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System Safety Policies

Revised: 6/1/94

University-Wide Safety and Health Administration

The General Safety and Health Policy of the University of Tennessee, its various locations, campuses and healthcare facilities.

University of Tennessee's Policy on Safety and Health

SUBJECT: I. UNIVERSITY OF TENNESSEE'S POLICY ON SAFETY AND HEALTH

EFFECTIVE: 3/15/86

REVISED: 6/1/89
It is the policy of the University of Tennessee to establish and maintain a climate conducive to the safe conduct of the University's various missions. In June 1976, the Board of Trustees approved the University of Tennessee Occupational Safety and Health Plan to meet standards with the Tennessee Occupational Safety and Health Act (TOSHA) (Tennessee Code Annotated 50-501) as a self-inspecting agency.

The University's plan originally formalized the safety and health program for employees at its various campuses and locations and established responsibilities of the University-Wide Administration (UWA) and at the various campuses for the conduct of the "plan."

The safety and health plan of the University of Tennessee now extends to:

  1. The safety and well being of students and visitors to the University and the general public who are on the premises of the University.
  2. The identification, evaluation and control of potential financial losses to the University arising out of accidents and injuries to people and loss or damage to property.
Responsibilities of University-Wide Safety and Health Administration

SUBJECT: II. RESPONSIBILITIES OF UNIVERSITY-WIDE SAFETY AND HEALTH ADMINISTRATION

EFFECTIVE: 3/15/86

REVISED 7/1/90
The responsibilities of the UWA Safety and Health Administration shall be:

  1. To evaluate, review and audit each campus, location and or health care facility for compliance with the University's safety and health policies.
  2. To serve as a liaison between the University and the Tennessee Department of Labor and other state and federal regulatory agencies.
  3. To support each campus and unit in the implementation of their various safety and health programs.
  4. To provide the President of the University and the Board of Trustees of the University of Tennessee current information on safety and health activities.
  5. To develop and recommend University policy relating to safety and health matters.
  6. To develop and maintain information on safety and health as an educational resource for the University.
Campus General Safety and Health Policy

SUBJECT: III. CAMPUS GENERAL SAFETY AND HEALTH POLICY

EFFECTIVE: 3/15/86
The University of Tennessee acknowledges the need to establish an overall policy for the assurance of the safety and health of its employees, students, visitors and the general public in the conduct of the University's various missions. The University realizes the necessity of a commitment of all levels of its faculty, staff and administration at every campus, location and health care facility in the accomplishment of these desired goals.

The University recognizes the uniqueness of its various settings in terms of facilities and mission and, therefore, seeks by the following policy statements to provide each campus, location and health care facility with basic general safety and health policy standards. Specific operational procedures shall be established and implemented by each campus, location or health care facility as may be needed or required.

The University will, as its overall policy, seek to adhere to the laws of the State of Tennessee and to local and federal codes, ordinances and regulations as may be applicable. In the development of general and specific safety and health policies and practices, the University will recognize the rules and guidelines set forth by various accrediting academic and scientific agencies.

It shall be the policy of the University that each campus in the establishment of its safety and health programs and activities will identify, evaluate, control and manage those hazards which may produce bodily injury and loss to property.

Each campus, location and health care facility shall develop an identifiable plan for a safety and health program that can be communicated to and carried out by the various departments and units of that campus in the conduct of its safety and health responsibilities.

Responsibilities of Campus Safety

SUBJECT: A. RESPONSIBILITIES OF CAMPUS SAFETY AND HEALTH OFFICERS

EFFECTIVE: 3/15/86

REVISED 4/1/93

GENERAL RESPONSIBILITY

The Safety Officer (SO) for each campus, location and health care facility of the University of Tennessee will review accident experience and safety problems that occur on property owned or leased by the University. He or she will review report of accidents, industrial illnesses and fires, and submit to appropriate person, recommendations to correct hazardous conditions. The SO has the responsibility to recommend changes in existing policies to improve safety and health conditions. The SO shall serve as a resource for the review of planned construction and remodeling of existing property in matters involving life, fire and employee safety and make necessary recommendations to those person responsible. The SO shall be the responsible campus officer in the determination, evaluation and recommendation of abatement of all physical hazards to life and property, and shall provide the technical support for the training and education necessary for the location's safety programs. The Campus SO shall establish a program for the review and investigation of employee and student concerns regarding safety and health issues and hazards.

PURCHASE AND DESIGN OF SAFETY EQUIPMENT

The administrative divisions and departments of each respective location shall consult with the SO as a resource for determining the need and availability of specific types of safety and health equipment.

