F IS/ AR -P.F1
MAY 11 1988
Memo1andum
To: Refuge lianagor, necedah National Uildlife Refuge
Fro Regional Refuee Supervisor, RF1
Subj ct: Safety Plan
Tho subject plan w s revie 1ed in this office and by Earl l4arkwell nd is approved as l'lritten.
The pl n should be updated within the next tro years using Regional R leas 24-90 as a guideline (attached).
Thanks for a "' 1 prepared plan.
John \ • Ellis
Attachments
Necedah National Wildlife Refuge Necedah, Wisconsin February 22, 1988
Submitted b~~ Q. ~ Date:~~ I S-8~
Concurrenc~G?~ Date: ,,Y'- ..5 --;_? cf
I.
II.
III.
IV.
v.
. INDEX
Policy Statement .
Administration and Responsibility.
Safety Organization ..
Emergency Information.
Safety Inspections . .
Buildings and Structures Vehicles and Boats . . .
. .
A. B. c. D. E.
Fire Prevention and Related Equipment. Storage of Pyrotechnics, Flammables, and Personal Safety Equipment ..
Pesticides .
VI. Accident Reporting Requirements.
.VII. Safety Procedures.
A. Fires ..... B. Office Safety. C. Motor Vehicle Safety D. Automotive Shop Safety . E. Watercraft Safety ... F. Public Safety. . . . . G. Operations and Maintenance
APPENDIX
1. Motor Vehicle Safety Checklist 2. JHA, P-2, Portable Fire Extinguisher Use 3. DI-134 4. Notice ABA/SSA, 12/01/87, Accident Analysis Form 5. JHA, P-3, Conducting a Prescribed Burn 6. Tips for the ATV Rider 7. ATV Off-road Practice Guide 8. All Terrain Vehicle Training Guide - USFWS 1985 9. Regional Instruction - Motorcycles and 3-wheel cycles
10. Bulletin Update ATV, ABA/SSA, 01/28/88 11. Accepted Hand Signals 12. Wisconsin Boating Regulations 13. Survival 10 Tips 14. JHA, Chainsaw Operations 15. JHA, Lawn mower Operation
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.01
.01
.02
.03
.03
.03
.03
. 04
.04
.04
.05
.05
.06
.06
.07
.07
.08
.09
I. POLICY STATEMENT
It is the policy of the U. S. Fish and Wildlife Service:
- To provide a safe environment for its employees and the public.
- To preclude unsafe acts through education and on-the-job training, and stress that safety is essential to the wise use of staff., materials, and equipment.
1
- That safety is an integral part of every task and that no job is so important or so urgent that sufficient time or precaution cannot be taken to perform it safely.
II. ADMINISTRATION AND RESPONSIBILITY
The supervisor is in a key position in the organizational structure to provide a safe working environment for employees and for the public.
Employees have the responsibility to:
- Comply with all safety precautions and instructions, both written and oral.
- Correct or report unsafe acts or conditions.
- Use safety equipment provided for hazardous machinery or conditions.
- Be alert to possibilities for improving safety measures to protect themselves, other employees, the public, and government property.
III. SAFETY ORGANIZATION
Each station with a staff of five or more employees will -appoint a station safety committee of not less than three members, one of whom will serve as chairman, and a station safety officer. The station safety officer responsibilities will rotate between assistant refuge managers, and the safety committee will report to the refuge manager.
The safety committee will be responsible for:
- Establishing procedures for handling suggestions and recommendations of safety concerns and following through with the concerns.
2
- Conduct regularly scheduled meetings for the purpose of discussing accident prevention methods, safety promotion, items noted on inspections, injury records, and other pertinent subjects.
- Investigate accidents for recommendations on preventing recurrence.
The station safety officer will have the following responsibilities:
- Serve as one of the three members on the station safety committee.
- Plan and initiate action for safety improvements.
- Advise and recommend safety programs.
- Stimulate interest in accident prevention.
- Conduct inspections for hazardous conditions and unsafe work practices.
- Investigate all accidents that occur on the refuge and submit all findings through the refuge manager.
- Serve as station safety officer for a five-year period.
IV. EMERGENCY INFORMATION
Fire Department: Necedah Volunteer Fire Dept. 608/565-2210 715/421-7800 715/325-5057
Police:
Wisconsin Rapids District Supervisor Robert Smith (Home)
Necedah Police Dept. 565-2405 Juneau County Sheriff Dept. 565-2551 Wisconsin State Highway Patrol 608/372-5998
Ambulance Service: Necedah Volunteer Fire Dept. 565-2210
Hospitals: Adams Co. Memorial Hospital 608/339-3331 Tomah Memorial Hospital 608/372-3971 Hess Memorial Hospital (Mauston) 608/847-6161 Riverview Hospital (Wis. Rapids) 715/423-6060
3
V. SAFETY INSPECTIONS
Safety inspections are a necessary component of a safety program. Facilities, structures, roads, and buildings must be maintained to Service Standards as required by the Maintenance Management System. The safety inspections provide detection, analysis, and correction of unsafe conditions and methods.
All staff members are required to report and correct any unsafe or unhealthful work practices or equipment as soon as they are discovered. A safety inspection is required annually, to assist staff members in recognizing unsafe conditions. A form for completing this inspection is provided each year by the Regional Safety Office.
In addition to the annual safety inspection, certain items require more frequent and specific inspections.
A. Buildings and Structures
1. Housekeeping and general storage practices need to be inspected during spring and autumn.
2. Electrical hazards are an on-going maintenance inspection.
3. Heating systems require at m1n1mum one annual furnace inspection prior to the heating season. During the heating season, chimneys are to be checked and cleaned bi-monthly.
B. Vehicles and Boats
Conduct on-going regularly scheduled maintenance in addition to the annual inspection done in accordance with the Motor Vehicle Safety and Maintenance Checklist (24 AM 4, Exhibit 2A). (See also Appendix 1.)
C. Fire Prevention and Related Equipment
Conduct on-going maintenance inspections, i. e., fire extinguishers require monthly checks and periodic testing in accordance with 24 AM 6. Smoke alarms should be tested quarterly. (See also Appendix 2.)
D. Storage of Pyrotechnics, Flammables, and Pesticides
Hazardous material containers and storage areas are usually inspected at least twice per year, normally during the fall and spring inventories.
4
E. Personal safety clothing and equipment is to be inspected prior to each scheduled use and during the spring and fall inspections.
VI. ACCIDENT REPORTING REQUIREMENTS
All accidents will be reported promptly on Department of Interior accident report form DI-134, following the instructions given and using the standard titles provided in its index, DI-134 (24 AM 1.13 [Appendix 3]). In addition to the DI-134, the Accident Analysis Form will also be completed in accordance with the Notice ABA/SSA, dated 12/01/87 (Appendix 4). The following is a list of reportable accidents:
- Work injuries; - Death, including heart cases; - Occupational diseases; - Motor vehicle accidents; - Water vessel accidents; - Aircraft accidents; - Property damages; - Fires; and
Tort Claims (fatalities, serious accidents)
All accidents will be reported, verbally, by the employee involved to his supervisor as soon as possible, but no later than 48 hours. If the employee is unable to make the report because of his/her injury or death, it is to be made by the employee next directly concerned with the accident.
A serious employee accident is any occurrence of an employee accident which is fatal to one or more employees or which results in the hospitalization of five or more employees. Permanent injury, likely to exceed 30 calendar days in lost time also falls into the serious accident category ..
