Home Safety and Risk Improvement Safety Manuals and Forms

Safety Manuals and Forms

Feel free to download our sample manuals and forms. We ask only one thing: Customize them to make them fit your workplace’s specific needs.

Search Models, Sample and Manuals

General Safety

The first step to creating a culture of safety is to outline general safety practices expected of your employees.

Sample General Safety Manual
Last Updated 06/11/2021

A General Safety Manual should be a tool that helps employers provide applicable safety information and direction to ensure that their employees understand and have the appropriate information for them to perform the duties of their position in a safe and responsible manner.

It is important to remember with all model programs, they are a template to get the employer started in the right direction. Each member should make sure that when using the manual it is only beneficial to their employees if it is used in conjunction with the members policies, procedures and culture.
This sample safety manual outlines management’s commitment to the safety for their employees and it provides employees with clear instructions and rules to mitigate or reduce the health and safety risks of the workplace. It also contains best practices for costs containment including claims management and hiring practices regarding safety.

The policy also addresses operating vehicles and equipment while taking medications, being ill or fatigued. Employers should review their policies on how to address employees that may be impaired due to illness or using medications while working. This is a policy very similar to what is by all Iowa League of Cities staff, and therefore followed by IWMCA administrative staff.

To help curtail the number of needless vehicle and equipment-related claims, IMWCA hopes that members will utilize this manual to give your employees and management more tools they can use to be safe drivers. At the end of the day, the manual is about getting wherever you’re going, including home, safe.
This manual was developed to assist IMWCA members with the development, training and enforcement of policies related to safe driving habits. The manual provides direction to employees and elected officials on improving the safety of all employees and elected officials while they operate vehicles and equipment for business purposes.

Manuals
Sample Safety Committee Agenda
Last Updated 06/11/2021

Safety committees should meet regularly to review incidents, claims and training opportunities.

Sample Safety Newsletter | Boone County May 2020
Last Updated 12/21/2019

Our thanks to Boone County for submitting their safety newsletter as an example. Have sample you’d like to share with other IMWCA members? Send it to the Safety and Risk Improvement team.

Forms
Sample Self Audit Form | Black Hawk County
Last Updated 08/18/2020

Performing an audit is not difficult, and it is not something that requires very much training.  You know what tools you use, how they perform, and if they are not operating properly. You also know where the eyewash, the shower, the first aid kits, and fire extinguishers are. Checking them and noting them on the tag or in a book is recommended and something to get into a habit of doing.  

This sample self-audit form will provide employers with a structure to develop and implement a safety self-audit process using the checklist for the different departments of their organization. This sample was used by Black Hawk County for all departments of the county.

Forms
Sample Incident Review form
Last Updated 08/19/2020

After a workplace injury or when an employee fails to follow safety protocols an employer conducts an incident review, and if applicable, employee discipline. IMWCA’s Safety and Risk Improvement team often speaks about “incident review,” while human resource professionals may also bring up the topic of employee discipline. Both are important and may even overlap, but these procedures should differ in goals and how they are carried out.

The goal of conducting an incident review is to learn what happened that led to either a “near miss” or actual employee injury and to identify/implement strategies to prevent the incident from reoccurring.

Incident review seeks to identify all contributing factors that resulted in the near miss or employee injury. The incident review is not intended to administer employee discipline. Rather, the review will look at a wide range of issues that could include any or all of the following: hazard identification process, policies and procedures, equipment condition, equipment maintenance records, site conditions, employee training, use of personal protective equipment, management commitment, applicable claims and safety records, and employee(s) actions.

This sample form provides a structure that employers can use to gather detailed information regarding an incident. The form is meant to be used by the supervisor of the injured employee, safety coordinators or other responsible for incident review.

Forms

Topic-Specific Manuals

Topic-specific manuals and training can help your organization target specific safety concerns.

Sample Slip and Fall Prevention Manual
Last Updated 06/11/2021

Injuries related to slips, trips, and falls account for approximately 25% of the number of annual claims in the IMWCA pool. Some of these injuries can be quite serious and impact the quality of life for the injured employee.

In fact, this issue is one we do not have to accept as employers or as employees since many of these injuries are preventable. How do we prevent these incidents? A key component is to develop  an employee awareness plan to “daylight” the issue and foster communication. This cannot be a once a year activity. These incidents happen through the year and it is important to keep the issue at the forefront throughout the year.

The goal is to help your employees identify and address the various factors that lead to slips, trips, and falls. These can be seasonal issues, general housekeeping needs,[b7]  and basic human behaviors. Increasing awareness and understanding often results in reduced frequency and severity of the incidents.