SAFETY AND HEALTH INFORMATION RESOURCE

The SO will maintain a current library of safety and health publications and will solicit access to libraries of such organizations as the National Safety Council, the National Fire Protection Association, Tennessee Department of Health and Environment, Center for Disease Control and various other organizations. The resources of the SO's library will be available to all members of the University community. The SO will prepare or provide training aids, charts, etc., necessary to support the safety and health goals of the University.

SAFETY AND HEALTH TRAINING

The SO will identify and, on request, assist departments in fulfilling their needs in training personnel in fire prevention and minor fire fighting, accident prevention, environmental health and sanitation, personal first aid and other related safety and health subjects.

ACCIDENT/INCIDENT REPORTS AND ANALYSIS

The SO will maintain an accurate file for all accidents and incidents, including work-related accident, occurring at that location, campus or health facility. The SO will perform, or cause to be performed , an investigation and analysis of each serious accident involving bodily injury or property damage occurring at his/her location and provide necessary information to the appropriate campus and/or system officials for the taking of any necessary action. A record of the SO's findings and recommendations will be maintained by the SO.

SAFETY INSPECTION

The SO will conduct, or cause to be conducted, safety and sanitation inspections of all facilities of the University at his/her particular location, campus or health facility on an annual basis with recommendations for abatement and/or correction to be provided to the appropriate person. Copies of the SO's findings in the course of these inspections shall be forwarded to the UWA Safety Office.

In locations where University employees are assigned to either premises not owned by the University or not under the direct control of the University, the SO shall determine the need to inspect and/or verify that these locations are inspected for any adverse conditions and necessary abatement to safety hazards are carried out in an appropriate manner. University employees at these locations shall be advised of the University of Tennessee Policies on Safety &;Health, Campus Safety Policy and the availability of the campus SO.

CAMPUS SAFETY MANUAL

The SO will be responsible for the updating, publication and distribution of the Campus Safety and Health Manual.
The Campus Safety and Health Manual will provide general rules for safety and health and establish basic policies and procedures that are to be followed by the campus in the conduct of the campus' safety program.
The SO will coordinate the formulation of specific policies and procedures for particular units or departments of his/her location. It is the responsibility of each department to support and enforce the policies and procedures contained in the Campus Safety Manual.
The SO shall review the Campus Safety Manual for its currency at least annually with the appropriate persons responsible.
The SO will distribute the University of Tennessee Policies on Safety and Health (this manual) to the appropriate departments and/or persons at his/her location, campus or health care facility.

OCCUPATIONAL SAFETY AND HEALTH ACT

The SO will comply with the requirements of the Tennessee Occupational Safety and Health Act (TOSHA) and other similar state and federal laws, including the maintenance of necessary campus safety records. The SO shall have the responsibility to report to the appropriate Campus and System official any significant breach of conformance to these laws. All inspections that are made by the SO will be directed toward compliance with the above standards.

The SO shall have the responsibility for the maintenance of all records and documents required by OSHA/TOSHA for his/her location. All records and documents shall be maintained in such a manner so as to provide immediate reference or availability to appropriate authorities upon their request.

ANNUAL SAFETY AND HEALTH REPORT

It shall be the responsibility of the Campus Safety and Health Officer to prepare an annual report of safety and health activities occurring on the campus for the past fiscal year (beginning July 1 of the previous year to June 30 of the present year). This report shall be prepared for the review and information of the chief administrative officer of the campus, location or health care facility and forwarded to the UWA Office by July 15 of the present year. The content and/or format of this report will be provided by the UWA Safety and Health Office prior to its due date.

Responsibilities of Department/Unit
SUBJECT: B. RESPONSIBILITIES OF DEPARTMENT/UNITS

EFFECTIVE: 6/1/89
It shall be the responsibility of each department or unit to support and enforce the policies and procedures contained in the Campus Safety and Health Manual, the Personnel Policies and Procedures Manual, and any other applicable safety and health rules and regulations. It shall also be the department's responsibility to make certain that all supervisors and employees are aware of safety and health rules and regulations and to provide the resources needed to train their personnel in all aspects of their jobs relating to safety and health that are within their particular area of responsibility. Specific operational procedures for safety and health shall be established and implemented as needed or required.

Safety and Health Inspection

SUBJECT: C. SAFETY AND HEALTH INSPECTION

EFFECTIVE: 3/15/86
It shall be the responsibility of each campus, location or health care facility of the University to develop a comprehensive Safety and Health Inspection Program. Such an inspection shall be no less than on an annual basis. The program shall be directed by the SO and shall be coordinated with appropriate campus officials.

The program shall include recommendations for the correction and abatement of those life safety, health and property loss hazards as may be identified in the course of these inspections. The inspections shall also determine specific compliance, understanding and practice of state, local and federal laws and rules regarding employee safety, public health, the environment, etc., relating to the specific functions at that location. The inspections shall include all facilities under the control of the particular campus, location or health care facility and shall be conducted on an annual basis. Report of the findings of the SO shall be made to the appropriate campus official.

