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Safety Policies, Rules & Regulations Employee Handbook Sept. 1, 2007
Transcript

Safety Policies, Rules & Regulations

Employee HandbookSept. 1, 2007

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Safety Policies, Rules & Regulations,Employee Handbook

Missouri Department of Transportation

Please Note: MoDOT has made a concerted effort to put it’s Safety Policies, Rules, and Regulations into the available space contained in this handbook. For an in-depth look at MoDOT safety policies and procedures please refer to the Risk Management Manual/Safety and Health Section, which can be found in the electronic version of the MoDOT Policy Manual.

Safety Policy, Approach and Responsibilities

Safety Policy Statement

Because NOT compromising the safety of our employees is a value of the organization, MoDOT is committed to providing a safe and healthful workplace for all employees, the following Safety Mission Statement is established.

For further information about this subject please refer to 29CFR 1903.1 – General Duty Clause

Safety Mission Statement

Having a workforce that is knowledgeable of and follows all work policies and procedures for their assigned tasks can prevent most incidents and occupational injuries. Therefore, all employees are assigned both the responsibility and accountability for following all safe work practices.

Recognizing and eliminating hazards will prevent injuries and occupational illnesses from occurring. Consistent and aggressive hazard recognition and taking immediate corrective action are instrumental in providing a safe and healthful workplace. Key components that support our safety effort include:

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Following procedures that are adequate, known, understood;Using and maintaining personal protective equipment appropriate or identified hazards;Using tools and equipment that are right for the job, using them in the safe manner and maintaining them according to manufacturer’s standards;Being alert to the hazards in your work environment.

The Department’s approach to safety, under the leadership of our Senior Management Team. will be accomplished by providing:

The safest work environment possible.Clear safety expectations to hold managers, supervisors and employees accountable.Safety training for all employees.Safe tools and equipment for our tasks.Safe, efficient work practices.Regular communications to our employees and the public about the dangers we face.

Introduction

To All Missouri Department Of Transportation Employees:

This Handbook of Safety Policies, Rules and Regulations has been developed through the collective efforts of all Districts and the Central Office. These policies, rules and regulations are based on:

Hazard identification and assessment.State, federal and local regulations.Current incident prevention information.

Regardless of your job, in the department, you play an important role in building and maintaining of Missouri’s highway and transportation systems. Your presence on the job is essential. We want you to work safely not only for your sake, but for the sake of your family, friends and co-workers.

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This handbook has been developed with your safety in mind. �t is essential that you know, understand and follow these rules regarding your personal safety. When in doubt regarding a safety policy, rule or regulation, ask your supervisor or District Safety and Health Manager for assistance. All Department employees must follow all rules regarding personal safety.

Remember: Your safety and well-being is dependant upon following these rules.

The following definitions apply:

Shall, must and will = MandatoryShould = Strongly RecommendedMay and can = Permitted

Help keep our workplace safe by making safety equal to productivity, cost and quality during every workday.

Contents

�. General �nformation .................................................................................1A. Do Not Sacrifice Safety for Productivity ........................................1B. Reporting �ncidents .........................................................................1

��. Disciplinary Policy ...................................................................................2

���. General Safety Responsibilities and Duties for All Employees ...............4A. Substance Abuse ..............................................................................4B. Drinking Water ...............................................................................4C. First Aid ...........................................................................................4D. Lifting ..............................................................................................6E. Working on or Adjacent to the Highway .........................................8F. Poisonous Plants ..............................................................................8G. Health Hazards ................................................................................9

�V. Personal Protective Equipment (PPE) and Safety Devices .................... 11A. General ........................................................................................... 11B. Required Personal Protective Equipment (PPE) ........................... 12

V. Traffic Controls ...................................................................................... 19

V�. Operators of Trucks, Power Equipment and Passenger Vehicles ...........20A. General ...........................................................................................20B. Driver’s Qualifications and Responsibilities .................................20C. Safe Driving Practices ...................................................................22D. Securing Cargo .............................................................................24E. Backing Policy ...............................................................................25F. Power Equipment Safety Precautions .......................................... 29G. Use of Small Tools .........................................................................34

V��. Facilities .................................................................................................. 36A. General ........................................................................................... 36B. Office ............................................................................................. 36C. Garages and Maintenance Buildings ............................................ 37

VIII. Confined Space Entry, Tanks and Vessels ............................................ 45A. Purpose .......................................................................................... 45B. Permit- Required And Non-Permit Confined Space Entry ........... 45

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I. General Information

A. Do Not Sacrifice Safety for Productivity

The Missouri Department of Transportation is committed to providing a safe and healthful work environment for all employees. This handbook is designed to provide MoDOT’s Safety Policies, Rules and Regulations in a concise, user-friendly manual. Following these policies, rules and regulations are a condition of your continued employment with MoDOT. Carefully review the information in this handbook. Become familiar with the topics that relate specifically to your work assignments. Review this handbook frequently. When you are unsure of the meaning of any policy, rule or regulation discuss your questions or concerns with your supervisor, District Safety and Health Manager, Safety Officer, or a Central Office Risk Management Representative.

B. Reporting Incidents

Employees shall report all incidents immediately to their supervisor, no matter how minor. Supervisors, in turn, shall immediately notify the District Safety & Health Manager. For incidents involving Central Office employees contact the Risk Management Safety Officer. The following information shall be reported:

Name(s) of employee involved in the incident.Time of the incident.Place of the incident.Name of witnesses to the incident.Nature of injury/injuries, or property damage.Description of how the incident occurred in a written narrative format.

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II. Disciplinary Policy

When safety policies and procedures are willfully disregarded and/or violated it may lead to disciplinary action or to your dismissal. Personnel Policy No. 2500, Standard Rules of Conduct outlines personal behavior that may lead to disciplinary action. A summary of the safety section of that policy follows:

Violate traffic laws or disregard or violate existing safety rules (as defined in the Safety Rules and Regulations, Employee Handbook or relevant operational manuals), which could endanger the health and safety of the employee, a coworker, or the general public. The District Safety and Health Manager or Central Office Risk Management Specialist will assist in the interpretation and clarification of matters involving safety policies, rules and regulations. Such violation may include but not be limited to the following:

Falsification of incident reports and/or failure to report an incident with in the required reporting guidelines.An employee’s refusal to obey a clear and proper order or directive to follow a prescribed safety policy rule or regulation.Alcohol or drug use which is directly involved in the causation of an incident.Any employee in a position of authority who fails to enforce or support department safety policies, rules, and regulations.�ncidents caused directly by an employee’s disregard for or violation of an existing safety policy, rule or regulation as determined by the district safety and health manager and the respective supervisory personnel.Failure to use department prescribed personal protective equipment when required to do so

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b.

c.

d.

e.

f.

