting, pushing, pulling, reaching, electrical (shock/arc), repetitive motion, chemical, biological, infectious disease, optical, or radiation exposure, thermal/heat/burns, respiratory chemicals, fumes, dust Job Hazard Activity; Describe task, procedure, equipment or tool use, etc. Describe present hazard control practice (Note: Control Hierarchy): 1. Engineering style controls (i.e. machine guarding), 2. Administrative controls (i.e. SOP's), 3. Work practices (i.e. training), or 4. Personal Protective Equipment Is Personal Protective Equipment required? If Yes, complete Part II ENT IIPP Appendix B 1 JSA office 3 of 9

5 Personal Protective Equipment (PPE) Assessment LOCATION: Certification: Date JOB HAZARD ACTIVITY (From Part I) Head Hands Arm Trunk Whole Body Eyes Face Ears Lungs

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7 PPE TRAINING Dept.: DATE: Trainer Printed Name This PPE Hazard Assessment was conducted by using all the day shift Custodians and 2 supervisors knowledge of the existing equipment and handling proce 3203 hazard assessment requirements and techniques. Employee are provided all PPE for protection agains Employees are trained (below) on when and what PPE is necessary (as listed above), how to wear and take applicable). EMPLOYEE PRINTED NAME EMPLOYEE SIGNATURE EMPLOYEE PR

8 Knees Feet Required PPE

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10 on The assessment was conducted edures, knowledge of Cal OSHA 8 CCR 3380 and IIPP st the hazards as established and noted above. care of the PPE, and any PPE limitations (as RINTED NAME EMPLOYEE SIGNATURE

11 9/1/2015 PPE Assessment IIPP Hazard Assessment - Part I Dept.: Plant Pathology, Entomology and Nematology Completed by: Andrew Ross Date Aug-14 ACTIVITY HAZARD CONTROL Personal Protective Equipment Hazard Class; describe how this activity is classified (transportation, equipment use, environmental, etc.) Describe Job Hazard Describe present hazard control practice Vehicluar transportation (car, truck, bicycle, etc.) Transportation (walking, hiking, etc.) Collision or traffic accident related injuries (crushes, cuts, scrapes, sprains, strains, breaks, burns, etc.) Falls, trips, slips (cuts, scrapes, sprains, breaks, strains, bruises, bumps, etc.) Registered UC Davis employee with valid drivers license required, successful completion of the UCD safe driver awareness training program strongly recommended (access course at: Appropriate field attire required (ie: closed toe/closed heel shoes, long pants, no sandals, no shorts, no bare shoulders, no bare midriffs), tri-annual field safety training required Is Personal Protective Equipment required? If Yes, complete Part II No No Equipment use (pumps, sprayers, tractors, chain saws, pruners, etc.) Environmental hazards (climate, weather, animals, insects, plants, etc.) Chemical, biological, or pesticide application (fertilizer, bio-control agents, fungicides, insecticides, herbicides, etc.) Lifting, climbing, repetitive motion Power tools and equipment hazards (welders, drill presses, table saw, grinders, hand drills, circular saws, Minor to severe injuries (crushes, cuts, abrasions, sprains, strains, breaks, eletrical shock, etc.) Exposure or contact related injuries (heat illness, heat stress, cold stress, bee stings, poison oak, bites, allergies, etc.) Exposure related injuries (ingestion, inhalation, burns, poisoning, rash, irritation, allergy, etc.) Back injuries, falls from ladders,repetitive motion injuries, etc. Minor, severe, to fatal injuries (crushes, cuts, abrasions, sprains, strains, breaks, eletrical shock, etc.) radial arm saw, etc.) ENT IIPP Appendix B 2 JSA greenhouse and field 1 of 4 Standard Operating Procedures (SOP's) required for any hazardous equipment use, documented training on equipment required through UC Davis Learning Management System (LMS) (Ex: hand and power tool training course for anyone who uses a chain saw), all equipment must be in good working order with all safety controls in place (EX: chain break and guard on chain saw, etc.) Annual heat illness prevention training required, tri-annual field safety training required Qualified applicator certificate required for insecticide use, hazardous communications training or UC fundamentals of lab safety course and laboratory hazard assessment tool training required, tri-annual field safety training required Appropriate safety training required for task (ie: ladder safety training for persons who climb ladders, ergonomics training for repetitive motion activities, etc.) All person using equipment or tools must be trained on the safe use and operation of that tool prior to using, All PPE's are provided by the department to ensure the safety of operators. PPE's must be worn by power tool or equipment operators at all times Yes No Yes No Yes