It shall also be the responsibility of the SO to follow-up on compliance with those recommendations for hazard correction and abatement made as a result of the inspection. The SO shall report the result of such compliance with these recommendations. Compliance with those recommendations made by the SO in the course of his/her inspection shall be given prompt attention by the appropriate dean, director or department head of the area affected.

Accident and Incident Reporting

SUBJECT: D. ACCIDENT AND INCIDENT REPORTING

EFFECTIVE: 3/15/86

REVISED 7/1/90
Each campus, location or health care facility shall develop a comprehensive procedure for the investigation and reporting of all safety and health related accidents and incidents which occur within the geographical jurisdiction of the campus/unit or may involve the campus/unit's personnel or property at other locations.

The procedure established should provide for a prompt and complete objective description of the incident and any injuries sustained. Subsequent investigation should include guidance to ensure that predominating and contributing cause information is obtained and must encourage the submission of recommendations designed to prevent future occurrences of a like nature.

Such reports of accidents, incidents or occurrences shall be on the form and in the manner as prescribed by the Office of Risk Management.

Each campus, location or health care facility shall encourage, promote and provide a method for employees and students to report unsafe and/or potentially hazardous conditions to the appropriate campus authority, including the campus safety and health officer. The reporting of such conditions by an employee shall in no way result in disciplinary action or reprisal against the employee.

An employee may report such conditions directly to the campus SO and request anonymity.

 
Accident Analysis and Loss Prevention
SUBJECT: E. ACCIDENT ANALYSIS AND LOSS PREVENTION

EFFECTIVE: 3/15/86
Each campus, location or health care facility shall develop an appropriate method for the analysis of accidents or occurrences which produce bodily injury or property damage. Such analysis should include: frequency of occurrence, severity of outcome and site of accident of a particular type of injury or nature of injury. Such analysis should provide the Campus SO with necessary information to establish trends of accident occurrence and, as such, should suggest appropriate preventive measures to be undertaken.

Loss prevention activities on the part of the Campus SO shall be consistent with the priorities and objective of the respective location considering past accident trends and newly identified exposure to specific hazards. Loss prevention methods will take various approaches. Among these are:

  1. The safety inspections of premises and equipment.
  2. The specific safety and health education (e.g. driver training, machine operation and instruction and use of safety and health equipment).
  3. The use of equipment and machinery according to design and safety manuals.
  4. The consulting with various departments on the planning of new activities, programs and construction.
Emergency Response Plan

SUBJECT: F. EMERGENCY RESPONSE PLAN

EFFECTIVE: 3/15/86

REVISED 4/1/93
It shall be the responsibility of each campus or location of the University to develop a comprehensive Emergency Response Plan. Such a plan shall be coordinated at the appropriate campus administrative level, utilizing the input and resources available to the campus internally and externally.

Such a plan shall be developed in the event of potential or actual catastrophic events (both natural and man-made) occurring on or in the proximity of the campus or property of the University. The plan shall include written policies and procedures for the following:

  1. Type of emergencies covered.
  2. Person to contact in the event of a disaster.
  3. Documentation of activities, including names of person involved, times, etc.
  4. Duties and responsibilities of person involved.
  5. Communications and public relations responsibilities.
  6. Method(s) of appraisal of situation.
  7. Evacuation routes.
  8. Relationship with public authorities, e.g. law enforcement, fire, civil defense, and environmental authorities.
  9. Medical - first aid facilities.
  10. Mutual aid with other facilities, community, etc.
  11. Role of campus SO.
  12. Methods of testing plan, communication of plan, and its update and revision.
  13. This plan should be reviewed by the appropriate campus administrators annually for its currency and appropriateness.
  14. The plan must be communicated to the appropriate campus departments and divisions for their knowledge in the event of need to participate in either drills or an actual disaster.
Fire and Electrical Safety

SUBJECT: G. FIRE AND ELECTRICAL SAFETY

EFFECTIVE: 3/15/86
The University of Tennessee will recognize all applicable federal, state, and local laws, codes and regulations as they pertain to fire and electrical safety in the protection of life and property. Appropriate standards and recommendations promulgated by federal, state and local agencies and accrediting organizations shall serve as guidelines for the establishment of policies and standards applicable to the University and its various campuses, locations or health care facilities. The National Fire Protection Association (NFPA), the Standard Fire Prevention Code, will serve as the basis for the University's policy and standards for fire and electrical safety.

Each campus, location or health care facility will be expected to cooperate with the local fire prevention authorities to the extent possible. Each campus, location or health care facility will establish a program for the inspection of each premises location for the purpose of identification and correction of fire hazards and the testing of fire suppressant equipment and systems.

