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HAZARD
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SAMPLE PROGRAM
MSDS CHEMICAL HAZARD PROGRAM
1. A written hazard communication program is in place
contains a sample program that addresses aspects of the
hazard communication standard.............................. Yes / No
2. A complete inventory of facility hazardous chemicals
is on file................................................. Yes / No
3. Material Safety Data Sheets (MDS) are on file for each
hazardous chemical......................................... Yes / No
4. MSDS are reviewed for completeness and to determine if any
personal protective equipment is needed.e.g.
Gloves/Goggles, checking to see if personal protective equipment
is on hand for chemical currently in use................... Yes / No
5. All Facility staff have received training in the hazard
communication standard.
OSHA inpectors often ask employee if they have been educated
reqarding chemicals hazards.
Employees should be able to tell you where the MSDS sheets
are located.............................................. Yes /No
6. Training on the hazard communication standard is incorporated
into the facility orientation program.
Employee files should show evidence of training.............Yes /No
7. Containers are labled with product name and hazard warnings
Check that labels are legible,pay close attention to housekeeping
chemicals that are transferred to smaller containers.
These must be labeled unless they are single use containers.
Yes /No
--------------------------------------
Director of Staff Signature
Page 1
HAZARDOUS COMMUNICATIONS STANDARD
PRE-TEST
1. CIRCLE THE CORRECT ANSWER.
The hazardous communication program contains all the following except:
A. Inventory List of hazardous chemicals.
B. Labeling of hazardous chemical containers.
C. First Aid Information.
D. Material Safety Data Sheets -MSDS-
E. A written hazard communication progam.
F. Employee Inservice Training.
G. CPR training.
2. Question number two: Fill in the blanks
A. The hazard communication standard is a requirement for all _____________
designed to protect _____________ from health hazards in the workplace
resulting from exposure to hazardous ______________________.
B. The facility's written hazard communication program can be found:_______
________________________________________________________________________
C. To find what precautions should be used when using a new chemical, the
employee should ___________________________________.
D. The key to safe use of hazard chemicals is to ____________the __________
E. Hazardous chemicals can most often be detected by ______________And
_____________________________.
F. Some of the hazardous substances in this workplace are: See Page 4
1._______________________________________________
2._______________________________________________
3._______________________________________________
4._______________________________________________
5._______________________________________________
Page 2
SUBJECT: TOXIC CHEMICAL WARNINGS INFORMATION
POLICY:It is the policy of this facility to warn residents and employees
about toxic chemicals that are known to be carcinogenic or to cause
birth defects or other reproductive harm.
PURPOSE:For the health and safety of residents and personeel and to meet
california state requirements proposition 65.
SCOPE:This Policy applies to [ ]
PROCEDURE
1. With the passage of the safe drinking water and toxic enforcement act
of 1986 has come new restrictions for california pharmacy practice.
Pharmacy patients and personnel must now be warned about toxic
chemicals commonly used in the pharmacies.
2. The new regulations, which became effective in february,prohibits the
knowing and
3. Under the ACT,products that contain substances which are know to be
carcinogenic or to cause birth defects or other reproductive harm
require written warnings.
These warnings must be posted at the point of delivery to the consumer
in our case the facility and / or on the premises where such substances
are stored. Violations of these restrictions could result in fines of up
to $2500.00 for each day the violation occured.
There are also incentives of up to 1/3 of the levied fines for persons
to report such incidents.
4. Tobacco Smoke" was added to the list of chemicals known to the state to
cause cancer. Businesses that permit smoking in their facilities are
required to provide warnings about the carcinogenicity of tobacco smoke,
unless they are able to demonstrate that the level of exposure to
tobacco smoke does not exceed the "No Significant Risk Level.
The following language is to be used to warn visitors, employees and
residents as to the exposue to environmental tobacco smoke.
WARNING: THIS FACILITY PERMITS SMOKING, AND TOBACCO SMOKE IS KNOWN
TO THE STATE OF CALIFORNIA TO CAUSE CANCER
Warning signs are to be posted at each visitor/employee entrance.
5. Dispensed prescription drugs are exempt from the law. Section 12601
states:for prescription drugs, the labeling approved or otherwise
provided under federal law and the prescribers accepted practice of
obtaining a patient's informed consent shall be deemed to be clear and
reasonable warning.
6. In this long term care facility, we should be aware that many medical
devices and supplies,such as IV sets, tubing, etc,are carcinogenic
substances, which are commonly sterilized with ethylene oxide, a listed
carcinogenic substance, we must, therefore warn persons to whom such
products are transferred without prescription,such as skilled nursing
facility personnel be informed.
7. Appendix "A" is a current listing of known carcinogens and reproductive
toxicants.
PAGE 3
HAZARDOUS COMMUNICATION PROGRAM
1. Employee information and training.
Employees are to attend a health and safety orientation set up by
Staff Development Dept, for information and training on the following:
An overview of the requirements contained in the Hazardous
Communication Regulation, including their rights under the regulation.
Inform employees of any operations in their work area where
hazardous substances are present.
Location and availability of the written hazardous substances.
Methods and observation techniques used to determine the presence or
release of hazardous substances in the work area.
How to lessen or prevent exposure to these hazardous substances
through usage of engineering controls, works practices, and/or
the use of personal protective equipment.
Steps the Facility has taken to lessen or prevent exposure to these
substances.
