Please describe the status of the safety program at your facility, including, but not limited to: how long the program has been in effect, the method used to develop the program, who is tasked with developing/maintaining the program, if formal and/or written policies and procedures exist, and whether all policies/procedures have been implemented. For elements of the program that are not fully established, explain the progress to date and schedule for future completion.

How does your facility teach awareness of and encourage personal safety?

What are the goals of the safety program at your facility?

What type of safety-related orientation and/or initial training are provided to new employees or those transferred from other departments? This may include one-on-one, hands-on, formal classroom, or other orientation/training efforts.

What type of on-going safety training is provided to employees? Provide information about the content, type, duration, and frequency of training, as well as whether it is provided by the facility staff, outside professionals, or a combination. If no formal program exists, show evidence that training is on-going (i.e. list courses attended or required, etc.).

Please list the safety equipment/supplies currently available for use at your facility. To ensure that the Committee understands the purpose and value of each piece of equipment, please list the equipment by category (i.e., confined space entry, HAZMAT, first aid, disease prevention, electrical safety, etc.). Feel free to create your own category headings and use as many categories as you feel are necessary to provide clarity.

Please provide a summary of the injury occurrence statistics for your facility over the past 5 years. Attach copies of OSHA logs or other recognized reporting forms. Also, provide the Workman's Compensation Rating Factor from your insurance company.

If so, please attach a digital copy in the field below, or otherwise mail a copy to the NEWEA office.

What type of Safety Committee has been established to oversee safety at your facility?

How is worker participation evaluated?

Is there a process for evaluating the qualifications of personnel to perform specific tasks or operate pieces of equipment? Is a written record of these personnel qualifications readily available to supervisors?

Do policies, procedures, and training efforts encompass and/or encourage safety awareness and behavior outside of the workplace and after hours (i.e., when not at work)? Please elaborate.

Does your facility conduct any outreach training or have other programs that benefit/encourage safety in the community, contractors, and mutual response operations? Please explain.

Please list and provide copies of any articles/publications/presentations/etc. on safety-related topics prepared by staff at the facility as a facility or individual effort.

Please comment on parts of your program that were successful, improvements made to the program, safety initiatives and suggestions implemented, ways that illness and/or injury were prevented as a result of the program, and any other highlights of your program during the previous year.

Please take this space to describe any safety-related feature that you believe sets your facility apart from other facilities of similar size, design, and staffing.

Please provide verification of membership for facility personnel.

By completing this field, you consent to the acknowledgement above.