Laboratory Safety

SUBJECT: H. LABORATORY SAFETY

EFFECTIVE: 3/15/86

REVISED 7/1/90
The SO has the responsibility to inspect laboratories for safety and health hazards, evaluate protective devices and review laboratory safety policies and procedures.

Inspection of laboratories by the SO shall include, but are not to be limited to:

  1. Laboratory Chemical Inventories.
  2. Electrical Exposures.
  3. Housekeeping and Storage.
  4. Physical Hazards.
  5. Handling of Hazardous Waste/Materials.

Evaluation of protective devices by the SO shall include:

  1. The annual inspection of fume hoods for flow and discharge by either the SO or a designated contractor. (More frequent inspections of laboratory fume hoods may be necessitated by a change in occupancy or use of the laboratory).
  2. The inspection of eye wash facilities, safety showers, and other safety or protective devices.

The SO will serve as the consultant to laboratory personnel for the development of a written plan or policy for its safe use and the SO shall determine both compliance and currency of the plan/policy. The laboratory's written policy on safety should include: policy on authorized use, incident and accident reporting, first aid provisions, hygiene and compliance with environmental policies and other laws. Such written policy shall also incorporate the requirements set forth in "Occupational Exposure to Hazardous Chemicals in Laboratories" {29CFR 1910.1450} effective May 1, 1990.

The practices of the laboratory's personnel in the storage and handling of supplies and waste shall also be included in the SO's inspection of each laboratory location.

Each laboratory shall display the appropriate signage relating to its use, hazards and persons to notify in case of an accident or emergency.

Those laboratories which are designated as the listed location for radioactive materials shall be within the joint purview of the Campus SO and the designated Radiation SO.
(See J. Radiation Safety)

Life Safety (Excluding Fire Safety)

SUBJECT: I. LIFE SAFETY (EXCLUDING FIRE SAFETY)

EFFECTIVE: 3/15/86
It shall be the policy of the University of Tennessee to conform with those standards, specifications and/or ordinances which specifically address life safety concerns. The campus SO shall maintain such information and data necessary to consult and/or determine appropriate compliance with life safety standards.

Radiation Safety

SUBJECT: J. RADIATION SAFETY

EFFECTIVE: 3/15/86

REVISED 6/1/90
The University of Tennessee, its locations, campuses, and health care facilities who possess, use, transport and dispose of ionizing radio active materials, shall do so in accordance with federal, state and local regulations governing the use of these sources. Each locations campus or health care facility shall appoint a Radiation SO and appoint a Radiation Safety Committee in accordance with its licensed or registered use of these sources.

The appointed Radiation SO shall have those duties and responsibilities for the safe handling, licensing, registration and disposal of ionizing radiation sources as may be required under the location's license(s) or registration(s). Such sources shall include, but are not limited to: radioactive materials, x-ray machines, and particle accelerators. The Radiation SO and the Campus SO shall assume those duties and responsibilities as may be necessary to ensure the safe use of those facilities containing these ionizing radiation sources.

In the event of any cited violation by federal, state, or local regulatory agencies, immediate notification and proposed remedy of same shall be made to both the Campus SO and University-Wide Safety and Health Administration.

Non-Ionizing Radiation Safety

SUBJECT: K. NON-IONIZING RADIATION SAFETY

EFFECTIVE: 3/15/86

REVISED 7/1/90
Each campus, location and health care facility shall establish the appropriate safety and health procedure and review all non-ionizing radiation usage, including lasers and microwaves. Such procedures shall address usage, condition and health exposures of those involved.

The following procedures shall be established relating directly to the use of lasers. These shall include, but are not limited to:

  1. Basic personal protection, including eye protection for users and observers.
  2. Training of employees and students in the proper use and safety handling of these devices.
  3. Registration of all lasers with the Campus SO, including their location, wave length and power.
  4. Labeling of all laser equipment with wave length and power.
  5. Hazard warning signs in areas where lasers are in use and a risk of injury is present.
  6. The immediate report of any incidents or accidents involving these devices.
  7. The ANSI Z136.1-4-6.2.4 standard shall be considered the appropriate standard for the University for protective eyewear.
  8. It shall be the responsibility of the Campus SO to monitor the compliance of the procedures established for the use of these devices.
Environmental Protection

SUBJECT: L. ENVIRONMENTAL PROTECTION

EFFECTIVE: 3/15/86
Each location, campus or health care facility shall establish a program to provide for the protection of the environment of the location and its surrounding areas so as to prevent impairment to the atmosphere, aquifer and surface.