A serious property damage accident is accidental damage to any Departmental property, excluding forest, range, and tundra fires, that results in property damage of $100,000 or more.
When other Federal, State, or Local requirements provide for the reporting of an accident, employee will render such reports to the appropriate officials. The supervisor will ensure that all appropriate action has been taken. Copies of every
VII.
required report prepared will be attached to the DI-134. In addition, appropriate U. S. Department of Labor, Office of Workmen's Compensation (OWCP) forms will be submitted.
If any OWCP form is prepared, a DI-134 report is required by the Department. Supervisors are responsible for determining that all prescribed procedures are followed.
5
Property damage of any type occurring on government property, other than that involving a motor vehicle, will be reported on a DI-134. The accident report will contain all pertinent information in the event a claim is filed against the government. Special additional reporting is required for accidents concerning aircraft, boats (any type of watercraft under 65' in length}, large watercraft, and catastrophes.
Fires on refuge property will be reported. Fires resulting in ·damage to buildings, structures, vehicles, boats, mechanical equipment, and aircraft will be reported on DI-134, especially if there are circumstances of significance beyond the station level.
A claim filed against the government is the right of any individual. It is for this reason that accident reports must be prompt, factual, and in sufficient detail to give full analysis of the accident. The accident reports should be supplemented by diagrams and photos as necessary to present information helpful to casual analysis and determination of responsibility.
SAFETY PROCEDURES
A. Fires
1. Structural. Building fires should be reported to the Necedah Volunteer Fire Department. The fire department will suppress structural fires at the headquarters area.
2. Wildfires. There are no. restrictions on suppression methods or seasonal applications on the refuge. The refuge will have no modified suppression action areas. Wildfires on the refuge must be suppressed and contained.
3. Prescribed Burning. Only permanent staff with Basic Firefighting Training can participate in prescribed burning as listed in the Prescribed Burning Plan for the refuge. The Refuge Forester and Maintenance Mechanic will normally act as Fire Boss in that
order. In the absence of the Refuge Forester, the Maintenance Mechanic will act as Fire Boss. (Fore more details, refer to the Prescribe Burn Plan and Appendix 5 in this document.)
B. Office Safety.
The following procedures and practices will be adhered to in all refuge office areas.
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1. Lighting will be checked regularly, burned out bulbs or florescent tubes will be promptly replaced.
2. Aisles, halls, and stairway shall be clear of objects.
3. Filing cabinet drawers will be closed when not in use.
4. Electrical and telephone cords will be placed to prevent a trapping hazard. Worn cords will be repaired or replaced.
5. Defective furniture will not be used.
6. Washing facilities and toilet rooms shall be maintained in a sanitary condition.
C. Motor Vehicle Safety.
The driver will be'responsible for the comfort and well-being of .all occupants of the vehicle. The driver will also be responsible for the safe condition of the vehicle. All malfunctions and unsafe conditions must be reported to the maintenance staff.
U. S. Fish and Wildlife Service drivers are required to participate in a minimum of eight hours of refresher training in defensive driving every three years, after attending the initial eight-hour course.
Each refuge vehicle has a DI-135, "Information on What to do" in the event of a motor vehicle accident involving a government vehicle.
Refuge staff utilizing the All Terrain Vehicle (ATV) three-wheeled cycle, are required to wear all personal protective equipment and be familiar with the safe operating procedures contained in Appendices 6-10. Also, ATV operators should be
familiar with 24 AM 4.15, which requires them to be properly trained and qualified to operate three-wheeled cycles.
D. Automotive Shop Safety
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1. Welding. All welding will be done by qualified individuals. Projects to be accomplished by welding will be done on the bench where sight shields and exhaust fans are available. Moveable fire hazards will be moved from the area of welding. Suitable fire extinguishers shall be maintained in a state of readiness for instant use.
2. Lifting devices, i. e., jacks, hoists, chain falls, etc. When lifting machinery or vehicles for repair or lube jobs, the load will be blocked tg prevent falls. When the load is raised to the desired height, it shall be cribbed, blocked, or otherwise secured immediately. {See Appendix 11.)
3. Jump starting vehicles. Check dead battery for fluid level, then connect jumper cables by the following procedure:
a. Attach red cable to good battery, positive terminal;
b. Attach red cable to dead battery, positive terminal;
c. Attach black cable to good battery, negative terminal;
d. Attach black cable to dead car's frame at least 12 inches away from battery to prevent explosion.
e. When dead vehicle starts, remove cables in reverse order, i.e., item d, item c, item b, item a.
E. Watercraft Safety
The Wisconsin Boating Regulations established by the Department of Natural Resources will be obeyed by the refuge staff (Appendix 12). In addition, Appendix 13 is a small booklet published by the Department of Natural Resources entitled "Survival 10 Tips."
Canoes and boats less than 20' are used on the refuge for goose nest surveys, drive trapping operations, and habitat work.
The refuge watercraft and associated equipment will be inspected a minimum of twice a year.
When caught in a storm or high wind,· keep the craft headed into the wind. You can use "sea anchors" made from dangling an object, jacket, or tackle box, etc., on a short length of rope from the bow end of the watercraft. The sea anchor will drag in the water and keep the bow into the wind.
Canoes have ballast tanks and will support you and can be paddled even though full of water. Be sure to inspect flotation material used in these ballast tanks as rodents will eat or remove this material to the point that you may not have any material left. All watercraft will be inspected for buoyancy before being placed into service.
A particular hazard at Necedah is the high number of stumps and logs in the pools and ditches which are just beneath the surface of the water. These hidden objects can easily puncture or capsize a boat or canoe.
F. Public Safety
There are four areas of concern for public safety while the visitors are on the refuge. The areas are as follows:
Self-guided Auto Tour Route. The auto tour route follows township roads where the townships are responsible for maintenance. Townships included in the tour route are Cutler, Kingston, and Necedah.
Hazards along the trail will be noted and the refuge manager notified. The public will be advised of the hazardous condition by a sign at the beginning of the tour route. If appropriate, designation of these roads as an auto tour route will be suspended by the refuge until the hazard has been corrected.
Observation Tower. The tower will be closed during winter, during thunder storms, and when work is being preformed on the tower.
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A thorough inspection of all steps and landings will be made prior to the tourist season to insure visitor safety. The tower will undergo weekly inspections and litter pickup in the area.
Nature Trail. The nature trail will be inspected at least once a week during the visitor season. Cracked limbs or branches that may fall on the trail shall be removed. The trail will be inspected after any thunderstorm or windstorm and any fallen debris will be removed.
When possible, the visiting public should be advised of the hazards along the trail such as biting insects, poison ivy, and deep water next to the trail.
Fishing Areas. The public fishing areas along the Sprague Dike and Goose Pool are open from June 1 through September 15. There are four water control structures that are popular fishing sites. The water control structures and dikes will be maintained at Service Standards according to the Maintenance Management System.
G. Operations and Maintenance
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1. Chain saws. Operators of chain saws must have taken the Chainsaw Safety Course, either by a classroom or self-study format, to be qualified to operate. It is to the advantage of the operator to have previous experience. See Appendix 14.
2. Lawn Mowers. The refuge has rotary lawn mowers, both push-type and self-propelled. Read the owner's manual. Ask the maintenance personnel for the owner's manual and have one of them demonstrate the mower if you have any doubts about its operation. See Appendix 15.