12 9/1/2015 PPE Assessment Hazard Class; describe how this activity is classified (transportation, equipment use, environmental, etc.) Describe Job Hazard Describe present hazard control practice Is Personal Protective Equipment required? If Yes, complete Part II DATE: IIPP Hazard Assessment Training Dept.: Plant Pathology, Entomology and Nematology Aug-14 This Hazard Assessment was conducted by on The assessment was conducted using all the day shift Custodians and 2 supervisors knowledge of the existing equipment and handling procedures, knowledge of Cal OSHA 8 CCR IIPP 3203 hazard assessment requirements and techniques. Employee are provided all training for protection against the hazards as established and noted above. Employees are trained (below) on when and what control is necessary (as listed above). EMPLOYEE PRINTED NAME EMPLOYEE SIGNATURE ENT IIPP Appendix B 2 JSA greenhouse and field 2 of 4

13 Personal Protective Equipment (PPE) Assessment LOCATION: Certification: Date JOB HAZARD ACTIVITY (From Part I) Head Hands Arm Trunk Whole Body Eyes Face Ears Lungs Knees Feet Required PPE

14 JOB HAZARD ACTIVITY (From Part I) Head Hands Arm Trunk Whole Body Eyes Face Ears Lungs Knees Feet Required PPE PPE TRAINING Dept.: DATE: Trainer Printed Name This PPE Hazard Assessment was conducted by on The assessment was conducted using all the day shift Custodians and 2 supervisors knowledge of the existing equipment and handling procedures, knowledge of Cal OSHA 8 CCR 3380 and IIPP 3203 hazard assessment requirements and techniques. Employee are provided all PPE for protection against the hazards as established and noted above. Employees are trained (below) on when and what PPE is necessary (as listed above), how to wear and take care of the PPE, and any PPE limitations (as applicable). EMPLOYEE PRINTED NAME EMPLOYEE SIGNATURE EMPLOYEE PRINTED NAME EMPLOYEE SIGNATURE

15 Laboratory Safety Review Checklist One Shields Ave Davis, CA Phone: (530) Fax: (530) U C Davis Environmental Health and Safety Laboratory Safety Review Checklist Principal Investigator: Lab Contact: Building: Department: Date: Phone: Room Number(s): Lab Name/Function: Please check Yes, No, Serious Violation or Not Applicable for each item. All No responses require follow-up within 30 days, unless otherwise noted and all Serious Violations require 3 day follow-up. # Y N S NA ITEM CARCINOGENS Last updated 3/6/2014 REFERENCE 1 Work and storage areas properly marked and controlled CCR Title (g) 2 California regulated inventory reported to EH&S CCR Title Carcinogen self audit complete UCD Carcinogen Safety Manual 4 Carcinogen Standard Operating Procedures available CCR Title CHEMICAL 5 Containers clearly labeled with contents and primary hazard(s) CCR Title (h), SN19, SN42 6 Chemical storage containers in good condition CCR Title (c), PP Corrosive chemicals stored below eye level CCR Title A, SN42 8 Combustible materials not stored with flammable chemicals CCR Title , NFPA30,SN19 9 Commonly used abbreviations posted in prominent location 10 Hazardous chemicals not stored on floor CCR Title , NFPA Lab free of expired or unneeded chemical CCR Title A, SN19 12 Maximum of 60 gallons flammables per storage unit/ max 3/fire area CCR Title (a), 13 Less than 10 gallons of flammables outside flammable storage NFPA 30, NFPA 45, PP290-65,SN19 14 Flammables used away from ignition sources 15 Flammable liquid storage containers 2 gallon or less CCR Title Flammable storage refrigerator/freezer approved and labeled NFPA , PP290-65, SN31 17 Incompatible materials properly segregated Pyrophoric chemicals segregated, contained and labeled; Entire building equipped with automatic sprinkler system Chemical storage cabinets clearly labeled (flammables, corrosives, etc) CCR Title (a), SN4, SN19, SN42 CCR Title CCR Title , SN135 CCR Title (b), CCR Title , PP290-65