3

including the failure to use seat belts while in a department vehicle, personal vehicle when conducting MoDOT business or while operating department equipment.�nappropriate operation of department vehicles or equipment, which could or does result in an incident.Horseplay or carelessness that does or could result in an incident.

g.

h.

4

III. General Safety Responsibilities and Duties for All Employees

A. Substance Abuse

Reporting for work under the influence of alcohol or drugs or the consumption of alcohol or use of drugs on the job will result in disciplinary action according to the procedures in the following Personnel Policies:

No. 2500 Standard Rules of ConductNo. 2508 Drug Testing Program No. 2511 Alcohol Testing Program

In addition, it is unlawful to manufacture, distribute, dispense, possess, or use controlled substances on the job.

B. Drinking Water 29CFR 1910.141 (B) – 29CFR 1926 (A.)(1)

Water for drinking purposes shall be readily available and must be obtained from known safe and approved sources. 29CFR 1910.141 (b) (iii). Portable water containers are available and when in constant use, should be cleaned and sterilized at least once each week with a chlorine bleach solution (1/4 cup bleach per 1 gallon water) and rinsed thoroughly. Paper cups furnished by the department are to be used. 29CFR 1910.141 (vi)

C. First Aid 29CFR 1910.151 (b)

All department vehicles and equipment, owned or leased, shall be equipped with a standard first aid kit containing the following medical items.Reminder: Dispose of and replace supplies that have reached their expiration date.

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Quantity Per Box

No. of Boxes Per Kit Description

10 1Antiseptic Swabs, sterile, 1” x 1”, prep pads saturated with an antiseptic solution

1 1 Eye Wash Solution, sterile, one net fl. oz. per bottle

10 1 External Analgesic, for insect bites2 1 Disposable Surgical Gloves1 1 Disposable Tweezers and Scissors1 1 CPR Microshield1 1 Emergency Blanket

1 1 Triangular Bandage, sterile with 2 safety pins

1 1 4” x 4” Bandage Compress, sterile, individually wrapped

16 1 Adhesive Bandage, sterile, plastic or cloth 1” x 3” minimum

Each facility or office should have a wall-mounted first aid cabinet and a current emergency first aid poster mounted on a wall in a highly visible spot which provides quick access in case of an emergency. First aid cabinets, as a minimum, should contain the following medical items:

Quantity Per Box

No. of Boxes Per Cabinet Description

16 2 Adhesive Bandages, plastic or cloth, 1” x 3” minimum

10 2 Adhesive Fingertip Bandages, plastic or cloth, size approx. 1-3/4” x 3”

10 2 Adhesive Knuckle Bandages, plastic or cloth, size approx., 1-1/2” x 3”

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Quantity Per Box

No. of Boxes Per Cabinet Description

2 2 Adhesive Tape, 1/2” x 2-1/2 yd..4 Min. 3 2” x 2” Compress, sterile

1 3 4” x 4” Bandage Compress, sterile, individually wrapped

1 3 Triangular Bandages, sterile, one per box with 2 safety pins

10 2Antiseptic Swabs, sterile, to be 1” x 1” prep pads saturated with an antiseptic solution

10 3 External Analgesic, for insect bites sterile, 0.5 cc disposable swabs

6 1/8 oz.12 1/16oz.24 1/32 oz.

1 Anti Microbial Medicated Ointment,

1 2 Eye Wash Solution, sterile, �sotonic Buffered Solution, 8 fl. oz. bottle

1 2 �nstant Cold Packs1 1 CPR Microshield1 1 Emergency Blanket2 4 Disposable Surgical Gloves1 1 Tweezers and Scissors

�n addition, triangular bandages, poison ivy protection products and insect repellents are available through the Central Office Distribution Center.First aid cabinets and kits should be properly stocked at all times.

D. Lifting

�t is recommended that an employee not manually lift more then 75 lbs. When possible, avoid manual lifting

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and lowering tasks by using equipment designed for that purpose, i.e., overhead cranes, pneumatic drum handlers, hydraulic lifts, hand trucks, etc. When manual lifting is required, each employee shall:

Think before lifting. Size up the load and determine if additional help is needed to safely handle the load because of its weight or shape.

Remove greasy substances from hands before lifting. Grip object firmly to prevent object from slipping from your grip.

Be sure footing is firm and your body is balanced before attempting a lift. Avoid awkward positions.

Bend your knees and bring the object as close to the body as possible.

Maintaining the natural inward curve of your lower back, lift vertically with the muscles in your legs using a smooth even motion free from jerking.

After completing the lift, move your feet and body to face the area of placement. To lower the object, reverse the procedure outlined in (5) above.

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2.

3.

4.

5.

6.

Figure 1

Place both feet close to the object and bend the knees. Get a good hand hold then lift the object smoothly, using both legs and the back muscles, while maintaining the natural inward.curve of your lower back.

Figure 2

Lift the object straight up keeping it close to the body. Don’t make any turning or twisting motions with the body.

Figure 3

Turn your body by changing foot positions. Make sure the path is clear. Also make sure there are no hazardous places or slippery spots in your path before walking.

Figure 4

Setting the load down is just as important as picking it up. Lower the object slowly by bending at the knees and still maintaining the natural inward curve of your lower back. Don’t let go until the object is securely on the floor.

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E. Working on or Adjacent to the Highway

MoDOT approved high visibility safety apparel shall be worn by all employees while on or near MoDOT right-of-way.When employees are working along or adjacent to the highway they should, if possible, work facing the direction of approaching vehicles or traffic.Employees must look in all directions before attempting to cross the highway. When it becomes necessary for an employee to walk on a highway for any distance, while not engaged in actual operations, they should walk on the side facing in the direction of the approaching vehicular traffic.Employees shall not wear headsets or earphones for the purpose of listening to the radio or music, while operating a vehicle, equipment, or flagging.

F. Poisonous Plants

The poison ivy plant should be recognized and avoided by employees. Employees who are allergic to this plant should exercise caution in locations where these plants may be present. Pre and post exposure treatments are available through the Distribution Center for your use.