3. Riding Lawn Mower. Many of the safety rules expressed for lawn mower owner's manual will apply to the riding lawn mower. There are several specific safety rules that must be observed and re-emphasized. The rules are the following:
- No passengers except for the operator; - Operator must be 16 years or older; - Drive slow over rough ground; - Look back before backing; - Slow down for turns;
- Keep people at least 50' away from operation; - Clear cutting area of rocks, sticks, and other objects that may damage blades; - Stop engine completely and make sure mower has stopped before dismount.
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4. Heavy Equipment and Heavy Trucks. Operators of heavy machinery, such as dozers, backhoes, farm tractors, and motor graders, must be certified to operate. Experience is needed to operate heavy trucks, such as the tractor-trailer combinations and the dump trucks.
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APPENDIX
1. Motor Vehicle Safety Checklist 2. JHA, P-2, Portable Fire Extinguisher Use 3. DI-134 4. Notice ABA/SSA, 12/01/87, Accident Analysis Form 5. JHA, P-3, Conducting a Prescribed Burn 6. Tips for the ATV Rider 7. ATV Off-road Practice Guide 8. All Terrain Vehicle Training Guide - USFWS 1985 9. Regional Instruction - Motorcycles and 3-wheel cycles
10. Bulletin Update ATV, ABA/SSA, 01/28/88 11. Accepted Hand Signals 12. Wisconsin Boating Regulations 13. Survival 10 Tips 14. JHA, Chainsaw Operations 15. JHA, Lawn mower Operation
UNITED STATES DEPARTMENT OF THE INTERIOR FISH AND WILDLIFE SERVICE
Appendix 1
Motor Vehicle Safety and Maintenance Inspection Checklist
Station Make and Type ~----------------------------~ -----------------------------------
License Number Odometer ------------------------- ----------------------------------------Date and Mileage Last Inspection ____________________________________________________ __
Check Correction Item Description Yes No Date/Sign.
1. Accident forms In vehicle 2. State safety ins~ection Current 3. Oil and filter Changed as required 4. Tune-ups and other Performed as
preventive maintenance re_quired 5. Lubrications Performed as required 6. Wipers,defrosters,washers Working properly 7. Horn Operates properly 8. Steering system (including Tight, with no excessive
front wheels play 9. Clutch Operates _pro_perly
10. Transmission O_l)_erates _I>_roperly 11. Nirrors Serviceable (not broken,
and tight) 12. Glass (all) Safe, serviceable 13~ Seat,backrest~su_Il_Ports Tight, serviceable 14. Gauges Operates properly 15. Brake system (foot and Safe, fully effective
parking) (linings checked in last 6 months)
16. Lights (including dash) Operating and no broken lenses
17. Radiator Adequate coolant (clean inside and out)
18. Seat belts Serviceable condition 19. Leaks:
a. Cooling system b. Oil Engine, transmission,
differential c. Exhaust system d. Fuel system e. Brake system Check dents & rust on lines
20. Engine appearance Exterior clean 21. Belts Serviceable, properly
adjusted 22. Oil (engine) At proper level
23. Battery and cables
30. Appearance, care
1. Accessories check if in vehicle) ( ) First aid kit ( ) Flashlight ( ) Fire extinguisher ( ) Tow chain ( ) Jack and wheel wrench ( ) Spare tire ( ) Inflated ( ) Tire chains ( ) Shovel ( ) Flares
Comments:
Inspector's Sign~ture
Adequate water, clean,
Proper pressure and tread, free of cuts and
ear
Date
~ ~
JOBACTIViTY: Portable fire extinguisher use
JOB HAZARD ANALYSIS UNITED STATES FISH AND WILDLIFE SERV1CE
PERSONAL PROTECTIVE EQUIPMENT REQUIR-ED: QUALIFICATIONS, EXPERIENCE, OR TRAINING REQUIRED:
BASIC JOB STEPS
Break work down to basic el~ments (such as remove. lilt. carry, stop, start, apply, return. squeeze. cut. wP.Id, saw, walk. hold. grind, place. etc.). Describe what is done .. not how :t is done.
Use of portable fire extinguishers.
Position the extinguisher for operation. The intended position is usually indicated, and operating instructions are usually on the extinguisher.
' Many extinguishers have a safeguard or locking device that prevents ~ccidental actuation. This locking device can be a lock pin or r~ng pin which ~ust be withdrawn. before the extinguisher can be used. Other devices are clips, cams, levers, or hose or nozzle re~trainers. On some extinguishers the restr~inin~ device is arrange~ to disenqagP. when the unit is normally handle~. ~o sep~rate motion is needed.
HAZARDS
For each job step, state what accident could occur and/or what hazard is present. To detcr:.,ine this ask yourself. Can the person fall; overext:t; be exposed to burns, fumes. rays, gas, etc.; hit against; be struck by; come in contact with; be caught in. on. or between?
Chemical burn to eyes.
Using the wron~ type of extinguisher can cause serious injuries. SJP-2
A small, easily extinguishable fire can become uncontrollable.
SJP-1
-OVER-
SAFE JOB PROCEDURE ( SJP)
State how each element of work should be performed to prevent the accident or avoid the hazard. What should the person do or not do? Be specific. Whilt precautions should be taken? Ask yourself, What can I do to eliminate, modify, guard, identify, or protect against the potential accident or hazard, including such things as how the worker stands, or holds, uses. carries. dresses, etc.?
1.
2.
3.
Many fires are small at origin and may be extinguished by the use of a proper fire extinguisher. However, always notify the fire department as soon as a fire is discovered. Don't delay notification pending results of the application of portable fire extinguishers. Always identify a safe evacuation path for yourself.
Ensure that extinguisher available is suitable for the type of fire likely to occur.
Check extinguisher periodically to ensure proper performance when needed.
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U.S. FISH AND WILDLIFE SERVICE Twin Cities, Minnesota 55111
Appendix 9
OCT 3 19B3
IECEDAH NWi File j I Pitch
SA- 24 AM 4 Regional Release "2!'111r-i"'r----J.
SEP 2 7 1983
REGIONAL INSTRUCTION
SUBJECT: Motorcycles, Motor Scooters, and Three Wheeled Cycles
PURPOSE. To p·rovide interim and supplemental guidance for the use of motorcycles, motor scooters, and three wheeled cycles pending revision of 24 AM.
Attachment A also provides the National Safety Council's Safety Education Data Sheet Number 98, "MOTORCYCLES" for supplemental safety guidelines.
FILING INSTRUCTION. File this Instruction in the Administrative Manual in 24 AM. Reni6"Vs...awi ""iklstx:~i&ftal· Bel..ae 4': ~3 .tate9 bgnst 36 19~2.._,_
4.15 Motorcycles, Motor Scooters, and Three Wheeled eycles
A. General Requirements.
(1) All operators must hold a valid operator card (SF-46) for the vehicle being operated.
(2) If the vehicle is to be operated on public roadways, both the operator and the vehicle must meet the applicable state requirements for such operation.
(3) Operators traveling alone shall establish a planned travel route and established time of arrival/or return with his/her supervisor and/or family member. A search will be made if the operator fails to report or check in within a reasonable time.
(4) All motorcycles and motor scooters will be equipped with spark arresters.
(5) Required Personal Protective Equipment for motorcycle, motor scooter, and three wheel cycle operations will be as follows: (Variations to these Personal Protective Equipment requirements may be requested in writing from and provided in writing by the Regional Safety and Occupational Health Manager).