16 20 Strong acids and strong bases stored in secondary containers CCR Title , NFPA400,SN42 21 Last updated 3/6/2014 Organic peroxides and other time sensitive materials dated when first opened; managed properly and disposed of promptly upon expiration CCR Title NFPA , SN23 22 Water reactive chemicals segregated, contained and labeled CCR Title , SN19, SN42 DOCUMENTATION 23 Appropriate signage posted (Right to Know) at all entrances to lab CCR Title , NFPA Building Emergency Evacuation Route posted CCR Title , SN19, SN Chemical Hygiene Plan updated within past 12 months CCR Title , PP290-27, SN33 26 CIS updated within past 12 months CCR Title (e), CCR Title , PP290-27, SN33 27 Emergency contacts posted at entrance to laboratory CCR Title , SN Department Illness and Injury Prevention Plan available and up-todate. CCR Title , PP Emergency Action Plan available and up-to-date CCR Title , PP290-56, SN19 30 Emergency assistance information posted CCR Title (f) 31 Hazard Assessment completed UCOP Policy, PP Medical Surveillance Program properly documented CCR Title (g), PP Readily accessible SDS s (hard copy or online) CCR Title (g), PP290-27, SN33 34 Annual self-inspection complete CCR Title Staff aware of procedure to report exposures or concerns CCR Title Staff aware of procedure to report incidents and near misses CCR Title Written Standard Operating Procedures available and current CCR Title , PP290-56, SN33 ELECTRICAL 38 3-prong plugs in 3-prong outlets 39 Appropriate clearance in front of electrical panels (36 ) NFPA /408.4, SN19 40 Electrical cords not a trip hazard NFPA Plugs, cords and receptacles in good condition UCD PP290-85, SN20, Fire Net 42 Extension cords used only temporarily (<90 days) CCR Title , SN19, SN20 43 No overloaded outlets, no daisy-chained extension cords or strips NFPA B, SN19, SN20 44 GFCI devices used within 6 of water source (post 2010) NFPA (B)(5), SN19 45 High voltage equipment clearly labeled CCR Title High voltage equipment properly guarded CCR Title Major equipment plugged directly into outlet UCD PP290-85, SN20 48 Appropriate personnel trained in Lock Out/Tag Out program CCR Title Power strips near liquids have surge protection EQUIPMENT 50 Appropriate safety information posted on equipment 51 Centrifuges are maintained to ensure safe operation 52 Moving parts of equipment properly guarded (opening < 1/2 ) CCR Title , SN115

17 53 Secondary containment for vacuum pump present FIRE 54 Aisles, exits, adjoining hallways free of obstruction CCR Title , SN19 55 Fire alarms, bells, horns and/or strobes free of obstruction CCR Title Fire extinguisher properly mounted CCR Title Fire extinguisher maintenance tag current CCR Title Fire extinguisher available as required CCR Title Fire extinguisher fully charged; pin and/or security seal intact CCR Title Fire doors unobstructed and easily closed CCR Title , SN19 61 FUME HOODS 18 of clearance between stored items and fire sprinklers, 24 w/o sprinklers CCR Title (c)10 62 Audible/visual alarm and/or visual airflow monitor functional CCR Title (e),SN19, SN35 63 Chemical work done more than 6 from front of hood CCR Title A, SN35 64 Certified within one year CCR Title (e),SN19, SN35 65 Fume hood illumination is working 66 Functional fume hood not used for storage, cluttered CCR Title A, SN19, SN35 67 Users understand how to check for airflow and annual certification sticker CCR Title Fume hood users have completed specific fume hood training CCR Title Proper sash height indicated and adhered to CCR Title GAS 70 Compressed gas cylinders stored upright and adequately secured CCR Title , SN42, SN60 71 Compressed gas cylinders labeled with contents and hazards CCR Title Compressed gas cylinders have full/empty tags attached CCR Title , SN42 73 Compressed gas cylinders stored separately CCR Title , SN42, SN60 74 Toxic gases properly stored in ventilated cabinet/fume hood CCR Title Compressed gas cylinders capped when not in use CCR Title , SN42, SN60 GENERAL SAFETY 76 Ceiling tiles in place and in good repair NFPA 77 Ergonomic evaluations done for computer work in excess of 4 hours CCR Title Food and drink stored away from haz mat; consumed outside of lab CCR Title A, PP Mechanical devices used for pipetting CCR Title A, SN19 80 Spills promptly cleaned by individuals trained to respond to spill CCR Title A, SN13 81 Floor is in good repair to prevent slips, trips and falls CCR Title A 82 Furnishings in lab easily decontaminated CCR Title A 83 Lab surfaces clean, organized, free of chemical contamination CCR Title , 5191A 84 Sink available near exit for hand washing (soap and paper towels) CCR Title Last updated 3/6/2014