Emergency and first aid procedures to follow if employees are exposed
to hazardous substances. Knowing how to read labels and review MSDS
information sheets to obtain appropriate hazards information.
Note: It is critically important that all company employees understand the
training. If you have any additional questions please contact:Admin
When new hazardous substances are introduced, the facility DSD
will review the above items as they are related to the staff and
work area, also new products will be introduced at the monthly
safety meeting.
APPENDIX "A"
HAZARDOUS
SUBSTANCES AREA USED MSDS
===============================================================================
ULTRA H-STRIPPER ********** HSK/GENERAL ************ SEE MSDS BOOK
-------------------------------------------------------------------------------
ACTION D *********** HSK/GENERAL ************ SEE MSDS BOOK
-------------------------------------------------------------------------------
LEGGE-ACY 2000 *********** HSK/GENERAL ************ SEE MSDS BOOK
-------------------------------------------------------------------------------
WET SHINE *********** HSK/GENERAL ************* SEE MSDS BOOK
-------------------------------------------------------------------------------
ELIM -STAPH #2 *********** HSK/GENERAL ************* SEE MSDS BOOK
-------------------------------------------------------------------------------
SPRAY * BUFF *********** HSK/GENERAL ************* SEE MSDS BOOK
-------------------------------------------------------------------------------
OXGEN TANKS ************ RESIDENTS ROOMS ********** SEE MSDS BOOK
-------------------------------------------------------------------------------
GASOLINE *************** OUTSIDE STORAGE ********* SEE MSDS BOOK
-------------------------------------------------------------------------------
PAGE 4
HAZARDOUS COMMUNICATION PROGRAM
HAZARDOUS NON-ROUTINE TASKS:
Periodically, employees are required to perform hazardous
non-routine tasks. Prior to starting work on such projects,
each employee will be given information by their supervisor
about hazards to which they may be exposed during such an activity.
THIS INFORMATION WILL INCLUDE:
Specific Hazards.
Protective/Safety measures which must be utilized.
Measures that the facility has taken to lessen the hazards including
ventilation, masks, gloves, presence of another employee and
emergency procedures.
EXAMPLE OF NON-ROUTINE TASKS PERFORMED BY EMPLOYEE OF THIS COMPANY:
SAMPLES TASKS
TASK HAZARDOUS SUBSTANCES
---------- ---------------------
SPRAYING FOR ANTS/ROACHES PETROLEUM DISTILLATES
HAZARDOUS SUBSTANCES IN UNLABELED PIPES:
In order to ensure that all employees who work on unlabled pipes
have been informed as to the hazardous substances contained within,
the following policy has been established:
Prior to starting working on unlabeled pipes all employees are to
contact the maintenance dept for additional information.
The hazardous substances in the pipe. Potential hazards, Safety
precautions which shall be taken.
ALL CONTACTORS MUST BE INFORMED:
To ensure that outside contractors work safely in this facility.
It is the responsibility of the maintenance supervisor to provide
contractors the following information.
Hazardous substances to which they may be exposed while on the jobsite.
The precautions all employees may take to lessen the possibility of
exposure by usage of appropriate protection measures.
PAGE 5
HAZARDOUS COMMUNICATIONS STANDARD
POST-TEST
1. CIRCLE THE CORRECT ANSWER.
The hazardous communication program contains all the following except:
A. Inventory List of hazardous chemicals.
B. Labeling of hazardous chemical containers.
C. First Aid Information.
D. Material Safety Data Sheets -MSDS-
E. A written hazard communication progam.
F. Employee Inservice Training.
G. CPR training.
2. Question number two: Fill in the blanks
A. The hazard communication standard is a requirement for all _____________
designed to protect _____________ from health hazards in the workplace
resulting from exposure to hazardous ______________________.
B. The facility's written hazard communication program can be found:_______
________________________________________________________________________
C. To find what precautions should be used when using a new chemical, the
employee should ___________________________________.
D. The key to safe use of hazard chemicals is to ____________the __________
E. Hazardous chemicals can most often be detected by ______________And
_____________________________.
F. Some of the hazardous substances in this workplace are:
1._______________________________________________
2._______________________________________________
3._______________________________________________
4._______________________________________________
5._______________________________________________
EMPLOYEE NAME:_______________________ DATE:_____________
PAGE 6
SIGN-OFF SHEET
I HAVE REVIEWED THE MSDS HAZARDOUS COMMUNICATION PROGRAM:
EMPLOYEE NAME ____________________________________
WITNESS:___________________________________________
AND I FEEL CONFIDENT THIS EMPLOYEE UNDERSTANDS WHAT WE HAVE DISCUSSED I HAVE STRESSED THE IMPORTANCE OF DISCUSSING ANY FUTURE QUESTION
RELATED TO MSDS FILES / AND HAZARDOUS WORK AREAS
KNOWS HOW TO CONTACT HIS/HER IMMEDIATE SUPERVISOR.
FOR ANY ADDITIONAL INFORMATION ABOUT NEW PRODUCTS.
THIS WILL BECOME A PERMANENT PART OF THE EMPLOYEE'S PERSONNEL RECORDS.
I HAVE READ AND I UNDERSTAND THE INFORMATION CONTAINED IN THE
MDSD SAFETY INFORMATION HANDBOOKLET.
DATE____________________