Distribution: AO; Wash. (DF; SS), Regs. 1, 2, 4, 5, 6, and 7 Attachment 1
•
(24 AM 4.15 continued)
(a) Steel-toed safety boots (b) Leather gloves (c) Protective headgear which meets ANSI Standards Z90.1
- standards for motorcycle crash helmets (d) Eye protection (e) Hearing protection (contingent upon the noise levels
being emitted by the individual piece of equipment)
2
NOTE: It is strongly recommended that operators and passengers wear long-sleeved shirts or jackets.
(6) Operators will not carry passengers except on those three wheeled vehicles so designed by the manufacturer.
B. Training.
(1) Operators must receive training on the safe operation and maintenance of each type of equipment.
(2) Job Hazard Analysis (JHA) development is encouraged as a training method.
(3) Operators must be trained in equipment performance limitations and capabilities.
(4) Project Leaders are encouraged to invite manufacturer representatives to provide onsite safety instruction.
~I~ Regional Director
Regional Release 24-74
Appendix 10
FEB 1 b i3:a
BIAIDR
• ------ . ABA/SSA - January 28, 1988
BULLETIN
SUBJECT: Update, All Terrain Vehicles
On the reverse of this Bulletin is a copy of the January 11, 1988, information and policy memorandum from the Assistant Director-Policy, Budget and Administration regarding the use of three-wheel all terrain vehicles.
Also attached is the Yamaha Motor Corporation ATV SAFETY ALERT for your infonnation.
/1. //)"7__..~ / ~~ ~-~c---r/";6~·~~~~~-,-
Earl Ma~~e~ 1 Safety and Occupational Health Manager
Distribution: AO; Reg'l. Saf. Mgr. 1, 2, 4, 5, 6, and 7; FWS, W~sh., D.C. (SSA)
Attachments (2)
United States Department of the Interior FISH AND WILDLIFE SERVICE
WASHINGTON. D.C. 20240
-111000.• ... C.ICTOIO. ---MOVICI In Reply Refer To:
·JAN 11 1988 IWS/SSA
To: Jtegional Directors
Frca: Assistant Director - Policy, Budget and Alhinistration
SUbject: Dpdate, All Terrain Vehicles
On Thursday, December 30, 1987, the Justice Department announced a consent decree with the manufacturers of three-wheel All Terrain Vehicles (ATV). The consent decree provides for:
1. An inmediate end to the, sale of three-lolheel models.
2. Repurchase of any three-wheel IIIOdels from dealer inventories.
3. A warning letter from the ma~ufacturer to current owners describing the possible hazards associated with three-wheel vehicle use.
4. The posting of warning posters in dealer showroo!IIS.
5. Free driver training courses to those who purchased three-w!"leel vehicles within the past 12 months.
6. A toll free hotline to be established for ATV ownez:s.
7. Developnent of industry standards for ATV eomox>nents.
8. An advertising campaign to warn ATV owners about possible hazards.
9. Banning sales or use of ATVs by children under the age of 12.
10. The pl acernen t of warning labels on ATVs.
Also, manufacturers will not oppose any State proposals to require licenses for ATV operators.
The consent decree did not require the recall of three-wheel A'Ns from current owners nor did it provide for a rebate progr~ for current owners. The fiC!lS that agreed to the settlenent did so without aanitting that the ATVs wre unsafe.
ibe Fish and WileS! ife Service (Service) will continue to utilize those 'three-wheel vehicles in the current inventory. The policy, as stated in 24 AH 14.3, nquires operators of such vehicles to be trained. Further requirements are fou~ in 24 AM 14.11, and the training guidelines are in the Service's All Terrain Vehicle Training Guide. A fXItTI of the Guide can be obtained froc the Regional Safety Manager.
...
YAMAHA MOTOR CORPORATION, U.S.A. 8555 KATELLA AVENUE • CYPRESS, CALIFORNIA 90630
MAIL ADDRESS: P.O. BOX 8555, CYPRESS, CALIFORNIA 10630
PHONE: (714) 781·7300
ATV SAFETY ALERT
The Consumer Product Safety Commission has concluded that ALL-TERRAIN VEHICLES (ATVs) may present a risk of DEATH or SEVERE INJURY in certain circumstances. While accidents may occur for many reasons:
•••
•••
•••
Over 900 people, including many'children, have died in accidents associated with ATVs since 1982.
Many people have become severely paralyzed or suffered severe internal injuries as a result of accidents associated with ATVs.
Thousands of people have been treated in hospital emergency rooms every month for injuries received while riding an ATV.
Because of this, the United States Government has filed a lawsuit against all manufacturers .and distributors of ATVs asking the Court to declare that ATVs are hazardous and to order the manufacturers and distributors to take actions to protect ATV riders. The distributors, while contesting the validity of the allegations made by the government, are presently engaged in discussions with the government to resolve these issues without litigation.
You should be aware that an ATV IS NOT A TOY AND MAY BE DANGEROUS TO OPERATE. An ATV handles differently from other vehicles, including motorcycles and cars. According to the Consumer Product Safety Commission, an ATV can roll over on the rider or violently throw the rider without warning and even hitting a small rock, bump, or hole at low speed can upset the ATV.
TO AVOID DEATH OR SEVERE PERSONAL INJURY:
• NEVER DRIVE AN ATV WITHOUT PROPER INSTRUCTION. TAKE A TRAINING COURSE. BEGINNING DRIVERS SHOULD RECEIVE TRAINING FROM A CERTIFIED INSTRUCTOR. Call 1·800-447-4700 to find out about training courses nearest you.
• NEVER LEND YOUR ATV TO ANYONE WHO HAS Nai' TAKEN A TRAINING COURSE OR HAS Nar BEEN DRIVING AN ATV FOR AT LEAST A YEAR.
(Please continue reading on reverse side)
• ALWAYS FOLLOW THESE AGE RECOMMENDATIONS:
--A CHILD UNDER 12 YEARS OLD SHOULD NEVER DRIVE AN ATV WITH ENGINE SIZE 70 CCD OR GREATER.
- A CHILD UNDER 16 YEARS OLD SHOULD NEVER DRIVE AN ATV WITH ENGINE SIZE GREATER THAN 90 CCD.
• NEVER ALLOW A CHILD UNDER 16 YEARS OLD TO DRIVE AN ATV WITHOUT ADULT SUPERVISION. CHILDREN NEED TO BE OBSERVED CAREFULLY BECAUSE NOT ALL CHILDREN HAVE THE STRENGTH, SIZE, SKILLS OR JUDGEMENT NEEDED TO DRIVE AN ATV SAFELY.
• NEVER DRIVE AN ATV AFTER CONSUMING ALCOHOL OR DRUGS.
• NEVER CARRY A PASSENGER ON AN ATV. CAR~YNG A PASSENGER MAY UPSET THE BALANCE OF THE ATV AND MAY CAUSE IT TO GO OUT OF· CONTROL.
• NEVER DRIVE AN ATV ON PAVEMENT. THE VEHICLE IS NOT DESIGNED TO BE USED ON PAVED SURFACES AND MAY BE DIFFICULT TO CONTROL.
• NEVER DRIVE AN ATV ON A PUBLIC ROAD, EVEN A DIRT OR GRAVEL ONE, BECA.USE YOU MAY NOT BE ABLE TO AVOID COLLIDING WITH OTHER VEHICLES. ALSO, DRIVING ON A PUBLIC ROAD WITH AN ATV MAY BE AGAINST THE LAW.