Poison Ivy Descriptions:

Leaves: Grow in groups of three, leaflets are not lobed; dark green in summer, scarlet and orange in fall

Berries: White and waxy in appearance

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Growth Form: Woody vine is most typical form; also grows as shrubs

Habitat: Grows in, on, or near trees often found along fence rows

Allergic reactions can occur by all of the following:

Direct contact with any part of the poison ivy plant, at any time of the year.

Smoke drifting from burning ivy foliage.

Tools that have been in contact with the plant should be cleaned immediately after use.

Contaminated clothing. Growth of poison ivy around buildings and storage areas should be treated with herbicides and removed.

Remember to use non-abrasive soap when washing the affected area.

G. Health Hazards

Employees may be exposed to various occupational health hazards as a normal part of their work environment. Employees could be exposed to the following: lead (29CFR 1910.1025), asbestos (29CFR 1910.1001), hazardous materials (29CFR 1910 Subpart H), bloodborne pathogens (29CFR 1910.1030), communicable disease, or components of an active or inactive meth lab. Medical surveillance programs and personal protective equipment, based on current occupational health standards, are provided for employees, who are routinely exposed to lead and asbestos.

Employees shall not pick up syringes, bandages, or other medical waste.

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All exposures to health hazards must be reported to your supervisor like any other incident or injury.

Anyone finding equipment or supplies used for manufacturing methamphetamine shall leave the area immediately and report their findings to their supervisor who will contact the appropriate law enforcement officials.

Abandoned buildings or vehicles on department right-of-way should be approached with caution. �n addition to clandestine methamphetamine labs, other dangers could be present.

�f any suspicious activity is observed, or a vehicle or package is found, the employee should leave the area immediately and report their findings to their supervisor.

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IV. Personal Protective Equipment (PPE) and Safety Devices

A. General

Employees shall wear personal protective equipment (PPE) appropriate for each hazard.

The department will provide required protective equipment for use by the employees. Supervisors shall control the issuance and replacement of this equipment. When PPE is furnished to the employee, it is the responsibility of the employee to use and maintain it as specified by MoDOT and the manufacturer.

Employees working on or near moving machinery with exposed moving parts, i.e., chippers and rotomills, shall not wear clothing or accessories that could be caught in moving parts. Refer to the manufacturer’s operating manual or talk with your supervisor if you are in doubt.

Long hair shall be controlled by wearing a suitable head covering or using other means to prevent their hair from becoming entangled in moving parts of equipment or machinery. �n addition, long hair must not hide or obstruct the visibility of an employee’s safety apparel.

Employees shall wear full-length pants that go to the ankles, while engaged in field operations. Employees should wear shirts that will protect them from sunburn. Employees shall wear shirts that are appropriate, not loose and/or low cut under the arms or around the neck. A safety vest is not a substitute for a shirt. Employees shall not alter MoDOT- approved safety apparel. Regarding jewelry, caution should be used when engaged in field operations. Removal of jewelry may be necessary to avoid injury.

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B. Required Personal Protective Equipment (PPE)

The department will furnish required PPE, except for foot protection and prescription safety eyewear, for which an allowance is provided. PPE purchased/provided for an employee is for that employee’s use only.

Head Protection (29CFR 1910.135) shall be properly worn where there is a possible danger of head injury from impact, or from falling or flying objects, or from electrical shock and burns, or where Mine Safety and Health Administration (MSHA) requires it.

Reminder: Only manufacturer’s approved liners shall be worn under hard hats, no ball caps, sweatshirt hoods, welding caps, etc.

2. Eye and Face Protection (29CFR 1910.133) MoDOT shall ensure that each affected employee uses appropriate eye or face protection when exposed to eye or face hazards from flying particles, molten metal, liquid chemicals, acids or caustic liquids, chemical gases or vapors, or potentially injurious light radiation.

MoDOT does provide a biannual allowance for prescription safety eyewear for safety sensitive employees that require prescription safety eyewear.

For more information see the Risk Management Manual Section 1.7 Prescription Safety Eyewear

Supervisors shall ensure that each affected employee uses eye protection that provides side protection when there is a hazard from flying objects/particles.

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The following table shall be used as a guide in the selection of eye and face protection for the appropriate hazard associated with the operation to be undertaken.

Goggles, Flexible Fitting - Regular Ventilation

Goggles, Flexible Fitting - Hooded Ventilation

Goggles, Cushioned Fitting - Rigid Body

Spectacles, Metal Frame, with side shields

Spectacles, Plastic Frame - with side shields

Spectacles, Metal-Plastic Frame - with side shields

Welding Goggles, Eyecup Type - Tinted Lenses

7A. Chipping Goggles, Eyecup Type - Clear Safety Lenses

8. Welding Goggles, Cover spec Type - Tinted Lenses

8A. Chipping Goggles, Cover spec Type - Clear Safety Lenses

9. Welding Goggles, Cover spec Type - Tinted Plate Lens10. FACE SH�ELD (Available with Plastic or Mesh Window)

10. Face Shield (Available with Plastic or Mesh Window)

11. Welding Helmets

1.

2.

3.

4.

5.

6.

7.

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Wear Eye and Face Protection

Operation HazardsRecm’dProtectors

Acetylene-BurningAcetylene-CuttingAcetylene-Welding

Sparks harmful raysMolten metal, flyingParticles

7, 8, 9

Chemical Handling Splash, acid burns, fumes

2, 10 (For severe exposure add 10 over 2). 10 (no mesh)

Chipping Flying particles 1, 3, 4, 5, 6, 7A, 8A, 10

Electric (arc) Welding

Sparks, intense rays molten metal

9, 11, (11 in combination with 4, 5, 6 in tinted

Furnace Operations

Glare, heat, molten metal

7, 8, 9 (For severe exposure add 10 (no mesh)

Grinding-Light Flying particles 1, 3, 4, 5, 6, 10 (no mesh)

Grinding-Heavy Flying particles 1, 3, 7A, 8A (For severe exposure add 10, no mesh)

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Operation HazardsRecm’dProtectors

Laboratory Chemical splash, glass breakage

2 (10 when in combination with 4, 5, 6)

Machining Molten Metals

Machining Flying Heat, glare, sparks, splash

7, 8 (10 in combination with 4, 5, 6 in tinted lenses, no mesh)

Spot Welding Flying particles, sparks 11

Filter Lens Shade Numbers for Protection Against Radiant Energy

Welding Operations Shade Nunber

Shielded metal-arc welding 1/16, 3/32, 1/8, 5/32, inch diameter electrodes 10

Gas-shielded arc welding (nonferrous) 1/16, 3/32, 1/8, 5/32- inch diameter electrodes 11