18 85 Sinks labeled Industrial Water Do Not Drink CCR Title Lab air negative to hallway CCR Title A 87 Refrigerators/freezers appropriately labeled according to use CCR Title A, SN31 88 Ergonomic evaluations done for repetitive motion activities CCR Title Vacuum systems fitted with traps or protective filter PERSONAL PROTECTIVE EQUIPMENT (PPE) 90 Appropriate gloves available for use with hazardous activities CCR Title , PP290-50,SN50 91 Equipment or process sound levels that may exceed 85 dba CCR Title 5096,PP290-53, SN Face shield available if required CCR Title , PP Gloves worn when skin contact with hazards may occur CCR Title , PP290-50,SN50 94 Lab coats, appropriate to activity are worn CCR Title , PP Lab coats, properly fitted, are available CCR Title , PP Glove(s) removed prior to exiting lab, handling telephone, etc. CCR Title (4)(F), PP Long pants worn as required by UCD PPE policy UCOP PPE, PP PPE properly cleaned and disinfected or properly disposed of CCR Title , 3383, SN13 99 Respirator users have been evaluated by EH&S and included in campus respiratory protection program CCR Title , PP290-50, SN Eye protection available and used as required by UCD PPE policy CCR Title , PP290-50,SN5 101 SAFETY EQUIPMENT Adequate supply of specialty PPE available (i.e. UV/IR glasses, lab aprons, cryogenic gloves) CCR Title (f), PP Emergency eyewash/showers accessible within 10 sec (55 feet) CCR Title (c), SN Emergency eyewash and shower stations free of obstruction CCR Title (c), SN19, SN Tests for eyewash and shower current and documented CCR Title (e), SN Appropriate chemical spill kits available CCR Title A, SN13, SN Calcium gluconate paste available for HF exposure 107 First Aid Kit accessible, stocked with unexpired products CCR Title (c) SEISMIC 108 Heavy items are stored on lower shelves CCR Title A, SN Shelving, file cabinets 5 or over and other tippable items anchored CCR Title A, SN Overhead storage is secured CCR Title A, SN Hazardous material storage shelves have lip or guard CCR Title ,SN52,SN83 TRAINING 112 All personnel completed Fundamentals of Lab Safety UCOP Policy 113 Specialized training for lab specific hazards documented CCR Title , 5191, Spill training documented CCR Title Training on lab specific SOPs documented CCR Title Training on Chemical Hygiene Plan documented CCR Title Last updated 3/6/2014

19 117 Training on IIPP documented CCR Title Training to manage or handle hazardous waste documented WASTE 119 Biomedical waste (red bag) properly disposed of HSC Secondary containment used for biomedical waste CCR Title Chemical waste containers compatible with contents; good condition CCR Title , SN8, SN Chemical waste containers closed except when in use CCR Title , PP All hazardous waste disposed of by EH&S UCD PP290-65, SN8, SN Hazardous waste in secondary containment CCR Title , PP290-65,SN Chemical waste containers properly tagged/dated/labeled for disposal CCR Title , PP290-65, SN8, SN42, SN All wastes within regulatory time limits CCR Title , SN Sharps containers appropriately labeled with contents, hazards HSC Sharps container s contents are not past the fill line CCR Title , SN3, SN Sharps disposed of in appropriate sharps container CCR Title Tight fitting lid in place on biomedical waste HSC Universal waste properly labeled/discarded/contained; < 1 year CCR Title , SN122 Comments: Corrective Action Items: Follow Up: Laboratory Survey Conducted by: PI or Lab Supervisor/Manager Signature: Date: CCR HSC NFPA PP SN California Code of Regulations Health and Safety Code National Fire Protection Association UCD Policy and Procedure Safety Net Last updated 3/6/2014

20 Entomology IIPP Appendix B3 Dept: Entomology Maintain bee hives. Job function Potential health or injury hazard Backstrain, repetitive motion injury, physical injuries due to slips, trips and falls. Heat illness. Bee stings. JOB SAFETY ANALYSIS Location: Laidlaw Honey Bee Research Facility Job type: apiary work Safe practice, personal protective equipment, or equipment Use correct tools and ergonomic practices. Take frequent breaks. Complete heat illness training at the start of employment. Wear protective clothing and learn proper bee handling practices. Use hand and power tools in the workshop. Honey extraction. Hazards from sharp objects. Electrical hazards. Hazards from sharp objects. Electrical hazards. Physical injuries due to slips, trips and falls. Always cut away from your body and watch location of blade at all times. Do not use extension cords in lieu of permanent wiring. Ensure that high wattage appliances do not overload circuits. Use GFIs in receptacles in potentially wet areas. Replace frayed or damaged electrical cords. Ensure that electrical cords are not damaged by being wedged against objects or pinched in doors. Use correct tools and ergonomic practices. Take frequent breaks. Do not use extension cords in lieu of permanent wiring. Ensure that high wattage appliances do not overload circuits. Use GFIs in receptacles in potentially wet areas. Replace frayed or damaged electrical cords. Ensure that electrical cords are not damaged by being wedged against objects or pinched in doors. Receive training of the use of mechanical extraction equipment.