• NEVER ATTEMPT TO DO "WHEELIES," JUMPS OR OTHER STUNTS.
• NEVER DRIVE AN ATV WITHOUT A GOOD HELMET AND GOGGLES. YOU SHOULD ALSO WEAR BOOTS, GLOVES, HEAVY TROUSERS AND A LONG SLEEVE SHIRT.
• NEVER DRIVE AN ATV AT EXCESSIVE SPEEDS.
• AL\VAYS BE EXTREMELY CAREFUL WHEN DRIVING AN ATV, ESPECIALLY WHEN APPROACHING HILLS, TURNS, Al'ID OBSTACLES AND WHEN DRIVING ON UNFAMILIAR OR ROUGH TERRAIN.
• ALWAYS READ THE OWNER'S MANUAL CAREFULLY AND FOLLOW THE OPERATING PROCEDURES DESCRIBED.
FOR MORE INFORJ\1ATION ABOUT ATV SAFETY, CALL THE CONSUMER PRODUCT SAFETY COMMISSION AT 1-800-638·2772, OR THE ATV DISTRIBUTORS' SAFETY HOTLINE AT 1-800-447-4700.
Appendix 11
--ACCEPTED HAND SIGNALS
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(£) A .. ..
~ SPEED IT UP-
START THE ENGINE STOP THE ENGINE INCREASE SPEED
(~)
~ ~
t C9) .
SLOW IT DOWN-DECREASE SPEED RAISE EQUIPMENT LOWER EQUIPMENT COME TO ME
~
~ b:==f} __ l"'" r---MOVE TOWARD ME -
FOLLOW ME THIS FAR TO GO STOP MOVE OUT- TAKE OFF
....
--
·10 TIPS FOR Appendix 13
HUNTERS · FISHERMEN Gi~il CANOEISTS AND OTHER SMALL
i BOAT { .USERS I
..
JOB ACTIVITY : Chainsaw operations •
JJOB HAZARD ANAL Y '•
UNITED STATES FISH AND WILDLIFE SERVICE
PERSONAL PROTECTIVE EQUIPMENT REQUIRED: Safety toed shoes, chainsaw chaps, gloves, 'goggles, hard hat. hearina orotection. ~
UAI,.IFICATIONS, EXPERIENCE, OR TRAINING REQUIRED: ha1nsaw safetY, course. xpenence and7or tra1ninq in use of tools and e
BASIC JOB STEPS
Break work down to basic elements (such as remove. lift, carry, stop, start, apply, return, squeeze, cut, weld, saw, walk, hold, grind, place, etc.). Describe what is done ·· not how it is done.
I. Prepare the area and the chainsaw for use.
II. Fueling and refueling.
HAZARDS
For each job step, state what accident could occur and/or what hazard is present. To determine this ask yourself, Can the person fall; overexL:t; be exposed to burns, fumes, rays, gas, etc.; hit against; be struck by; come in contact with; be caught in, on, or between?
a. Cuts to the hands while inspecting chain.
b. Flashback causing burns to the body.
-Over-
SAFE JOB PROCEDURE
State how each element of work should be performed to prevent the accident or avoid the hazard. What should the person do or not do? Be specific. Whill precautions should be taken? Ask yourself, What can I do to eliminate, modify, guard, identify, or protect against the potential accident or hazard, including such things as how the worker stands, or holds, uses, carries, dresses, etc. 7
1. Use the correct chainsaw for the particular cutting task. The saw should be no larger or longer than required for the average size of th~ wood being cut.(c,d)
2. Inspect chainsaw before use to ensure that the handguard, spark arrester, and chain catcher are in place.(a,b,c,d)
3. Clear work area of debris to ensure good footing.(c)
4. Allow the chainsaw to cool for at least ten minutes before refueling.(b)
5. Use a funnel in fueling in order to eliminate spillage. Leave small airspace at the top of the tank to allow for expansion. Don't look into the gas tank while refueling. Move at least 10 feet from the fueling area before starting the chainsaw. Use an approved safety can for fuel mix. (b)
6. Start the chainsaw according to the manufacturer's directions. Never attempt to start the chainsaw on your knee or leg. (c)
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BASIC JOB STEPS
III. Starting the chainsaw.
IV. Using the chainsaw in actual operations.
V. Transporting the chainsaw.
HAZARDS
c. Cuts on hands, arms or legs or other· parts of the body.
d. The chainsaw may kickback and strike the operator.
e. Cuts and burns to the body.
SAFE JOB PROCEDURE
7. Avoid cutting limbs above mid-chest height.(d)
8. Use a well-balanced stance. Always hold the chainsaw firmly with both hands and use· the proper grip (i.e., forward handle with left hand, palm down, rear handle firmly grasped with the right hand).(d)
9. Don't touch the tip of the bar to any object while the chainsaw is running.(d)
10. Maintain control, don't lean forward. Be aware of the outward or downward path the saw will take after the wood is cut.(d)
11. Avoid fatigue and overexertion by pacing yourself during the task.(d)
12. Ensure the engine/chain has stopped, and the guide bar and chain saw are behind you before transporting.(e)
13. Use the bar guide sheath to cover saw before carrying.{e)
14. When proceeding down a steep grade, turn sideways and carry the chainsaw in the downhill hand.{e)
15. Carry the chainsaw in the cargo area of the vehicle. (e)
' ... " .,
•.
LawnmO\'Jer operations , . \ I
JOB ACTIVITY : '•
JOB HAZARD ANALYSIS UNITED STATES FISH AND WILDLIFE SERVICE
PERSONAL PROTECTIVE EQUIPMENT REQUIR£D: QUALIFICATIONS, EXPERIENCE, OR TRAINING REQUIRED:
Gloves, gles, hearing protection, safety toed shoes. Experience and/or training in use of too 1 s and ec
BASIC JOB STEPS
Break work down to basic elements (such as remove, lift, carry, stop, start, apply, return, squeeze, cut, weld, saw, walk. hold, grind, place, etc.). Describe what is done ·· not how it is done.
I. Prepare mower for operation.
II. Check fuel level.
HAZARDS
For each job step, state what accident could occur and/or what hazard is present To determine this ask yourself, Can the person fall; overexL"t; be exposed to burns. fumes, rays, gas, etc.; hit against; be struck by; come in contact with; be caught in, on, or between?
a. Cuts to·hands during examination of the blade.
b. Exposui~ to gasoline fumes. Possible ignition of gaso 1 i ne fumes.
-Over-
SAFE JOB PROCEDURE
State how each element of work should be performed to prevent the accident or avoid the hazard. What should the person do or not do? Be specific. WhiH precautions should be tllken? Ask yourself, What can I do to eliminate, modify, guard, identify, or protect against the potential accident or hazard, including such things as how the worker stands, or holds, uses, carries, dresses, etc.?
1. Examine the mower to ensure all protective shields are in place. Do not operate the mower until such shields are in place. Wear work gloves when examining the blade.(a,c,d,)
2. Store the gasoline in approved containers.(b)
3. Handle oil and gasoline outside of buildings.(b)
4. Fuel the lawmower out of doors. If the mower has been running, allow the engine to cool for at least 5 minutes before refueling.(b)
5. Immediately wipe all spills.(b)
6. Ensure a suitable fire extinguisher is located near gasoline storage areas or where filling takes place.(b)
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BASIC JOB STEPS
III. Starting the lawnmower engine.
IV. Lawn mowing.
HAZARDS
c. Feet may contact the blade. Possibility of slips and/or falls.
d. Operator being struck by debris. Bystanders being struck by debris. Blade can become. bent or broken.