Gas-shielded arc welding (ferrous) 1/16, 3/32, 1/8, 5/32-inch. diameter electrodes 12

Shielded metal-arc welding 3/16, 7/32, ¼-inch. diameter electrodes 12

5/16, 3/8-inch. diameter electrodes 14Atomic hydrogen welding 10-14

Carbon-arc welding 14Soldering 2Torch brazing 3 or 4Light cutting, up to 1 inch. 3 or 4Medium cutting, 1 inch to 6 inches 4 or 5Heavy cutting, over 6 inches 5 or 6Gas welding (light), up to 1/8-inch. 4 or 5Gas welding (medium), 1/8 to ½ inch. 5 or 6Gas welding (heavy), over ½ inch. 6 or 8

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3. Respiratory Protection (29CFR 1910.134) shall be worn when so indicated by the product’s Materials Safety Data Sheet (MSDS) and results of air monitoring are conclusive. Appropriate medical surveillance and fit testing shall be required prior to use.

4. Aprons (29CFR 1910.132) shall be worn as required by Material Safety Data Sheets (MSDS) for chemical exposure.

5. Foot Protection (29CFR 1910.136) Appropriate foot protection shall be worn by all employees.

Employees who work in departments where there is a routine exposure to drop or compression hazards, shall refer to Risk Management Manual – Section 1.5 Safety Footwear.

6. Personal Flotation Devices (29CFR 1926.106 (a))

MoDOT employees working over or near water or where the danger of drowning exists, shall be provided with U.S. Coast Guard-approved personal flotation devise or buoyant work vests.

Prior to and after each use, the buoyant work vests or life preservers shall be inspected for defects, which would alter their strength or buoyancy. Defective units shall not be used.

7. Hand Protection (29CFR 1910.138) shall be worn when working with hot material such as asphalt; when welding or cutting; and when handling chemicals as required by MSDS.

Anti-vibration gloves shall be worn when operating equipment with vibratory hazards such as jackhammers, chain saws, vibratory tampers,

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concrete saws, and pavement breakers, etc., unless the equipment has built-in anti-vibration protection, in which case the anti-vibration gloves are not required.

�t is recommended leather work gloves be worn by all Department employees when engaged in field operations, equipment fabrication and warehousing activities.

8. Fall Protection (29 CFR 1926.501)(a)(2). shall be worn when:

Working anytime in a bucket truck, platform truck, manlift, or in an under-bridge inspection unit (fall protection must be attached to a manufacturer’s designated anchorage point on the boom or basket.)Working from suspended scaffolding 6 feet above the ground or other level.Walking or working adjacent to an unprotected side or edge 6 feet above a lower level.

See Risk Management Policy Section 2.5 Fall Protection for more specifics.

9. Seat Belts (RSMo 307.178) shall be worn properly by all operators and passengers in department owned, leased or rented equipment or vehicles.

a.

b.

c.

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10. MoDOT Approved High Visibility Safety Apparel shall be worn by all employees when on or near MoDOT right-of-way.

Employees shall not alter MoDOT- approved safety apparel.

Refer to Risk Management Policy - Section 1.6 Class II & III Safety Apparel.

11. Hearing Protection (29CFR 1910.95 (a) (b) (c)) shall be worn when operating or working around equipment or tools with noise levels of 85 decibels or greater, such as chain saws, gas operated weed eaters, mowers, motor graders, compressors, concrete saw, jackhammers, sandblasters and pile drivers.

Rule of Thumb: While standing three feet apart, if you have to raise your voice to be heard over equipment noise, it is probable that the noise level is above 85 decibels.

Hearing protection should be worn in accordance with the manufacturer’s directions.

12. Chain Saw Chaps shall be worn by employees when operating a chain saw/pole saw.

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V. Traffic Controls (29CFR 1926.200(a))

Prior to performing flagging duties, employees shall satisfactorily complete MoDOT’s Flagger Training Program.

Flaggers must wear appropriate PPE.

Employees shall not use cell phones, headsets etc. while engaged in flagging operations

All trafiic control should be planned according to MoDOT’s Traffic Control fo Field Operations Manual

Refer to MoDOT’s Traffic Control for Field Operations Manual for more specifics.

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VI. Operators of Trucks, Power Equipment and Passenger Vehicles

A. General

Department owned, rented or leased vehicles are to be used for performing the work and business of the department as stipulated in MoDOT Policy 0504, Vehicle Usage and Liability.Operators of rented or leased equipment or vehicles must follow all rules and regulations just as if they were operating or driving MoDOT owned equipment or vehicles.The public considers all employees, to be representatives of the department and must abide by Missouri motor vehicle laws. You are expected to set a good example by driving safely and being courteous.Driving in excess of the posted speed limits will not be tolerated and will result in disciplinary action. All operators shall follow safe operating procedures as outlined in the operator’s/owner’s manual.

B. Driver’s Qualifications and Responsibilities

All operators of department owned, leased, or rented motor vehicles and equipment must comply with the following:

All employees must have a valid operator’s or commercial driver’s license (CDL) with them while driving.

All use of state-owned or leased vehicles must be authorized by the department.

1.

2.

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�f an operator feels that they are temporarily impaired, because of illness or from taking medication, and are physically unable to safely operate a motor vehicle, they shall report their condition immediately to their supervisor.

Reminder: Policy 2511, Alcohol Testing Program, requires operators to report alcohol use (includes over-the-counter cold remedies containing alcohol) within 4 hours of driving.

Policy 2500, Personal Conduct, Policy 2507, Drug Free Workplace and Policy 2508, Drug Testing Program, should be referred to for specific information of when to report medication use to your supervisor.

4. Operators and all passengers shall properly wear their seat belts at all times while in department or non-department equipment or vehicles. All employees shall use three-points of contact, facing towards the vehicle, when entering and exiting a truck, motograder, loader, etc.

5. �t is the driver’s responsibility to see that passengers are seated and no part of their body projects over the side of the vehicle. Never permit riding on bumpers, the hood, fenders, or running boards, or allow passengers to jump on or off of moving vehicles or equipment. Crowded cabs or front seat may interfere with the driver and should be avoided. There shall be no more people riding in a vehicle than there are seat belts available.

6. �n case of an incident, the employee shall review and complete the incident reporting form (“In Case of an Incident” form and RM4 (Ell)) carried in the glove compartment of the vehicle

3.

