Plans, Forms and Templates

Injury & Illness Prevention Program

Each ANR location is required by state law and UC policy to have a written Injury and Illness Prevention Program (IIPP).  IIPP templates for Cooperative Extension offices and Research and Extenstion Centers are found below.

• IIPP

Survey - Confirm Updates of Required Safety Plans

Survey - UC-ANR Biosecurity Survey

Training Plan & Tracking Form

• Employee Health & Safety Training Requirements
• Instructions for Training Tracking Form
  • Office Employees
  • Field Employees
  • Laboratory Employees
  • Maintenance Employees

Inspection Checklists

• AED Inspection Checklist
• ATV Inspection Checklist (Landscape)
• Eyewash / Safety Shower Monthly Inspection Checklist
• Fire Extinguisher Monthly Inspection Checklist
• First Aid Inspection Checklist
• Forklift Daily Inspection Checklist
• Portable Ladder Inspection Checklist
• Tractor Daily Inspection Checklist (Landscape)
• Vehicle / Trailer Inspection Checklist
• Onsite Program Reviews
• Lab safety checklist (rev 3-2015) mm

Other Templates and Forms

• New Employee Safety Checklist
• Emergency Action Fire Prevention Plan
• Safety Meeting Training Record
• LHAT form
• Chemical Hygiene Plan
• Chemical Inventory List Form
• Hazardous Waste Label
• ANR Project Safety-Risk Plan
• Incident Report (other than employee injury)
• Workers' Compensation Forms
• Bloodborne Pathogen Plan template (UC Davis)
  
• Zoonotic Disease Biosafety Plan (ANR template)

Required Postings

• Tractor Safety Posting
• Forklift Safety Posting
• Labor and Employment Postings (UCOP Human Resources)
  Note: ANR EH&S annually sends each ANR office a large poster that combines these required postings. For more information, Ask EH&S