SAFE JOB PROCEDURE
7. Keep feet outside of protective shields. Place one foot on mower as a brace. Pull starting cord without jerking the cord.(c)
8. Survey the area to be mowed before mowing operations begin. Remove noticeable debris. Oo not operate the mower over irregular surfaces, or fixed objects, curbs, etc.(d)
BASIC JOB STEPS
In order to st~rt the rlischarqe of the extinguishing aaent, one may have to t~ke one or more actions such as inverting, bu~ping, tur~ing, or squeezing a v~lve ~andle or lever, pushing a lever, or pumping.
The extinguishing aqent must b~ applied onto the. fire in the proper ~~nner according to the type of extinguisher being used.
Using a portable extinguisher to fight a Class A fire.
Class A fires are fires of ordinary combustive materials, such as wood, cloth, paper, rubber and many plastics.
In this situation you may use a Foam, Soda Acid, Pump Tank (which contains water), Gas Cartridge (which contains water expelle~ by carbon ~ibxide), or a Multi-Purpose Dry Chemical extinguisher. (A Multi-Purpose Dry Chemical extinguisher can be used to fight Class A, B, C fires, or an Ordinary Dry Chemical can be used to fight Class~. B fires.)
HAZARDS I SAFEJOBPROCEDURE
-OVER -
4. When using a Foam extinguisher, don't play the stream into the burning liquid; allow the foam to fall lightly on the fire. _..
5. When using a Soda Acid or Gas Cartridge type extinguisher, direct the stream to the base of the flame.
6. When using a Pump Tank type extinguisher, place your foot on the footrest and direct the stream to the base of the flames.
7. When usinq a Multi-Purpose Dry Chemical extinguisher, direct strea~ to the base of the flames. Follow up by directing the dry chemicals at the remaining material burning.
8. Refer to 4 above.
9. When using a Carbon Dioxide extinguisher, direct the discharge as close to the fire as possible. First direct it at the edge of the flames and then gradually forward and upward.
10. When using an Ordinary Dry Chemical extinguisher, follow the instructions given in 7 above.
BASIC JOB STEPS
Using a portable extinguisher to fight a Class B fire.
Class B fires are fires in flammable liquids, oils, greases, tars, oil base paints, lacquers and flanrnable gases.
In this situation you may use a Foam, Carbon Dioxide, MultiPurpose Dry Chemical, or Ordinary Dry Chemical.
Using a portable extinguisher to fight a Class C fire.
Class C fires are fires which involve energized electrical equipment where the electrical non-conductivity of the extinguishing media is of importance.
In this situation you may use a Carbon Dioxide, Multi-Purpose Dry Chemical, Ordinary Dry Chemical.
NOTE:
1. Soda acid extinguishers contain two chemicals, sodium bicarbonate and sulfuric acid. These extinguishers are now considered obsolete since their manufacture in the U.S. was discontinued in 1969. It is believed they
............
·•.
HAZARDS SAFE JOB PROCEDURE
11. Refer to 9 above.
12. Refer to 7 above.
-OVER-
BASIC JOB STEPS
have been replacerl within the Service. They are mentioned in this JHA since Service employees may still encounter one, and they are still listed in the current National Fire Protection Association standard on portatle fire extinguishers.
2. Tt is strongly encouraged, where possible, for Service employees to receive "handson" training in operation of portable extinguishers from competent sources.
HAZARDS SAFE JOB PROCEDURE
(
•u.s. GOVERNMENT PRINTING OFFICE; 1878- 262-840
( ,. ' '
INSTRUCTIONS FOR COMPLETING FORM 01-134 Appendix 3
r I
NOTE: This is a four pan snap-out form. Retain the last copy for your file:,, send the renut.inin~ copi~!t. still a:.!.embk~. through normill bureau/office channl'l~. Tear vfr thi~ p<Jgl.' ~f instructions to assist you in completing the forn:.
INSTRUCTIONS: Complete all applicable blocks, insertin~ the appropriate code where called for. All information on this report refer.lo per.on named in Block~ and/or property identified in Block 23. Information contained in this report may be added to and/or corr«'led by use of Form 01·134.(' "Supple me mary Accident/Incident Report."
FIELD REPORT NO.- The usc of a number here is optional unless required by bureau or office.
DATE - Enter date of report.
BLOCK I -REPORTING UNIT AND ADDRESS- This code identifies the bureau/office and subdivisions thereof. Organizational codes are assitzned by the Burcau/Ofti,.., Safety 111anagcr.
·BLOCK 2- NAME OF PERSON INVOLVED: Enter name of person who had accident, was injured. or became ill. When more than one per.on is injured in the same a.cident oruc,·upaoion•l ---- illness. complete separate report fom\ for each person injured. (leave blank when there is no w8y to identify a person with propeny llamap:~ or fire.)
ADDRESS. When reporting accidents/incidents involving persons other than employees. enter complete home address of individual. Addresses of cmployct.>~ is option:..! to hurc.•Ju requirements.
BLOCK 3- AGE- Enter age of person involved. If unknown, give best eslimale.
BLOCK 4 • SEX- Check appropriate box, when applicable.
BLOCK 5- SOCIAL SECURITY NUMBER- Enter number of the employee involved. Not required for non..:mployees.
BLOCK 6 • EMPLOYMENT STATUS- Enter the code ..,hich identifies the person involwd in the accident or illn,•ss:
06 C'oncessioncr II Vol. in !he Parks 12 Vista
16 CETA 0 I Penn anent • 02 TemporJry 03 Emergency 04 Job Corpsman OS Conlraclor
07 Youth Con. Corps (Siaff)** 08 Youlh ('on. Corps (Enrollee) 09 Public (Visilor)
13 Employee Family Member 14 Tribal Member
I 7 Young Adull Con. Corps (Staff)•• 18 Youn~ Adull ('on. ('orps
I ('urp~llh:lllhc.•r I )I) Stud~..·ntiBIAI I 0 Public (Oiher) IS Other (Explain in Block ~4)
*Includes Job Corps Slaff ••USl· code 01 orO~ when applicable
BLOCK 7- OCCUPATIONAL CODE- Enter pay plan and occupational series code. !Employees only.) bam pies: ;G I slu f3fof] f W! IllS 1 ~ lu f ~I BLOCK 8- DATE AND TIME OF INCIDENT- Enler dale and lime of accident or discovery of occupalional illness. Example: July 4. 1976 al I :3S p.m. is reconkJ a>
f7f6IO f7fO l4flf3f3l S I using the 24-hour clock system.
~l:.OC'K 9- ACTIVITY- Enter the code which best describes the activity the person named in Block~ was engaged in at tim\' of an:idt.>nt or O(CUp;.~tional illn~..·~,:
00 No! applicanle 01 Administrative/Clerical 02 Fire Fighling 03 Heavy E4ulpment Operalion 04 lnaclive (Res!, Sleep, Etc.) OS Law Enforcement 06 Locomotion (Walking, Running. El<.) 07 Maintenance and Repair (Buildings,
Grounds, Road~. Eh;.) 08 Maintenance and Repair lMachinc.·ry
and Equipment)
09 Materiah Handling 10 Ob!!erving, lnspcdion. Sun-t:ying, Etc. II Operating Hand Tools (Powered and
Nun-Powered) 12 Operating Ma~hincry 13 Performing Service. NEC' 14 Recreation 15 Search & Rc.·~·Ul' 16 Tro:aining flnstrudor)
17 Training ITr;.~in~,.•,.•l I M Tr;.~nsport-Opaator I Vehkk.
Aircr~ll't. Watcra~tfl. Animal I I 9 Transpnrt-lla,~~..·n~~.·r ( Vl'11il:k.