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and inform the supervisor or their designee and District Safety and Health Manager or their designee immediately.

7. Operators shall make a pre-trip inspection of all Commercial Motor Vehicles (CMV) before use. Supervisors and operators will be held accountable for conducting pre-trip inspections for the CMV fleet. For a complete list of components to be inspected, refer to Missouri’s Commercial Driver’s License Manual or the appropriate equipment training manual.

8. Operators of non-commercial motor vehicles and equipment shall ensure routine maintenance is conducted in accordance with General Services maintenance schedules. Visually inspect these vehicles and equipment and report any damage or deficiencies to the appropriate mechanic or General Services Manager.

C. Safe Driving Practices

The most recent Missouri Driver’s Guide and Missouri Commercial Driver’s License (CDL) Manual published by the Department of Revenue has been adopted as part of this handbook of safety rules and regulations.

Any violation of rules contained in either guide or manual will be considered a violation of the safety rules.

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Acquire These Safe Driving Habits:

When starting from a parked position, make a circle check first to make sure all equipment and materials, such as tools, signs, and loose aggregate are secure and the area around the vehicle is clear.

When driving at night, always drive so that you can stop within your sight distance. This means DON’T OVERDR�VE YOUR HEADL�GHTS.

Always be aware of road conditions. Moisture, ice, snow, loose gravel, or hazardous conditions should dictate extra caution.

Keep far enough behind the vehicle in front of you so that there will be adequate stopping distance.

When parking, make sure that the vehicle is parked so that it will not roll. Setting the parking brake, blocking the wheels, cutting the front wheel to the curb (does not apply to protective vehicles), or lowering the blade or bucket will prevent rolling. The transmission should always be placed in gear or park position when a vehicle is parked.

All brakes including the parking brake should be kept in good working order. The parking brake should always be set while vehicle is parked.

Signal in sufficient time to warn other drivers that you are stopping or turning.

RSMo 304.012 states that headlights shall be used when wipers are used during inclement weather, i.e., rain snow, fog, etc..

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D. Securing Cargo - see MoDOT’s Cargo Securement Manual for additional information on this section. A brief summary of the manual is as follows:

All employees that haul cargo will be trained in the proper methods of securing cargo for transportation. �t is the driver’s responsibility to ensure his/her vehicle will:

Comply with all state laws regarding weights, lengths, and widths while hauling materials or equipment; and Meet or exceed USDOT Federal Motor Carriers Regulations with regard to securing cargo.

�t is the responsibility of the driver or operator to ensure their cargo is loaded and secured to prevent the cargo from leaking, spilling, blowing or falling from a vehicle, even if the cargo was loaded by someone other than the driver.

Loss of even small cargo from your vehicle can have serious consequences. Tailgates must be installed upright and tight. Cargo in the bed of a dump truck shall be contained and tailgates must be in the upright position. �tems of cargo such as shovels, rakes, signs and signposts carried on the outside of the vehicle must be secured to prevent them from falling off your vehicle.

A tiedown consists of any combination of D-rings, chains, and straps, binders, and hooks. Only DOT, Grade 7/70, 3/8” or better tie downs shall be used to secure heavy equipment. Check your tiedowns for tightness after the first 50 miles and every 150 miles or 3 hours of your trip.

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Remember, when using chains, your chain is only as strong as it’s weakest link so inspection of chain prior to tiedown is essential.

Working load limit is the maximum load limit that may be applied to a component. This limit is provided by the manufacturer of the component.

An anchor point is that part of the structure, fitting, or attachment on a vehicle or article of cargo to which a tiedown is attached. Securement of heavy equipment requires a minimum of 4 points of securement.

Only Direct Securement shall be used to secure heavy equipment.Anchor close to front and rear of equipment at 45 degree angle (if possible). Cross chain if possible. Secure articulating equipment. Secure accessories against movement.

All MoDOT motorized vehicles and towed vehicles carrying material that may reasonably be expected to become dislodged and fall from the vehicle during transport shall have a protective cover over the load. RSMO 319.075

E. Backing Policy

The safest way to operate a vehicle is to plan ahead and avoid backing whenever possible. �f that means going a little out of your way to avoid backing, do it. �t is much safer than backing.

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When backing, the following shall be followed:

Whenever another Department employee is available to assist a driver, that employee will assist as a spotter to guide the driver when backing a vehicle with a significant blind spot to the rear of the vehicle.

The driver shall conduct a Circle Check prior to entering the vehicle.

Backing should be kept to a minimum.

A Word of Caution:

�f not performed properly, spotting can be hazardous for both the spotter and the driver of the vehicle. To avoid injuries and damage to property the following rules for hand signals should be observed:

The spotter shall be visible to the driver at all times. Should eye contact be broken the driver is to cease backing immediately and resume the activity only when the spotter is again visible in the mirror;

The spotter must be fully aware of their surroundings at all times. They must follow the movements of the backing vehicle, as well as any other moving vehicles in the immediate area;

The spotter must keep sufficient distance between the backing vehicle and his/her standing position to avoid being struck by the backing vehicle, and,

The spotter will always use uniform hand signals, such as those shown in this manual.

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MoDOT’s Hand Signals for Directing Vehicles

Move this Much

Both forearms vertical, hands open and palms facing inward. Hands indicate actual distance the vehicle can be moved and the hands can be moved together as the vehicle moves toward the stopping point

Stop

One forearm vertical (left or right) with hand clasped and other arm relaxed at side.

Move to This Point

One forearm vertical and hand open with palm to rear while the other arm is extended ownward and pointing to the spot where the vehicle should be stopped

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Move Away From Me

With both hands vertical, palms to the front and hands open, move hands and forearms front to rear (pushing toward direction of travel).

Move Toward Me

With both hands vertical, palms to the front and hands open, move hands and forearms front to rear (pulling toward direction of travel).

Turn and Move in This Direction

Arm extended in direction vehicle is to move, with hand open and palm down while other forearm vertical with hand open and palm to the rear. Move hand and forearm front to rear (direction of travel)

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F. Power Equipment Safety Precautions (29CFR 1910.147)

Repairs, adjustments, or oiling/greasing of machinery while energized is strictly prohibited.

An operator shall not attempt to perform any operation with power equipment that is beyond the safe operating limits for such equipment and not specified in the operations manual. Failure of equipment, while performing an operation for which it was not designed, cannot be classified as a mechanical failure.