Given the prevalent number and costs of claims due to slips, trips and falls, the Iowa Municipalities Workers’ Compensation Association (IMWCA) has developed this program using industry information to assist our members in developing and implementing strategies proven to prevent slip, trip and fall injuries. While the emphasis of this information is to protect employees from work-related injury, some of this information can also be used to prevent slip, trip and fall incidents involving the public visiting your buildings and facilities.

Related Resource:
SHIELD’s Study Results on Slip and Fall Prevention Recording

Manuals
Sample Safe Driver Manual
Last Updated 06/11/2021

Vehicle accidents remain as one of the top causes of injury among IMWCA members. Distracted driving has become a significant factor in the growing number of vehicle-related incidents, and the lack of seatbelt usage contributes heavily to the severity of vehicle-related claims. When the two factors are combined the compounded effect on large, costly injuries becomes staggering.

IMWCA has previously adopted a policy requiring members to adopt and implement a seatbelt policy that goes beyond state law. The result was a decline in seatbelt incidents for those members that adopted and consistently enforced the policy. Conversely, members that do not have a separate policy or have not enforced their policy continue to see significant losses.

The Safe Driver Manual has a model seatbelt policy that also covers off-road equipment and passengers. The model policy also clarifies who qualifies for the slow, route exception defined in state law, which is generally misinterpreted to be broader than it really is. In addition, the new model also makes clear that management is responsible for the enforcement of the policy.

The manual includes commonly asked questions, seatbelt facts and seatbelt-related training that IMWCA members can access through Learn.
Distracted driving has become a bigger issue as more employees rely on cell phones to communicate personal and work needs. The model policy defined distracted driving and sets guidelines for employees to follow to safely use personal communication devices. Some of the updates include use of hands-free technology that is now available in more trucks and heavy equipment.

The policy also addresses operating vehicles and equipment while taking medications, being ill or fatigued. Employers should review their policies on how to address employees that may be impaired due to illness or using medications while working. This is a policy very similar to what is by all Iowa League of Cities staff, and therefore followed by IWMCA administrative staff.

To help curtail the number of needless vehicle and equipment-related claims, IMWCA hopes that members will utilize this manual to give your employees and management more tools they can use to be safe drivers. At the end of the day, the manual is about getting wherever you’re going, including home, safe.

This manual was developed to assist IMWCA members with the development, training and enforcement of policies related to safe driving habits. The manual provides direction to employees and elected officials on improving the safety of all employees and elected officials while they operate vehicles and equipment for business purposes.

Manuals
Sample Solid Waste Manual
Last Updated 06/11/2021

IMWCA currently serves most of the publicly-owned solid waste facilities including landfills, recycling centers, transfer stations and household hazardous waste sites.

The Sample Solid Waste Manual was developed to assist these members with continuing to provide safe work environments. This manual is a template to not only provide access to the safety policies and practices that solid waste agencies are obligated to establish and provide for their employees, it also identifies common vulnerabilities for solid waste agencies and employees.

This manual attempts to identify many of the safety standards that apply to landfill, recycling, composting and transfer station operations under OSHA 1910 General Industry Standards and 1926 Construction Standards. A link to the OSHA standard for further detail and key points that operators must consider in developing these programs. Links to Model OSHA programs are attached to help emplo

Manuals
Sample Excavation Guide
Last Updated 11/06/2020

IMWCA members are directly or indirectly exposed to excavation danger on a regular basis. Many municipalities perform water, sewer and other excavation activities that involve open trenches. Even when the member hires a contractor to dig, a municipal employee often ends up entering the trench to perform work. Add to that the hundreds of fire and EMS departments that are called upon to render aid when the unthinkable happens and someone is buried in a trench collapse. 

OSHA has created a set of rules and regulations that, when followed, will eliminate almost any situation where a trench collapse can result in a fatality which are linked below. The problem is, people are either unaware of the rules, are unaware of the dangers inherent in a trench, or they just choose to ignore them and take short cuts. 

This guide will provide information on the Occupational Safety and Health Administration’s (OSHA) general safety requirements for excavation work as published in 29 Code of Federal Regulations 1926 Subpart P. This can be used as a basic training tool.

Forms

Working with Model Programs

All the versions of Word are a little different, but the instructions below can provide guidance in customizing IMWCA model program documents.

1. Remove the Watermark (IMWCA | Model)

  • Found under “Page Layout”.
  • Choose “Remove Watermark.”

IF not found there, try:

  • “Design” tab of Word.
  • “Watermark” and “Remove Watermark”, which is at the bottom of the dropdown.

2. Update the Revision Date in the Footer

Remember when you last updated or reviewed the policy by changing the “Rev:” Date in the Footer of the Model programs.

  • Double-click on the footer.
  • Then use the date (at least the month and year) of the last review or update.