It shall be the responsibility of each location, campus or health care facility to establish a program utilizing available resources in the compliance with good practice in industrial hygiene, sanitation and food services and preparation. The Campus SO shall act as the location's consultant and as a resource in matters relating to compliance with applicable codes, regulations, and laws relating to environmental safety and health and hygiene matters, performing such inspections as may be necessary or required in cooperation with local and state agencies.

It shall also be the responsibility of the Campus SO to determine for his/her location, campus or health care facility any need to acquire necessary license, permit or similar authorization (other than radioactive materials license) relating to environmental safety and health and hygiene matters. The Campus SO must work with others as may be appropriate in the securing and maintaining of such licenses, permits or similar authorization.

Machine Operation Safety/Protective Equipment

SUBJECT: M. MACHINE OPERATION SAFETY/PROTECTIVE EQUIPMENT

EFFECTIVE: 3/15/86

REVISED 6/1/89
It shall be the responsibility of each campus to provide for safe usage of well-built and well-maintained machines. These machines shall be maintained in a proper manner by providing guarding to protect the user from hazards created by point-of-operation, nip points, rotation parts, flying chips and sparks. Also, specified procedures shall be provided for use on these machines and training provided by the University before any person shall be allowed to operate any machinery. All applicable regulations shall be followed to ensure the safety of the user.

The safe use of machinery and equipment shall include the maintenance of all safety devices provided with the purchase of the machine or provided subsequently. It shall further be the policy of the University to enforce the proper use of all necessary and required personal protective equipment by the user of this machinery.

Visitor/Patient Safety

SUBJECT: N. VISITOR/PATIENT SAFETY

EFFECTIVE: 3/15/86

REVISED 6/1/89
Each campus, location or health care facility shall establish a program for the assurance of the safety of those persons in addition to the University's employees who may be a visitor, patient or student who utilize the facilities or services offered by the University. Such a program should include:

  1. Identification and evaluation of potential hazards arising out of the particular use of University facilities or property, both real and personal.
  2. Determination of what is the safe and appropriate use of University property.
  3. Compliance with municipal and/or state fire and safety codes for public property.
  4. Conformity to those standards established by various accreditating agencies.
  5. A system for the correction or elimination of identified hazards or exposures for potential injury or loss to the University.
  6. Accidents or incidents involving visitors, patients or students must be promptly reported to the Office of Risk Management.
  7. Each campus, location or health care facility should establish within that entity an interdisciplinary committee for the purposes of reviewing potential hazards, incidents and accidents that occur at that location for the purpose of advising the campus administration and the SO on policies and practices relating to the prevention and control of such occurrences.


*Reference Subject D. ACCIDENT AND INCIDENT REPORTING

First Aid and Medical Treatment

SUBJECT: O. FIRST AID AND MEDICAL TREATMENT

EFFECTIVE: 3/15/86
Each campus, location and health care facility will develop and communicate to the campus community a plan for the first aid or emergency medical treatment of those persons who may become ill or injured on the premises of the University. Such a plan shall include the care needed for the employees, students and visitors of the University, except for hospital or clinic patients.

Hazardous Material Safety

SUBJECT: P. HAZARDOUS MATERIAL SAFETY

EFFECTIVE: 3/15/86

REVISED 7/1/90
Each campus, location or health care facility will establish a program for the safe handling of those materials which may be hazardous in their use or disposal, including biological and pathological materials.

The hazardous material program of the campus or unit shall comply with all existing state, federal and local codes, ordinances and laws relating to the transportation, use, storage and disposal of whatever may be determined by those regulations to be "hazardous."* The program shall be communicated and available to all departments and persons who may be in contact with these materials and/or subject to the regulations governing these materials.

It shall be the Campus SO's responsibility to evaluate, coordinate and administer this program.

The program will include:

  1. Identification and evaluation of hazardous materials.
  2. Safety procedures for the handling of hazardous materials.
  3. Inventory of chemicals and material safety data sheets.
  4. Proper labeling and storage of hazardous materials.
  5. Proper and lawful means of the transportation and disposal of hazardous materials, including the designation of a responsible person or unit to supervise the storage and the disposal of the hazardous materials.
  6. The communication of the program to those persons who may be affected by these and the training of those persons.
  7. There shall be an annual evaluation of the compliance and currency of the program.

In the event of any cited violation by federal, state, or local regulatory agencies, immediate notification and proposed remedy of same shall be made to the Campus SO and the UWA Safety Office.

*See Subject: L. Environmental Protection, P. 19, regarding
licenses, permits and authorization.

Motor Vehicle Safety

SUBJECT: Q. MOTOR VEHICLE SAFETY

EFFECTIVE: 3/15/86

REVISED 5/1/93
Motor vehicle policy and procedures are stated in The University of Tennessee Transportation Services Policies and Procedures on the use of University-owned Motor Vehicles - July 1989, or the most current revision of this policy. This policy must be made available to all drivers of University-owned vehicles. A copy should be maintained in the glove box of the University-owned vehicles and is also available at each motor pool location.