No one shall be permitted to ride on power equipment other than authorized attendants or mechanics.

Employees shall not jump on or off of equipment at any time.

Operators shall use short ropes or chain taglines attached to the dump bed trip handles to trip tailgates while trucks are moving except in cases where adequate carriers or cages are specifically provided for employees operating tailgate spreaders.

No one shall be permitted to ride on draw bars.

When conducting normal operations on roadway surfaces or shoulders, equipment should move in the direction of traffic whenever possible.

Operators of trucks and equipment shall always watch for overhead utility lines when the bed or boom is being raised.

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The use of conspicuously colored cones or cone sleeves to warn operators as to the location of overhead utility lines is recommended.

Vehicles equipped with booms must have the boom lowered and secured before moving.

When dumping loads on roadway, have a spotter available for watching overhead lines.

State Law mandates only authorized personnel can do any work activity within 10 feet of a high voltage line.

Operators of heavy equipment shall use extreme caution when working close to edges of cuts or fills.

The operator of heavy equipment on slopes must continually guard against overturning their equipment. The operator needs to be aware of the operating characteristics of the unit (changes of center of gravity, slopes, wheel base width, articulation, etc.)

Equipment shall only be operated at safe speeds consistent with conditions on the particular job.

Operators of equipment shall not attempt to direct traffic while their equipment is in motion.

When operators are turning road equipment, the turn shall be made only at a point where there is adequate sight distance for approaching traffic from both directions. When a second person is available, they will flag traffic for everyone’s safety.

Employees shall not ride on conveyor belts or elevator buckets. Also, employees should not walk or stand under loaded conveyor belts.

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Specialized equipment such as, wheel saws, draglines, and excavators shall be operated by those employees qualified and are designated to by their supervisor.

Exercise care when locating equipment on unstable ground by using mats or heavy planking on soft ground to distribute the load. �f specialized equipment such as an excavator or dragline is placed on a platform over an excavation, install shoring and bracing to prevent a cave-in.

When a signal person is used to assist the equipment operator or direct the work, the signal person should be positioned so there is an unobstructed view of the work area and operator. The operator should immediately stop any equipment when the signal person is no longer visible.

Operators of heavy equipment shall not leave running equipment unattended.

Equipment shall not be engaged without an operator at the controls.

When leaving or parking a bulldozer, backhoe, excavator or dragline, etc., the blade, dipper boom, or bucket shall always be lowered to the ground and the brakes locked. �f the unit has a cab, it should be closed and locked.

Never crawl under a bulldozer, motorgrader or snowplow blade to connect or disconnect a towing cable or work on blades unless adequate blocking is in place.

Any specialized equipment with revolving cabs, when moving under its own power, should be swung so the operator is facing in the direction the machinery

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is traveling. This equipment shall not be moved until a qualified person is available to supervise the movement.

Stand to the side of tires on motorgraders or any equipment using ring type clincher rims when inflating. Special air hose extensions should be utilized.

Never depend entirely on jacks when making repairs on equipment that has to be jacked up. Raised truck beds should be blocked or supported before working under the bed. Always be sure the equipment is safely blocked before beginning work.

Always block motorgrader and bulldozer blades and loader buckets before changing cutting edges.

Never use a frayed or worn cable on cable-controlled equipment. Defective cables may break and injure the operator or other workers.

Operators shall follow the manufacturer’s recommended inspection and maintenance schedules.

Jackhammering

Jackhammer operators shall use appropriate eye, hand, hearing protection, and shall wear appropriate footwear or foot guards. Holding a jackhammer bit in place between feet is prohibited.

2. Chainsaws, Weedeaters And Chippers

�t is extremely important that anyone working around this equipment be completely familiar with the operator’s manual to ensure their safety in working with this machinery.

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The following precautions shall be observed when operating a chain saw:

Wear personal protective equipment such as hard hat, safety goggles, chain saw chaps, hearing protection and anti-vibration gloves (optional if the chain saw has an anti-vibration handle) and a safety vest. Avoid wearing loose fitting clothing that could get caught in the chain saw.Always start the saw on the ground, not on your knee or in the air.When carrying the saw any distance, carry it by the handle with the motor off and the guide bar to the rear so you can throw it clear in case you fall.When operating a chain saw, always stand to the side of the cutting path.Never cut limbs or small brush with the nose of the bar.Chain saws should not be operated at or above shoulder height. Shut off motor and let it cool before refueling. Wipe gasoline spills from motor. Check manuals of other specialized cutting equipment and follow the manufacturer’s safety instructions. Specialized equipment includes: power pruners, gas powered pruning saws, pole saws, limb cutters, etcWear close-fitting clothing and safety equipment appropriate for the job. Wear suitable hearing protection devices such as earmuffs or earplugs to protect against loud operating noise and also wear appropriate eye/face protection.

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Never reach inside the safety shroud when the engine is running. Never lubricate or service the machine while it is running. Keep hands, feet and clothing away from the power-driven parts.

3. Trenching/Shoring and Excavating

MoDOT personnel shall contact Missouri One Call System as well as other utilities to ensure that all underground utilities are identified and marked prior to doing excavation work.

No employee will be asked to enter an excavation four (4) feet or deeper until they have been adequately trained.

Excavations five (5) feet or deeper, where employee occupancy can be reasonably anticipated, must be protected by an appropriate protective system determined by a trained competent person.

Refer to Risk Management Manual – Policy Section 2.4 Excavation Policy (Trenching and Shoring Procedures) for more information

Reminder, Risk Management Manual Section 2.3, Confined Space Entry Procedures, may apply.

G. Use of Small Tools

Only tools that are in good condition shall be used. Some of the conditions that constitute a defective tool are: burred or mushroomed heads on hammers. sledges, mauls, chisel heads, etc., and splintered, broken, rough or loose tool handles, sprung jaws, dulled edges on cutting tools, etc.

j.

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Tools that are not in good condition shall either be repaired or replaced with a new tool.

Always use the proper tool for the job. For example, do not use a wrench as a hammer, or a screwdriver as a chisel.

Always use tongs when holding a bull point, front pin wedge, or drill for sledging. Use only mauls or sledges for striking.

Workers shall be in proper position before using axes, hatchets, sledgehammers, or similar tools. They shall have proper stance, with a firm footing, and be clear of obstructions or co-workers.

All power cords should be inspected for cuts, abrasions, and splicing. Removal of ground plugs is strictly prohibited.