21 WORKSITE SELF INSPECTION FORM General Office Environment Location: Inspector: Department: Date: Phone: PLANT PATHOLOGY AND NEMATOLOGY Administration and Training Are all safety records maintained in a centralized file for easy Yes No NA 1. access? Are they current? Have all employees attended Injury & Illness Prevention Program Yes No NA 2. training? If not, what percentage has attended? Does the department have a completed Emergency Action Plan? Yes No NA 3. Are employees being trained on its contents? Are chemical products used in the office being purchased in small Yes No NA 4. quantities? Are Material Safety Data Sheets needed? Are the Cal/OSHA information poster, Workers Compensation Yes No NA 5. bulletin, annual accident summary posted? Yes No NA 6. Are annual workplace inspections performed and documented? General Safety Yes No NA 7. Are exits, fire alarms, pullboxes clearly marked and unobstructed? Are aisles and corridors unobstructed to allow unimpeded Yes No NA 8. evacuations? Is a clearly identified, unobstructed, charged, currently inspected Yes No NA 9. and tagged, wall-mounted fire extinguisher available as required by the Fire Department? Are ergonomic issues being addressed for employees using Yes No NA 10. computers or at risk of repetitive motion injuries? Is a fully stocked first-aid kit available? Is the location known to all Yes No NA 11. employees in the area? Are cabinets, shelves, and furniture over five feet tall secured to Yes No NA 12. prevent toppling during earthquakes? Are books and heavy items and equipment stored on low shelves Yes No NA 13. and secured to prevent them from falling on people during earthquakes? Yes No NA 14. Is the office kept clean of trash and recyclables promptly removed? Electrical Safety Are plugs, cords, electrical panels, and receptacles in good Yes No NA 15. condition? No exposed conductors or broken insulation? Yes No NA 16. Are circuit breaker panels accessible and labeled? Are surge protectors being used? If so, they must be equipped Yes No NA 17. with an automatic circuit breaker, have cords no longer than 6 feet in length, and be plugged directly into a wall outlet. Yes No NA 18. Is lighting adequate throughout the work environment? Are extension cords being used correctly? They must not run Yes No NA 19. through walls, doors, ceiling, or present a trip hazard. Are portable electric heaters being used? If so, they must be UL Yes No NA 20. listed, plugged directly into a wall outlet, and located away from combustible materials. IIPP-Appendix C-Office January 2008 Completed copies of this form should be routed to the department Safety Coordinator and must be maintained in department files for at least three years.

22 ACCIDENT INVESTIGATION FORM Name of Injured Person: Date of Injury: Name of Supervisor: Telephone #: Department: Location of Injury: Brief Description of Accident: Nature of Injury (describe all body parts affected): Was Training Provided? Yes No NA Were established procedures followed? Yes No NA Were tools or equipment adequate for task? Yes No NA Were environmental conditions a factor in the incident? Yes No NA Elaborate on Responses: Proposed Corrective Action: Supervisor: Date of Report: Signature: IIPP-Appendix D January 2008 Completed copies of this form should be routed to the department Safety Coordinator and kept in department files for at least three years.

23 HAZARD CORRECTION REPORT Department: DEPARTMENTS OF PLANT PATHOLOGY AND NEMATOLOGY This form should be used in conjunction with the Hazard Alert Form (IIPP Appendix A), as appropriate, to track the correction of identified hazards. All hazards should be corrected as soon as possible, based on the severity of the hazard. If a serious imminent hazard cannot be immediately corrected, evacuate personnel from the area and restrict access until the hazard can be addressed. Supervisor/Safety Coordinator Name: Supervisor/Safety Coordinator Signature: Telephone: Date: Description and Location of Unsafe Condition Date Discovered Required Action and Responsible Party Completion Date Projected Actual IIPP Appendix E January 2008 Completed copies of this form should be routed to the department Safety Coordinator and kept in department files for at least three years.

24 SAFETY TRAINING ATTENDANCE RECORD Departments of Plant Pathology and Nematology Training Topic: (attach a copy of the training session curriculum) Date: Instructor: Location: Training Aids: Time: Attendees Please print and sign your name legibly. Use additional sheets if necessary. No. Print Name Signature IIPP-Appendix F-1 January 2008 Completed copies of this form should be routed to the department Safety Coordinator and must be maintained in department files for at least three years.