Reference also shall be made to the University of Tennessee Fiscal Policy Statement, Statement 05, Section No. 090, Part No., 01 Paragraph 3. These policies set forth the University rules for the operation of all of its owned motor vehicles, licensed for use on public highways.

The requirements set forth in this policy shall be the responsibility of the SO in cooperation with those person(s) who have other responsibilities relating to the use of University-owned vehicles.

This policy encourages the use of a campus safety committee in the carrying out of campus specific automobile safety program procedures. However, future OSHA rules relating to this subject may require a specific employer-developed safety program, including accident evaluation, driver requirements and training.

The University's program shall consist of the following minimal requirements pending the OSHA and TOSHA adoption of a final rule. It may be necessary to have additional requirements, depending upon the rules as they are adopted.

Each campus shall have a policy specific to its particular mission and use of automobiles. The basic requirements of such policy shall be:

  1. Campus review of all accidents involving vehicles owned by the University or used on behalf of the campus/unit. Such review may not be necessary for accidents involving no more than $200.00 damage to the vehicle, no injury, and no third party involvement.
  2. Review the circumstances of the accident in an attempt to determine whether or not the accident could have been avoided.
  3. Determination of any violation of University policy regarding the authorized use of the vehicle.
  4. Recommendation for future action, if any, including, but not limited to, driver training and restricted use of vehicles owned by the University.
  5. Determination of prompt reporting of accidents involving University-owned and/or operated vehicles to the appropriate University department(s).
  6. Any special training necessary prior to authorized use of University-owned automobiles.
  7. The development of an internal campus flow of information regarding automobile accidents for the use of the SO.

The Office of Risk Management will provide each campus with information about all automobile accidents reported. Such reports will be provided at least quarterly.

Actions of Regulatory Agencies

SUBJECT: R. ACTIONS OF REGULATORY AGENCIES

EFFECTIVE: 4/1/87
The University recognizes the public's concern for a safer and healthier environment. Local, state and federal governments have created laws and established agencies to monitor and to regulate potential safety and health exposures to the public. It is the policy of the University not only to comply with such laws, but also to cooperate with the local, state and federal agencies who regulate and enforce them.

  1. It shall be the responsibility of the SO to serve as the campus' representative during any visit or inspection by local, state, or federal regulatory agencies except in matters involving ionizing radioactive materials.
  2. The designated Campus Radiation SO shall act as the campus' representative on all matters involving ionizing radioactive materials and in accordance with the campus' licensed use of these materials.
  3. The Campus SO and Radiation SO shall report the visit of any local, state or federal regulatory agencies to their campus administration.
  4. The SO and/or the Radiation SO shall immediately report to both the campus administration and the UWA any actual or anticipated criticisms, citations or adverse findings by the local, state and federal regulators following their visit.
  5. It shall be the responsibility of each campus, location or health care facility to undertake the necessary action to remedy and to correct the source of such action or concern of regulating agency.
  6. The UWA shall, in addition to other appropriate administrative persons, be notified immediately of any fine or penalty that has been proposed or levied by the regulatory agencies for alleged violations of law within that agency's jurisdiction.

Cross References:

  1. Subject III - Campus General Health and Safety Policy, P. 3.
  2. Subject A - Responsibilities of Campus Safety and Health Officers, P. 4-7.
  3. Subject J - Radiation Safety, P. 17.
  4. Subject P - Hazardous Material Safety, P. 23.
Deterrent Reward Program

SUBJECT: S. DETERRENT REWARD PROGRAM

EFFECTIVE: 5/1/88

REVISED 7/1/91
The University will make every reasonable effort to prevent or control those activities which may present risks of bodily injury and property damage. Various unlawful acts by individuals as described here are subject to this policy.

Each of these acts can, and do, expose the University, its employees, students and the public to unnecessary risks of bodily injury of property damage.
These offenses are:

  1. Falsely reporting the presence of an unlawful explosive or incendiary device with the intent to mislead, deceive or disrupt the operation of the University or a scheduled event sponsored by the University.
  2. Any act of arson, falsely reporting a fire or other emergency, falsely setting off a fire alarm system, tampering with or removing from their proper locations fire extinguishers, hoses or any other emergency equipment except when done with real need for such equipment.

*Such acts are in violation of existing Tennessee law.

  1. Up to five hundred dollars ($500.00) will be offered for information leading to the identification, apprehension and successful prosecution of violators through the University disciplinary system or the courts, as deemed appropriate by the University's administration.
  2. Such a reward shall be paid subject to the approval of the Vice President for Business and Finance and based on the recommendation of the Chancellor or Chief Administrator of the location where the offense occurred. Please submit all requests for reward to the Director of Risk Management.