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VII. Facilities

A. General

Safety policies, posters and other information relating to safety shall be posted on the bulletin board of each department facility. The bulletin board shall be located in a permanent, well-lighted place readily accessible to the employees. Employees are responsible for periodically reviewing this information.

The supervisor in charge shall be responsible for posting safety information in an orderly fashion. The condition of a safety bulletin board reflects the commitment of the supervisor towards the safety program.

Safety information shall be displayed for a period of at least one month and outdated information removed periodically.

Disposal of any waste or hazardous waste materials shall be governed by department procedures that will conform to local, state, and federal regulations.

Wood flooring or woodwork near stoves, furnaces and stove, or steam pipes shall be properly protected by fire resistant material. Proper clearance shall also be provided between protective sheeting and a wood surface.

Trade wastes, treated lumber, trash, etc, shall not be burned in wood burning stoves.

B. Office

Machines shall never be cleaned or adjusted while in

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motion. Sharp burrs should be immediately removed from any machine, cabinet, stand, or furniture.

Caution should be exercised when opening file drawers to prevent tipping. File and desk drawers should be pushed back into place before leaving the files and desks.

Guards on paper cutters shall always be in place when the machine is being used.

Fire extinguishers of the appropriate size and type shall be provided, maintained and placed in all offices. All employees should be familiar with the location of fire extinguishers and know how and when to properly use the extinguisher.

C. Garages and Maintenance Buildings

Refueling Motor Vehicles

MOTORS SHALL NOT be running while the vehicles are being refueled. The nozzle of the fuel hose shall be kept in direct contact with the tank to guard against the ignition of the fuel by static electricity.

The engine must be shut off before refueling starts.

Smoking is prohibited within fifty (50) feet of any fuel dispensing area.

The two-way radio and cell phones shall be turned off while the vehicle is being refueled.

The vehicle must be attended, while fueling.

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2. Fuel Cans

All new gasoline cans shall be of a construction approved by Underwriters Laboratory (UL) with the original factory cap and flame arrestor installed.

Gas cans shall be stored in separate storage buildings/area away from spark producing equipment and operations.

All fuel cans shall be UL approved and shall be marked for the contents therein.

All fuel cans shall be removed from the vehicle prior to filling.

No fuel cans shall be filled while located in the bed of a pickup truck with a bed liner.

3. Ventilation

To prevent danger from carbon monoxide gas poisoning and exposure to potential carcinogens, mechanics or operators shall not run or idle vehicle motors while in a storage building or garage unless building windows and doors are open or exhaust fumes are carried away by means of a suction ventilating system.

Paint spray booths shall be constructed and maintained with the appropriate exhaust fans and motors.

Exhaust fans shall be maintained according to manufacturer’s recommendations.

Smoking is prohibited in the vicinity of paint booths.

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A fire extinguisher shall be mounted near the paint booth.

Painting done in other areas, must have adequate ventilation.

4. Welding And Cutting

Employees shall wear appropriate PPE when welding or cutting.

Only those engaged in welding should be permitted around welding Equipment or be permitted to assist the welder unless equipped with appropriate PPE.

Properly adjusted shields shall be placed around welding operators to prevent other employee’s exposure to glare.

The electrode holder and connecting cable on electric welders shall be completely insulated.

Welding activities should be screened off from other work activities with an opaque partition, such as a canvas wall.

Welding operations shall not be performed in close proximity to any explosive materials or in the presence of flammable materials, gases or vapors.

Do not weld or cut on containers that have held flammable liquids or vapor.

Containers shall be purged with water before welding operations are started.

All electrical welding machines operated from electric power circuits shall be on a grounded circuit.

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5. LP-Gas and Compressed Gas Safety

Transferring of LP-Gas by unauthorized MoDOT employees is strictly prohibited.

Any MoDOT employee involved in the transfer of LP-Gas from any container to another, shall be trained and certified by successfully completing the National Propane Gas Association’s Certified Training Program or equivalent and shall attend the required refresher training course a minimum of every three years.

(Missouri Statute LP-Gas Law- 2 CSR 90-10.012 Registration and Training)

All LP-Gas dispensing stations shall have recommended fill procedures posted in a conspicuous location and all dispensing stations shall be equipped with a state-approved scale to be utilized for the safe filling of LP-Gas cylinders. LP-Gas cylinders of (100) pounds water capacity or less shall be filled by weight only utilizing a state-approved scale.

All oxygen and acetylene valves shall be closed and all pressure released from the regulator before employee leaves work.

All compressed gas cylinders shall be used, stored and transported in the upright position.

Cylinders shall be secured to holders, to walls, or to racks, by chains or other appropriate means.

To prevent a serious explosive reaction, oil and greasy substances must be kept away from oxygen cylinders, valves, hoses and couplings.

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Storage areas must be well ventilated.

Oxygen and acetylene tanks shall be stored a minimum of 20 feet from each other, and separate from any flammable, combustible, and/or spark producing materials, tools or operations.

When compressed gas cylinders are stored in protective structures, structures must be constructed of noncombustible materials at least 5 feet high having a fire-resistance rating of at least one-half hour.

For more information see Risk Management Manual Section 2.6 LP-Gas and Compressed Gas Cylinders and Section 2.2 Building Safety Inspections

6. Cleaning Agents

Only employees thoroughly instructed in the use of steam cleaning equipment and the dangers of hot chemical solutions shall be permitted to use the cleaning equipment.

Employee shall never point a gun or hose used in the cleaning process at another person.

Operators of steam cleaning equipment shall wear the PPE required by the labels on the chemicals used for cleaning and the operator’s manual of the equipment being used.

Chemical compounds used as cleaning agents on trucks or equipment shall be immediately flushed off to eliminate personal contamination and damage to equipment paint.

Approved commercial liquids that are not injurious or flammable should be used for

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cleaning purposes. The use of gasoline or diesel for cleaning, degreasing and/or as a solvent is prohibited.

Follow manufacturers recommendations for proper ventilation.

Use of compressed air for cleaning work surfaces shall be limited to a pressure of 30 psi or less.

Use of compressed air to clean employee’s clothes or their person is prohibited.

Appropriate eye protection shall be used when cleaning equipment.

7. Storage of Hazardous Materials

All hazardous materials shall be stored in designated hazardous materials storage areas.

All Material Safety Data Sheets for hazardous materials used at the facility must be available for review by all employees. �t is recommended that all MSDSs be kept in a binder in a known location for all employees who work with hazardous materials.

