Template for Departments’ Injury and Illness Prevention Program at The

Template for Departments’ Injury and Illness Prevention Program at The

Template for Departments' Injury and Illness Prevention Program at the University of California, Berkeley

(Note: This template was downloaded from the web site of the Office of Environment, Health & Safety at the University of California, Berkeley, http://ehs.berkeley.edu/. The forms mentioned in this template can also be downloaded from the web site. Click on "Injury & Illness Prevention Program" under the "Services, Programs, & Compliance Assistance" heading on the EH&S home page.)

Departments at the University of California, Berkeley can use the following template to create a written Injury and Illness Prevention Program (IIPP) that meets the requirements of state law. (Each department at UC Berkeley is required to have its own IIPP.) Putting the written program into action will help to ensure a healthful and safe workplace for department employees.

To use the template, replace any italicized text with your department's specific information. Then send a copy to the Office of Environment, Health & Safety (EH&S) at 317 University Hall #1150 for review. (You may also send it as an e-mail attachment to ehs@uclink.berkeley.edu.) EH&S will review the draft against applicable legal requirements. The next step is to put the program into action. An IIPP's benefits will be realized only through effective implementation.

University of California, Berkeley

(Department Name)

Injury and Illness Prevention Program

(Date adopted)

University of California, Berkeley

(Department Name)

Injury and Illness Prevention Program

TABLE OF CONTENTS

I. INTRODUCTION AND PURPOSE

II. RESPONSIBILITIES

III. IDENTIFYING WORKPLACE HAZARDS

IV. COMMUNICATING WORKPLACE HAZARDS

V. CORRECTING WORKPLACE HAZARDS

VI. INVESTIGATING INJURIES AND ILLNESSES

VII. EMPLOYEE HEALTH AND SAFETY TRAINING

VIII. ENSURING COMPLIANCE

IX. RECORD KEEPING

X. CAMPUS SAFETY RESOURCES

APPENDICES

University of California, Berkeley

(Department Name)