Each campus or unit may elect to establish an advisory committee who responsibility shall be to recommend the implementation of this policy.

Maintenance of Employee Health Records Required by Law

SUBJECT: T. MAINTENANCE OF EMPLOYEE HEALTH RECORDS REQUIRED BY LAW

EFFECTIVE: 4/1/92
There exists certain required records mandated by state, federal and University rules that must be retained for various periods of time by the University. These records must be readily available and secure. Since these records can contain both sensitive and personal information, including, but not limited to, accident information and personal medical and health information, it is essential that these records be maintained and handled in a highly confidential manner and available only to authorized University personnel and governmental agencies.

Campus Responsibility

Each campus will establish a procedure (plan) to ensure the appropriate method of maintaining these records. Since these records involve information that may be developed by the Campus SO, risk management liaison, and possibly campus personnel and security functions, involvement and input into the development of the campus specific policy should come from those areas. The campus plan should include the person/department specifically responsible for the maintenance of these records. Development and implementation of the campus policy on this subject must have the approval of the appropriate chancellor or vice president.

University-Wide Risk Management/Safety Responsibility

  1. Shall determine the adequacy of proposed or amended campus plan prior to implementation.
  2. Shall provide, when applicable, those records that are needed and not available at the campus level.
  3. University-Wide Risk Management/Safety will attempt to identify those records that require campus maintenance.
  4. Will audit annually each campus' compliance with its established plan for records maintenance.

Records to be Maintained

The records to be stored and retrievable are:

  1. "OSHA (TOSHA) 200" and applicable investigative information. Period of storage: 5 years from date of year in which accident occurred.
  2. Employee exposure to toxic and other hazardous chemicals. Period of storage: 30 years from last day of employment.
  3. Employee exposure to bloodborne pathogens. Period of storage: 30 years from last day of employment.

What Documents Must be Maintained

  1. "OSHA 200 Log" for year involved, plus records of accident reports and investigation. No hospital or physicians records are to be attached or included.
  2. Maintenance of records of toxic and hazardous chemical exposures to employees. Records are to be kept only of those persons having been treated for symptoms arising out of a known exposure that has been documented. Included is medical information and any investigative or accident reports made at that time.
  3. Maintenance of records of exposures to bloodborne pathogens. Records are to be kept only of those persons having been treated for symptoms arising from the known exposure or where a questionable exposure has occurred. Included is medical information and any investigative or accident report made at that time.
  4. Under (2) and (3), exposures involving non-employees shall be maintained for a period of 5 years from date of occurrences.
  5. All records must be marked confidential.
  6. This policy shall operate as an exception to the recordkeeping requirements found in the University of Tennessee Fiscal Policies.

Any questions or potential exception to this policy must be brought to the attention of the UWA. All records are to be maintained in a secure and confidential manner.

Employee Safety and Health Concerns

SUBJECT: U. EMPLOYEE SAFETY AND HEALTH CONCERNS

EFFECTIVE: 4/1/93
The University recognizes the need to provide assurances to its employees and students that their concerns about the environment and work conditions at the University are safe and meet all required safety standards. Employees are to be provided with an appropriate method and/or a means to express any such concerns and these concerns must be reviewed by the University for appropriate action.

  1. Each location, campus and health care facility shall develop a policy and procedure that will assure the following:
      1. An active method to solicit employee concerns, complaints and/or method of reporting of unsafe conditions.
      2. There is a specific procedure in writing for the handling of employee concerns, complaints and/or reporting of unsafe conditions by the appropriate campus party.
      3. There exists a method by the appropriate campus party to act upon and respond in a timely manner to any such employee concerns and complaints of unsafe conditions.
      4. That the campus SO or the designated person(s) shall maintain a record (log) of all such complaints or concerns made by employees or students. Concerns relating to personal security and potential criminal acts are to be addressed outside of this policy.
  2. Persons who may make known their concerns or complaints about their safety and health shall: 
      1. Not be subject to any retaliatory or disciplinary action by the University.
      2. Be encouraged to promptly report all such concerns and complaints to the appropriate campus person(s).
      3. Be able to make their concerns or complaints known anonymously in accordance with the existing campus policy and procedure.
      4. Be informed of their right to report to Tennessee Occupational Safety and Health Agency (TOSHA), in addition to their reporting their concerns or complaints to the appropriate campus person(s).
      5. The SO should analyze the employee concerns based on nature, location, department and severity annually, making any recommendations for action to the campus administration based on this analysis.
  3. Specific instruction and information about this policy and the campus procedures shall be included in all employee orientation and subsequent safety related training.
  4. Compliance with the aforementioned policy and procedures shall be monitored by the SO at each location, campus or health care facility.