Aircr;tft. W:.~tc.·r,raft. Anim&Jil ~0 Fond Prql;.~fation/lbndlinl! :! I ftou~d.:l'l'pin~ HO Otlwt. N EC 99 Unknown
OLOCK 10- STATE IN WHICH INCIDENT OCCURRED· Entertw~lettt."r state abbf\.'viatiort ao;; used in Zip Code.• Directory. For Oul~id.~ United Stutes and ih Tc.•rritorie~. use 00 as code.
BLOCK II -TYPE OF ACCIDENT/INCIDENT- Enlcr appropriate code.
01 Slruck Againsl II Conta..:t With Electric Currc.•nt 02 Struck By 12 Conta~..·t With Temperaluil· Lx.trt'ml'S 03 Fall From Differcnl Levd 13 Conta..:l Wilh Radiation!!>, Caustics. 04 Fall on Same Level Toxk and Noxiou!'l Sub!l>tan..:c-~ OS Slip or Twisl (No! Fall) 14 Noise Expo~un! 06 Caught In, Under or Between IS Oc<.:upational Disease 07 Rublled or Abraded 16 Bile (Animal, lnsecl. Elc.) 08 Bodily Reaction 17 Explosion 09 Overexertion 18 Fire 10 Drowning 19 Immersion
BLOCK I~· RESULT OF ACCIDENT/INCIDENT- Enler I he appropriate code:
Motor Vehicle Accidt.>nls: ~0 Colli~ion or Sidc.·o;;wipt' With Another
Vchtdc.··-lioth Vc.•hk·k!> in Motion .lO Collision or Sit.h.·~wipl' With :• Standing
Vehicle or Stationarv Ohkl'l 40 f'ion~.:ollision Acddenl;- (h<·nurncll.
Ran Off Ro:.~dway. Slnhkn Stop or Swn. I l1..'.
50 1\:nt ('h:.Jri!-C:.Jhk As Motor Vl·IH,.·k Fkl't Al·l·idl.'nl As Uefincd in ANSI-lll5.1
80 Accidcnl Type. NEC 99 Unclas.\ifiL·d. ln~uffkicnt Daw
00 Incident fNo Injury or Property Damage} 01 Personal Injury Only
0~ Pro pert)' Dam:.JgL' Only 04 Pcrsonallnjur) With Propl.:'rty D<.~m:.J);!l'
0~ Oc..:upational lllm-ss
BLOCK I 3 ·NATURE OF INJURY/ILLNESS· Enler !he appropriate code:
OU No Injury 0 I Amputation 02 Asphyxia, Strangulation. Drown in~ 03 Burn or Scald (Heat) 04 Burn (Chemical 1 05 Concusston Ob Conta~dous or Infectious Diseases 07 Contusion, Crushing, Bruise 08 Cut. Laceration. Punctwc-09 lkrmatitis I 0 Dislocalion
II Electric Shock. Electrocution I~ Fracture 13 Freezing. Frostbite, Exposure 14 Htaring loss or Impairment 15 Heat Stroke. Sun Stroke. Exhaustion I b Heart Allai,;'k 17 Hernia. Rupture 18 lnflammat1on or Irritation or Joints I tJ Poisoning. Systemk · ::!0 Pneumoconio~is ~I Radiation Eff<"<·ls. Sunburn. l:lc.
BLOCK 14 ·SEVERITY OF INJURY/ILLNESS· Enl<r the approprialc code:
00 No lf1iur)· Involved 01 First Aid Only 02 Medical Only ( Phy,;cian)
1 NEC = Not Elsewhere ldenlified.
OJ Disabling Injury !Temporary) 04 Disabling Injury (Permanc:nii"Jrliall
•• I' •
Re~piratory ( ·omlllion n U'\h.' ,\~~,·nl!lo)
~J Sl·ratch~.·,. Ahr~,,iun!'l
~4 Spr:..in!<!., Stmin~ ~~ Strol~·
~0 Mullipk lnjuril·~ ~7 Dtwrdt'r!'!. Due.· to l'h~ ,,~,·aJ A~~.·nh ~~ UtsorJl·r~ Du~· w kc.·r~..·:..h·d Tr;.~un1.1
HO On·up;.~tton:..lllln~·~'· NtC M I Olh<r lnjur). );I'("
<19 Unda:"!'ifil·d. !'\nl lkll'nuiJH'd
05 l>i!Wblintt Injury ( Perman .. ·nt T ut!il) 06 Disanlin~ Injury !Fatal I
REPORT OF ACCIDENT/INCIDENT FORM 01-134 tl-711 l
r---· ..... ~··-··· J ~v
t ·- ---~ ~ ~- ~ ... -------- ___ ....,. _____ ---~- ··--·-...
Form Dl-134 (January 1978) U. S. DEPARTMENT OF THE INTERIOR FIELD REPORT NO. Exception to. SF..:91A-92
Safety Management Information System .,_ Approved by Bureau of the Budget March 1963
REPORT OF ACCIDENT /INCIDENT DATE
--I. REPORTING UNIT AND ADDRESS I l 2. NAME OF PERSON INVOLVED (last, first, mic/c/le initial)
3. AGE 4. SEX 6. EMPLOYMENT STATUS
0Male ADDRESS ( incluc/e zip coc/e) I 0 Female
7. OCCUPATIONAL CODE
(last cligit here)
l s. SOCIAL SECURITY NUMBER
Use separate form for each person involved I I I 1 l l I e. DATE AND TIME OF INCIDENT - Zl. LOST TIME DATA MO. DAY YR.
YR. I MO. I DAy I HR. I MIN. 9. ACTIVITY a. Date unable to perform regularly
I I I I I I I I I established duties -
10. STATE IN WHICH INCIDENT OCCURRED b. Date returned to work (Regularly established c/uties)
II. TYPE OF ACCIDENT/INCIDENT c. Date returned to work (Restricted work activities)
12. RESULT OF ACCIDENT/INCIDENT --~·--·--·
I d. Date terminated 13. NATURE OF INJURY/ILLNESS
e. Date permanent! y transferred to 14. SEVERITY OF INJURY/ILLNESS I ighter duty
f. Number of days of restricted work IS. PART OF BODY AFFECTED activity
16. SOURCE (What wos usee/, clone, contacted, etc?) TO BE COMPLETED BY SAFETY MANAGER ONLY
g. Number of days lost (Optional) 17. HUMAN FACTOR (ANSI-Z16.1)
h. Number of lost workdays (Required) 18. PHYSICAL/ENVIRONMENTAL FACTOR (OSHA-29 CFR 1960.2 (n))
I YES NO Recordable occupational injury/illness YES NO 19. REPORT SENT TO OWCP? I
i. (OSHA-29 CFR 1960.4)
21. PROPERTY OWNERSHIP 23. IDENTIFICATION OF PROPERTY INVOLVED (name, moclel number, size, make, type, etc.)
22. AMOUNT OF PROPERTY DAMAGE a. Government: []] (Dollars Only)
a . GOVERNMENT
·II -11l"'fl !+ .. l.llll I I 1 o ~-~~- b. Other:
24. NARRATIVE OF ACCIDENT/INCIDENT (lncluc/e who, what, when, where, one/ how)
Continue on separate sheet, if necessary
25. CORRECTIVE ACTION TAKEN OR PLANNED
WHEN: Now ______ F'iscal Year------
Signature and title of reporting official lniti al s of Bureau Safety Manager --------------------------------------------,----------------------+---Signature of reviewing authority Date Date
U.S. FISH AND WILDLIFE SERVICE Twin Cities, Minnesota 55111
NOTICE
/\ppendi x 4·
~ -
-·vfl'.i -j ! 21 ABNSSA - December 1, 1987 I :3 i
,.a! RECEJVm OTHF.