For further information see the MoDOT Risk Management Manual Intranet Web Site where all MSDSs are located.

http://wwwi/ri/msds_results.asp

8. Portable Ladders

Portable ladders are designed as one-person pieces of equipment with the proper strength to support the worker as well as their tools and materials.

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Following are the four general classes of portable ladders:

Type IAA - Extreme heavy duty industrial with a load capacity of 375 pounds

Type IA - �ndustrial. Extra heavy-duty with a load capacity of 300 pounds.

Type I - �ndustrial. Heavy-duty with a load capacity of 250 pounds.

Type II - Commercial. Medium-duty with a load capacity of 225 pounds.

Type III - Household. Light-duty with a load capacity of 200 pounds.

When using a portable ladder follow these safety tips:

Do not hand-carry loads when climbing up a ladder.Do not reach so far that you lose your balance. Move the ladder instead.Non-skid feet or spurs may prevent a ladder from slipping on a hard, smooth surface.Do not stand on of the ladder’s top three rungs.A damaged side rail may cause one side of a ladder to give way. Ladders, which are damaged in this way, should be removed from service.Ladders used to reach a walking surface or roof must extend at least three feet beyond the top edge and be secured to the landing at the top.Extension ladders need both side locks latched to prevent overloading.Stepladders should be securely spread open. Never use a folding stepladder in a closed position.

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Be aware of electrical hazards. Shock can occur with metal ladders or wet wooden ladders.Don’t place ladders in front of doors opening toward the ladder unless the door is blocked, locked or guarded.Face the ladder when ascending or descending.Don’t use a ladder as a brace, skid, guy or gin pole, gangway or for other use not specifically recommended for use by the manufacturer.

A simple rule for setting up a ladder at the proper angle is to place the base a distance from the vertical ( 4:1) wall equal to one-fourth the working length of the ladder.Step ladders shall not exceed 20 feet in length and single sections of extension ladders shall not exceed 30 feet. Two-section ladders shall not exceed 48 feet in length and over two-section ladders shall not exceed 60 feet in length.Based on the nominal length of the ladder, each section of a multi-sectioned ladder shall overlap the adjacent section by at least the number of feet noted in the following chart:

Normal length of ladder OverlapUp to and including 36 feet 3 feetOver 36 feet, up to and including 48 feet 4 feetOver 48 feet, up to 60 feet 5 feet

Note: Ladders having defects are to be taken out of service immediately.

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VIII. Confined Space Entry, Tanks and Vessels (29CFR 1910.146)

A. Purpose

The purpose of the Confined Space Entry Program is to prevent incidents by training and equipping employees so as to eliminate or control the hazards, i.e., oxygen deficiencies, toxic gases, associated with entering, working within and exiting confined spaces.

B. Permit- Required And Non-Permit Confined Space Entry (29 CFR 1910.146)

For the purpose of Department safety policies and procedures a confined space is defined as any space that meets all of the following criteria:

Has adequate size and configuration for employee entry;

Has limited means of entering and exiting, and,

�s not designed for continuous employee occupancy.Permit-Required Confined Space

A permit-required confined space has one or more of the following characteristics:

Contains, or has the potential to contain, a hazardous atmosphere.

Has an internal configuration such that an entrant could be trapped or asphyxiated by inwardly converging walls or by a floor which slopes downward and tapers to a smaller cross-section

Contains a material that has the potential for engulfing an entrant, i.e., grain, mud, salt, rock, sand, etc.

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Contains any other recognized serious safety or health hazard.

These confined spaces pose the greatest danger to entrants and require the most extensive safety precautions to be taken. �t is best, whenever possible to leave these jobs to the professionals that are equipped to handle work in these environments.

If the workplace contains permit-required confined spaces all affected employees shall be informed (when feasible) by the posting of danger signs or by any other equally effective means. The warning shall included the existence and location of and the danger posed by the permit-required confined space, i.e., Danger—Permit-Required Confined Space, Do Not Enter.

Refer to Risk Management Manual Section 2.3 Confined Space Entry Procedures

Not compromising safety because we believe in the well being of employees and customers is a value of MoDOT. Your safety is important to the department. A part of your job requirements is to follow all safety policies, rules and regulations. Having a positive attitude about safety and observing established safety practices will increase your safety, the safety of your fellow employees and the public’s safety

4.

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Missouri Department of TransportationSupervisors Safety Orientation ChecklistEach Department Supervisor shall thoroughly instruct each employee in the safety requirements of the job. This checklist is provided for that purpose. The employee instruction shall be completed within one week of the date of the employee’s date of hire. The Supervisor shall check each of the items on this form at the time the instruction is given. When completed, sign and return this form to the District Safety and Health Manager

Employee Name: _____________________________________Department: _____________ Work Location: _____________Position: ________________ Date Hired: ________________Safety Topic Covered Completed 1. Discuss general safety rules _________________________ 2. Explanation of safety rules for specifi c jobs ______________ 3. General discussion of safety devices ___________________ 4. Reporting unsafe conditions _________________________ 5. Job conduct _____________________________________ 6. Proper lifting techniques ___________________________ 7. Safety suggestions ________________________________ 8. Reporting injuries ________________________________ 9. Available First Aid and CPR Programs __________________10. Emergency procedures _____________________________11. Personal protective equipment ________________________12. Housekeeping ___________________________________13. Storage of materials _______________________________

14. Fire Protection ___________________________________

Employee Signature: ____________________ Date: _________Supervisor Signature: ___________________ Date: _________Comments: ___________________________________________________________________________________________

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Missouri Department of Transportation

Safety, Policies, Rules, & Regulations Employee Handbook Acknowledgement

2007 Edition

Date: ________________________

� hereby acknowledge receiving my personal copy of the Missouri Department of Transportation, Safety Policies, Rules, & Regulations – Employee Handbook, and fully realize that � am obligated to read it, become familiar with it, and review it at least once per year, as a condition of my employment. �f � cannot comprehend or understand any information in this booklet, � realize that � am required to contact my supervisor in order to clarify any need for knowledge, as expressed in this booklet.

I accept that the personal issuance to me of this book satisfi es any posting requirement of any applicable Missouri Statutes, or standards, rules, or regulations of any state agency.

Further, � understand that failure to comply with the policies, rules, and regulations set forth in the publication may result in disciplinary action, up to and including dismissal.

Employee Signature: _______________________Employee Printed Legal Name: ________________

ORG Number: ________ ORG Name: _____ ____Date Received: ________


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