Reference: TCA Section 50-3-101-50-3-918 (TOSHA) University of Tennessee Policies on Safety & Health, Subject A, P. 4-7, and Subject D, P. 10.

Annual Safety and Health Audit

SUBJECT: V. ANNUAL SAFETY AND HEALTH AUDIT

EFFECTIVE: 5/1/93
The University of Tennessee has assigned the responsibility for an annual safety and health evaluation, review and audit of each campus, location and health care facility to the University Wide Safety and Health Administration. The UWA has the responsibility to develop and maintain the standards and criteria used for such an audit in order to determine overall compliance and quality of performance. This audit is an audit of campus compliance and is not to be construed as an evaluation of any individual's performance.

  1. The UWA will prepare an agenda and necessary pre-audit standards and communicate them in a timely manner to the safety officers of each campus, location or health care facility.
  2. It is the responsibility of the SO to thoroughly, and in a timely manner, respond to requests for information, analysis, and documentation of safety and health conditions prior to the Annual Safety and Health Audit. The Annual Safety and Health Audit shall consist of:
      1. A review by UWA of the SO's analysis of existing campus safety compliance provided to the UWA.
      2. Determination of the status of any outstanding findings and/or recommendations made during the previous audit.
      3. The UWA will review the current status of all safety and audit criteria with the SO.
      4. A joint visit by the UWA and SO of various campus locations and facilities will be conducted in order to evaluate specific compliance and make recommendations for the abatement of safety hazards where needed.
      5. Following the completion of the Annual Safety and Health Audit, the UWA will issue a written audit report addressing any findings and needed abatements.
      6. The SO should review the written audit report and may respond, or seek clarification, to any findings prior to the date set for abatement.
      7. The SO will have the responsibility to report to the UWA within the time provided in the audit report to on the correction and/or abatements as listed in the Annual Safety and Health Audit.
Campus Safety Committee

SUBJECT: W. CAMPUS SAFETY COMMITTEE

EFFECTIVE: 6/1/94
Pending OSHA standards and existing State of Tennessee law requires the establishment of a Safety Committee at each primary location of an employer.1 It shall be the policy of the University of Tennessee that such a committee be established.

The committee shall consist of:

  1. Representation from the faculty, exempt and non-exempt staff and student body. The exact ratio membership and number, and term of those persons appointed shall be determined by the Chancellor or his/her designatee.
  2. Appointment to the safety committee shall be made by the Chancellor or Chief Executive Officer of the campus involved.
  3. The chair of the safety committee shall be appointed by the Chancellor or Chief Executive Officer.
  4. The committee shall meet at least semi-annually. The unapproved minutes of its meetings shall be reported as soon as possible to the Chancellor or Chief Executive Officer of the location; with copies to UWA Safety Officer.


COMMITTEE CHARGE

The committee shall review and advise the administration, including the Chancellor or Chief Executive Officer, on matters relating to the safety and health of employees, faculty, students and visitors to the university. Specific duties of the safety committee shall include:

  1. To review and advise the SO and the administration on proposed or amended campus safety and health policies and procedures.
  2. Review reports of the SO relating to potential physical hazards and practices that might be a source of future accidents, injuries or illnesses, and make recommendations for further actions to be taken. The safety committee is to be advised of those efforts already taken place to reduce or control future accidents from occurring.
  3. To review and recommend to the administration the goals and objectives for future actions by the campus SO in the conduct of the safety and health program of the campus.
  4. To serve and assist the campus safety function in the:
      1. Dissemination of information, policies and procedures about safety and health, throughout the university community,
      2. Analyzing the courses, trends and occurrences of various types of accidents involving people and property and make recommendations for any needed action,
      3. Assist or make recommendations for the coordination of all available campus resources for safety and health including, but not limited to, the special talents, knowledge and assets available to accomplish the safety and health function at the campus and,
      4. Review the results of the Annual Safety and Health Audit and provide support and assistance where and when needed to achieve needed abatements or corrections.

OTHER RESPONSIBILITIES OF THE SAFETY COMMITTEE

  1. To serve as an additional conduit of information to and from the administration, the staff and faculty on matters involving safety and health,
  2. To represent the needs of all members of the university community on matters involving their safety and health.

EXCEPTION TO THIS POLICY

Does not apply to:

  1. The existing Radiation Safety Committees required under the comprehensive nuclear licenses,
  2. The already established Hospital Safety Committees, or
  3. Any existing student safety (Security) Committee.


1 Tennessee Workers Compensation Reform Act of 1992, and proposed and pending OSHA Workplace Safety Act.

Reference: Subject N. Visitor/Patient Safety, Page 21.
Subject Q. Motor Vehicle Safety, Page 24.

May 26, 2022