Portland Community College | Portland, Oregon Portland Community College

Health & Safety Manual


December 2021

Ch 1. General Safety Program & Responsibilities


Appendix A – PCC Board Policy B507

Appendix B – Safety Training List by Type and Department


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

Form 2: Hazardous Condition Report


Ch 2. Accident/Incident Investigation


Appendix A – Definitions

Appendix B – References

Appendix C – Resources


Form 1: Injury or Property Incident Report —Online 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 Bloodborne Pathogen 

              Exposure Control Plan Chapter 4

Form 5: Kaiser Hepatitis B Form 2015 [pdf]


Ch 3. Safety Committees Charter


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


Ch 4. Bloodborne Pathogen (BBP) Exposure Control Plan


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 for PCC Employees

Form 2: Sharps Injury Log

Form 3: Training Checklist


Reference Documents

i          Injury or Property Incident Report – Available Online 

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 [pdf]

vi        Kaiser Permanente Urgent Care Location Sheet

vii       Kaiser Permanente Hepatitis B Full Series Immunization Program Instruction Sheet


Ch 5. Confined Space Entry


Appendix A -Definitions [pdf]

Appendix B – Index of Campus Locations [pdf]

Appendix B – CA [pdf]

Appendix B – Climb [pdf]

Appendix B – DC [pdf]

Appendix B – Metro [pdf]

Appendix B – Newberg [pdf]

Appendix B – RC [pdf]

Appendix B – SE [pdf]

Appendix B – Swan Island [pdf]

Appendix B – SY [pdf]

Appendix B – Willow Creek [pdf]

Appendix C -Confined Space Summary [pdf]

Appendix D -Multi Gas Detector Usage and Calibration


Form 1: Training Agenda

Form 2: Confined Space Permit [pdf]

Form 3: Hot Work Permit Instructions [pdf]

Form 4: Hot Work Permit Sample [pdf]


Ch 6. Electrical Safety – under reconstruction [intranet]


Appendix A – Definitions [pdf]

Appendix B – Electrical Safety Training [pdf]

Appendix C – Understanding Arc Flash [pdf] [pdf]

Appendix D – Resetting Circuit Breakers [pdf]

Appendix E – Electrical Energized Work Permit [pdf]


Ch 7. Hazardous Material Emergency Response Plan


Appendix A – Definitions

Appendix B – Emergency Spill Kit Contents

Appendix C – Personal Protective Equipment (PPE)


Form 1: Spill Assessment

Form 2: Site Work Plan


Ch 8. Hazard Communication


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


Ch 9. Chemical Hygiene Plan – Laboratories


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


Ch 10. Control of Hazardous Energy – Lockout/Tagout 


Appendix A – Definitions

Appendix B – Lockout/Tagout Devices


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

Form 2: Lockout/Tagout Periodic Inspection


Ch 11. Noise & Hearing Conservation


Appendix A – Definitions

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


Form 1: Online Injury or Property Incident Report  See Health and Safety Chapter 2, Form 1

Form 2:  Sample Standard Threshold Shift (STS) Letter


Ch 12. Personal Protective Equipment (PPE)


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


Additional Reference Documents

COVID-19 Risk Exposure Assessment

COVID-19 Face Covering Guide


Ch 13. Hazardous Building Materials


Appendix A – Definitions

Appendix B – PCC Building Inventory

Appendix C – Asbestos Containing Material (ACM) Examples


Ch 14. Powered Industrial Trucks, Material Handling Vehicles and Powered Mobile Equipment


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


Ch 15. Mechanical Hazards – Controls and Facility Safety – under reconstruction


Ch 16. Hot Work (Welding Safety)


Appendix A – Definitions


Form 1 – Hot Work Permit


Ch 17. Respiratory Protection Plan


Appendix A – Definitions

Appendix B – Respirator Selection Table

Appendix C – Respirator Program Element Chart

Appendix D – Occupational Health Providers


Form 1: Medical Clearance Request for Respirator Use

Form 2: OSHA Medical Evaluation Questionnaire

Form 3: Respirator Assignment and Fit Record

Form 4: Respirator Voluntary Use

Form 5: Cleaning and Storage

Form 6: Respirator Inspection Record

Form 7: Plan Evaluation Checklist


Ch 18. Contractor Hazard Notification (Multi-employer sites)


Appendix A – Definitions


Form 1: Contractor Notification Project Hazard Assessment

Form 2: COMPLETED SAMPLE Contractor Notification Project Hazard Assessment


Ch 19. Industrial Hygiene Program & Air Monitoring Results – under reconstruction [pdf]


Ch 20. Fall Protection Program


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


Ch 21. Regulated Waste


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


Ch 22. Environmental Protection & Stewardship


Appendix A – Definitions

Appendix B – Reference Links


Form 1 – Monthly UST Inspection Checklist


Ch 23. Cranes, Hoists and Slings


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


Ch 24. Heat Illness Prevention Plan


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


Form 1 – Department Work Plan


Ch 25. Wildfire Smoke Protection 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