~I . 6! '71 :6 i i 91
/ 67 Filo I £.f15ifch j SUBJECT: Safety Feedback - Accident Analysis
DEC 0 7 19
lmBAB m Due to the computer orientation of our Report of Accident/Incident (Dl-134), reporting and reviewing officials often refer only to the accident narrative to understand the "who, what, when, where, and how" of an accident. All of the coded information, which is important in understanding the full story, is easily lost in the "numbers column".
fOm Larson, Regional Office-Division of Refuges, ha~ developed a simple method of assisting the Report of Accident/Incident {~I-134) reader understand what happened without cross checking to a code sheet. Tom developed the attached Accident Analysis form for distribution at a Project Leaders meeting. Since the first distribution, we have noticed the form's effectiveness in the review process when used as a supplement to the DI-134.
The form is optional and we encourage its use.
~r thanks to Tom for his idea and contribution to the Feedback program.
e;7.~ Safety and Occupational Health Manager
Distribution: AO; FWS, Wash., D.C. (SSA); RF2 (Tom larson); Reg'l. Saf. Mgr. 1, 2, 4, 5, 6, and 7
Attachment
:
' I
ACCIDENT ANALYSIS
--------------(name- block* 2) a-----------(employee status - block 6) was involved in an accident on on
-----------------(reporting unit - block 1) at ___ _
(a.m./p.m.). This individual was--------------------
------------- (describe activity - block 9) when --------------------------(describe type of accident/incident - block
11). The accident/incident resulted in -------------(describe result
of the accident/incident - block 12). The accident resulted in --------
-----------(describe nature of injury - block 13). The severity of the
injury involved --------------- (describe the severity of the injury- block 14). The body part affected was----------- (list body
part affected - block 15). The source of the injury was -----------(list source - block 16). The source of the injury (;QIJld have been eliminated or reduced
by (list options):
The human factor involved in the accident was
(list human factor - block 17). The human factor could have been eliminated or reduced
by (list options);
The physical/environmental factor involved in the accident was ______ . ________ _
(list physical/environmental factor - block 18). This factor could
have been eliminated or reduced by (list options):
*Blocks refer to codes given on the instructions for completing Form 01-134
The property was owned by--------------- (list property ownership - block 21). The property involved was----------------(identification of property involved - block 23).
The following actions will be taken for this specific employee to ensure that such an accident does not happen again {list actions to be taken to ensure that this or a similar accident does not happen again):
Station Safety Officer Date Project Leader Date
\ ~
.
. . JOB HAZARD ANALYSIS
UNITED STATES FISH AND WILDLIFE SERVICE
JOB ACTIVITY: Conducting a prescribed burn
~--------------------------------------~~----------------------------------~~~ PERSONAL PROTECTIVE EQUIPMENT REQUIR'fD: Leather gloves, hard hat, safety toed shoes, fire QUALIF.ICATIONS, EXPERIEN.CE. OR TRAINING REQUIRED:
txper1ence anator tra1n1ng 1n the use of tools ardant clothes. fire shel
BASIC JOB STEPS
Break work down to basic elements (such as remove. lift, carry, stop, start, apply, return, squeeze. cut, weld, saw, walk, hold, grind, place, etc.). Describe what is done .. not how it is done.
I. Develop advance prescription that identifies conditions necessary for the prescribed burn.
II. Determine the area to be b~rned, and required preparations. Consideration should be given to the types and amount of fuels.
Meet manual reauirements. Course No. S-1
HAZARDS
For each job step, state what accident could occur and/or what hazard is present To determine this ask yourself, Can the person fall; overexL;-t; be exposed to burns, fumes. rays, gas, etc.; hit against; be struck by; come in contact with; be caught in, on, or between?
a. Prescribed burn may not be manageable during certain adverse weather conditions. Excessive fuel buildup could result in uncontrolled burn.
b. Lack of notification of local authorities could result in unnecessary danger and embarrassment.
c. Too large an area can overextend available personnel and equipment.
d. If fuels are too dry and/or heavy, uncontrolled fire can result.
-Over-
SAFE JOB PROCEDURE
State how each element of work should be performed to prevent the accident or avoid the hazard. What should the person do or not do? Be specific. WhiJt precautions should be taken? Ask yourself, What can I do to eliminate, modify, guard, identify, or protect against the potential accident or hazard, including such things as how the worker stands, or holds, uses, carries, dresses, etc.?
1. The burn must take place in accordance with conditions specified in prescription: fuel amount, weather, local authorities affected by the burn. Prescription should include plan for cutting fire lanes. (a)
2. Prescription should include notification of local authorities, neighboring residents and the public where applicable.(b,i)
3. Ensure adequate personnel and equipment are available for prescribed burn. Equipment must be in good working order and in adequate supply for tasks.(c)
4. Give consideration to burning characteristics of fuels.(d)
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t:SASIC JOB STEPS
III. Use of heavy equipment to establish fire lanes for fire control.
IV. Determine moisture content of fuels, request current weather forecast.
V. Briefing of personnel involved.in prescribed burn.
HAZARDS
e. Possible accident during operation of heavy equipment.
f. If fuels are too dry, wild fire can result. If fuels contain too much moisture, prescribed burn may not meet objectives.
g. Personnel who are not properly briefed can endanger themselves or others.
-Over-
SAFE JOB PROCEDURE
5. Operate only equipment for which qualified.(e)
6. Cut fire lines in accordance with advance prescription. Fire lanes should be cut around entire perimiter of designated burn area.(e)
7. Burn must take place in accordance with conditions specified in the prescription. (f)
8. Briefing of personnel should cover scope, duration, and anticipated conduct of the prescribed burn. Actions to take in the event of the unanticipated, such as a sudden change in weather conditions, equipment failure, uncontrolled wildfire, etc., should be addressed.(g)
9. Each member of prescribed burn team should have map of the area showing the interior and exterior fire lines.{g)
10. Ensure that proper personal protective equipment is prescribed and used.(g)
11. Personnel should be trained in use and limitations of personal protective equipment.(g)
ASIC JOB STEPS
VI. Termination of the burn.
HAZARDS
h. Fire could reignite if not entirely out. Large areas may burn through the night and/or continue to smoke.
i. Smoke may not dissipate at night, and may cause hazardous traffic conditions on nearby road ways.
SAFE JOB PROCEDURE •
12. Check burn area throughout the night for R£CD fire start up.(h)
13. Notification of planned burn should made to local authorities, neighboring residents, and the public, where appropriate. (1)
be Nn,, n .~
NECEDAH
' )\ '--·
