Model Plans

These policies are provided by the Maine Department of Labor SafetyWorks! program as a guide to assist employer in compliance with safety and heath regulations. It is the responsiblity of the employer to modify these documents to meet site-specific hazards.

Respiratory Plan for Fire Departments - This sample plan concerns respirator use in general industry and construction workplaces as regulated in 29 CFR §1910.134 .

General Respiratory Plan - Sample respiratory plan for general industry and construction workplaces (not for fire departments.)

Emergency Action Plan - Workplaces must have an emergency action plan to ensure employee safety in case of emergency. Companies with 10 or more employees must have this plan in writing.

Hazard Communication Plan - Any workplace that has hazardous materials must have a written Hazard Communication program. Because most chemical products, even cleaning products, are consider hazardous, most workplaces need a Hazard Communication program.

Lockout Tagout form for Equipment - Forms for lockout/tagout procedures,programs and equipment.

Control of Hazardous Energy Sources (Lockout/Tagout) - Workplaces where employees do maintenance or repair work need a written Lockout/Tagout program to protect against unexpected startup of equipment.

Volunteer Firefighter Model Policy - Public Law 296 provides volunteer firefighters protection from discipline or discharge, in certain employment situations, on the grounds that the volunteer firefighter arrives late or does not arrive to work because the volunteer firefighter is responding to certain emergencies to which the fire department is called to respond. The law allows written agreements between employees and employers to supersede the terms of the proposed law. This model policy / agreement has been developed as an option for employers to use.

Chemical Hygiene Plan - Non-production laboratories where small scale chemical experiments are conducted must have a chemical hygiene plan, under OSHA's Laboratory Standard (29 CFR 1910.1450). This sample plan is for secondary schools.

Fire Prevention Plans - Plan to assist employers in fire prevention.

Facility Inspection Checklist(MS Excel Version) - Provides guidance to employers for the periodic inspection of thier facilities.

Fire Department and EMS Blood Borne Exposure Plan - Provides fire department and EMS with a guide for all areas that are required to be part of a BBP exposure plan.

OSHA 300 Injury Reporting Forms - Provides OSHA 300, 300A Summary Form and 301 Forms

Silica Program - Model program to assist employers with high levels of Silica exposures with monitoring,record keeping and training

Hearing Conservation Program - Construction - Assists employers in devoloping a hearing conservation program

Asbestos Exposure Program - This Asbestos Operations and Maintenance Program has been developed to eliminate and control hazards associated with asbestos containing materials located at your site.

Lock Out / Tag Out Program - Program to assist employers in ensuring employees are using procedures to isolate energy sources prior to maintenance and other duties of equipment in the workplace.

Confined Space Program - Sample Permit Required Confined Space program. Itentifying spaces, equipment used, employee responsibilities ...

Blood Borne Pathogen Plan - Provides employers who have employees with BBP exposures, a guide for all areas that are required to be part of a BBP exposure plan.

Flammable Liquids Storage - An employer guide to proper storage procedures for flammable liquids.

N-95 RESPIRATORY PROTECTION PROGRAM - State of Maine public sector employers who require n-95 respirators to be used are required to have this program in place. This is a guide to be in compliance.

Lockout Procedure for Dump Body Trucks - Example Lockout Procedure for Maintenance on Dump Body Truck

Sample Lockout Procedure for Front Loader - Lockout Procedure for Maintenance on Front Loader

Lockout Procedure for Water Pump - Detailed sample lock out procedure for a waste water pump.

Lock out procedure annual review form. - Annual Lockout - Tagout Administrative review of detailed writen procedures of lockouts for equipment.

Lockout Tagout Training Form - Ensures that training has been received on the Mandatory Lockout - Tagout Program. Provides checklist of items to be trained on.

Facility Inspection Checklist (MS Word Version) - Provides guidance to employers for the periodic inspection of thier facilities.

Safety Training Sign Off Sheets - Provides needed documentation for employers to track employee training has been conducted.

General Industry Hearing Conservation Program - Policy to assist employers who are required to have a hearing conservation in general industry.

Qualitative Fit Test Form - This form is for fit testing tight fitting respirators using the saccharine method.

Workstation Checklist - Helps identify risk factors contributing to work-related discomfort or problems at workstations.

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