Portland Community College | Portland, Oregon

Appendix A – PCC Board Policy B507

Appendix B – Academic Training Chart

Appendix C – Operational Training Chart

Form 1: Supervisor – Manager New Employee Department Safety Training Checklist

Form 2: Hazardous Condition Report

Form 3: Hazardous Condition Report Investigation

Appendix A – Definitions

Appendix B – References

Appendix C – Resources

Form 1: Injury or Property Incident Report

Form 2: Supervisor’s Accident/Incident INVESTIGATION Report

Form 3: How to Conduct an Accident Investigation

Form 4: Blood Borne Pathogen (BBP) Post-Exposure Incident Form – see reference 2 document in Ch 4 Bloodborne Pathogen Exposure Control Plan

Form 5: Kaiser Hepatitis B Form 2015

Appendix A – Definitions

Appendix B – Meeting Format

Form 1: Safety Committee Agenda

Form 2: Safety Committee Minutes

Form 3: Inspection Audit Worksheet

Form 4: Safety Inspection Correction Recommendation Sheet

Form 5: New Member Checklist

Appendix A – Definitions

Appendix B – Sharps Containers Use & Disposal

Appendix C- Student (Non-Employee) BBP Exposure Control Plan

Appendix D – Occupational Health Providers

Form 1: Hepatitis B Immunization Acceptance/Declination

Form 2: Sharps Injury Log

Form 3: Training Checklist

Reference Documents

i           Injury or Property Incident Report  

ii          BBP Incident Report

iii         Supervisor Accident Investigation Report – See Health and Safety Manual Chapter 2

iv          Employee 801 Report & Pain Diagram – Available from Risk Services

v          Center for Disease Control (CDC) Hepatitis B Vaccine Information Sheet

vi         Kaiser Permanente Urgent Care Location Sheet

vii        Kaiser Permanente Hepatitis B Full Series Immunization Program Instruction Sheet

Appendix A -Definitions

Appendix B – Confined Space Summary

Appendix C – Cascade

Appendix C – Climb

Appendix C – Downtown Center

Appendix C – Metro

Appendix C – Newberg

Appendix C – Rock Creek

Appendix C – Swan Island

Appendix C – Sylvania

Appendix C – Willow Creek

Appendix D – Multi-Gas Detector Usage and Calibration

Appendix E – Tripod Inspection

Appendix F – Utility Tunnel Safety

Form 1: Confined Space Assessment

Form 2: Confined Space Entry Permit

Form 3: Utility Tunnel Safety Work Plan

Appendix A – Definitions

Appendix B – Emergency Spill Kit Contents

Appendix C – Personal Protective Equipment (PPE)

Form 1: Hazardous Release Assessment

Form 2: Site Work Plan

Appendix A – Definitions

Appendix B – Global Harmonize System (GHS) Pictograms

Appendix C – MSDSonline Overview and Instructions Guide

Form 1: Chemical Prior Approval Form

Form 2: New Chemical or Non-Routine Exposure Training Document

Appendix A – Definitions

Appendix B – Laboratories & Storeroom Locations

Appendix C – GHS Reference Materials

Appendix D – Inventory of Carcinogens and Other Specific Hazards

Form 1:  Laboratory & Storeroom Inspection Checklist

Appendix A – Definitions

Appendix B – Lockout/Tagout Devices

Form 1: Lockout/Tagout Equipment Evaluation & Energy Control Procedure

Form 2: Lockout/Tagout Periodic Inspection

Appendix A – Definitions

Appendix B – Evaluating Noise Reduction Ratings (NRR) of Hearing Protectors

Form 1: Online Injury or Property Incident Report 

Form 2:  Sample Standard Threshold Shift (STS) Letter

Appendix A – Definitions

Appendix B – PPE Use by Department (as of May 2020)

Appendix C – Infectious Disease Hazard ID and Protection (including COVID-19)

Form 1:  Hazard Assessment & Training

Reference Documents

COVID-19 Risk Exposure Assessment

COVID-19 Face Covering Guide

Appendix A – Definitions

Appendix B – PCC Building Inventory

Appendix C – Asbestos Containing Material (ACM) Examples

Appendix A – Definitions

Form 1: Powered Industrial Truck Inspection Form

Form 2: Aerial Device, Mobile & Work Platform Operator Inspection Checklist

Form 3: Harness Inspection (Qualified Inspector)

Form 4: Lanyard Inspection

Form 5: Utility Vehicle Operator Inspection Checklist

Form 6: Powered Industrial Truck Checklist Record

Form 7: Powered Industrial Truck Training Certification

Form 8: Utility vehicle Operator Department Training Log

Appendix A – Definitions

Form 1 – Hot Work Permit

Appendix A – Definitions

Appendix B – Respirator Selection Table

Appendix C – Respirator Program Elements

Appendix D – Occupational Health Providers

Appendix E – Respirator Voluntary Use

Form 1: Medical Clearance Request

Form 2: OSHA Medical Evaluation Questionnaire

Form 3: Respirator Assignment

Form 4: Cleaning and Storage

Form 5: Respirator Inspection Record

Form 6: Plan Evaluation

Appendix A – Definitions

Form 1: Contractor Notification Project Hazard Assessment

Form 2: COMPLETED SAMPLE Contractor Notification Project Hazard Assessment

Appendix A – Definitions

Appendix B – Summary of Controls

Appendix C – Requirements for Guardrail Systems and Hole Covers

Appendix D – Requirements for Designated Areas

Appendix E – Requirements for Travel Restraint and Personal Fall Arrest Systems

Form 1: Fall Protection Work Plan (FPWP)

Form 2 : Personal Fall Arrest System (PFAS)

Form 3: Harness Inspection Form

Form 4: Lanyard Inspection Form

Form 5: Lifeline and Rope Inspection Form

Appendix A – Definitions

Appendix B – Lists of Hazardous Waste

Appendix C – Satellite Accumulation Log

Appendix D – Hazardous Waste Log

Appendix E – Sewer Discharge Log

Appendix F – Waste Labels Fact Sheet

Appendix G – Bulk Used Oil Tanks

Appendix A – Definitions

Appendix B – Reference Links

Form 1 – Monthly UST Inspection Checklist

Appendix A – Definitions

Appendix B – Alloy Steel Chain Slings

Appendix C – Wire Rope Slings

Appendix D – Metal Mesh Slings

Appendix E – Natural and Synthetic Fiber Slings

Appendix F – Synthetic Web Slings

Form 1 – Daily Inspection Checklist

Form 2 – Quarterly Inspection Checklist

Appendix A – Definitions

Appendix B – PCC Locations

Appendix C – Apparent Temperature Chart

Appendix D – Preventing Heat-Related Illnesses

Appendix E – Heat Related Illnesses – Signs, Symptoms, and Responses

Appendix F – Acclimatization Practices

Appendix G – Work/Rest Schedule Options

Form 1 – Department Work Plan

Appendix A – Definitions

Appendix B – PCC Locations

Appendix C – Employee Communication Template

Appendix D – Exposure Controls

Appendix E – Filtering Facepiece User Seal Checks

Appendix F – 5-3-1 Visibility Chart

Appendix A – Definitions

Form 1 – Scaffold Work Plan

Reference Documents

Scaffold Code of Safe Practices

Procedures for Visual Inspection of Welded Tubular Frame Scaffolding Accessories

Rolling Towers/Mobile Scaffold: Inspection, Maintenance, and Use Tip Sheet

Appendix A – Definitions

Appendix B – Compatibility Chart

Appendix C – Example Department Procedure

Form 1 – Inspection Checklist