Chapter 9 - Occupational Safety And Health Program

1-9.1  INTRODUCTION

This chapter is published to define the Occupational Safety and Health (OSH) Program for the Indian Health Service (IHS).  It is not intended to be all-inclusive but is designed to serve as a general outline for carrying out the OSH program.  In all cases, the provisions set-forth in this chapter shall meet or exceed the minimum requirements for OSH programs as set forth in Title 29 Code of Federal Regulations (CFR), Part 1960, entitled "Basic Program Elements for Federal Employee OSH Programs and Related Matters;" Section 19 of the Occupational Safety and Health Act; and Executive Order 12196, dated Feb. 26, 1980.  While not specifically mentioned in the OSH related regulations, executive orders, program guidance, etc., it is in the Agency and in the public interest to afford the same safe conditions to visitors, patients, contractors, and others present in IHS facilities.  Where applicable to OSH program matters, the appropriate section of Part 1960 is referenced.

This chapter prescribes IHS policy with respect to:

1. Conducting safety programs for all IHS operations, installations, and construction activities; applying safety standards to all operations; and training IHS employees in safe practices.

2. Ensure a safe environment for all IHS patients, employees, and visitor  Policy shall also apply to those locations operated under contract where IHS employees have been assigned under Intergovernmental Personnel Act or similar arrangements.

3. Investigating, reporting, and summarizing injuries, occupational diseases, and property damage within IHS for managerial information, program guidance, and to meet Occupational Safety and Health Administration (OSHA) requirements and, where appropriate, Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and Health Care Financing Administration standards.

4. Providing health care for IHS employees related to occupational illness and injury, return to duty policies, light duty programs, and all other administrative responsibilities related to the Federal Employee Compensation Act (FECA).

5. Medical Surveillance programs for IHS employees.

6. Assignment of responsibilities for the foregoing activities.

   The Indian Health Manual, (IHM) Part 1, Chapter 6, entitled "Program Administration," Section l-6.4, contains Incident Report for HSA-123.  Incident Report form HSA-123 is superseded in IHS facilities by IHS Incident Report form IHS-516.  This form will be used to report any incident of injury or occupational illness.  If additional documentation is required, the HSA-123 may be attached to the IHS' Incident Report  Due to the sensitive nature of adverse events in medical care requiring documentation, the facility director should work with an experienced physician or nurse practitioner as well as the safety officer to determine which incidents should be reviewed by the OSH Committee and which incidents should be reviewed by the Pharmacy and Therapeutics, Risk Management, or other named committees charged with quality assurance.  Recording procedures, standards and codes, claims and compensation procedures, useful references, and other information applicable to this chapter are found in the Manual Appendixes and Manual Exhibits.

1-9.2  POLICY

The Director, IHS, reaffirms and supports the policy of the President of the United States to conserve manpower and material to the maximum degree possible through the application of a comprehensive, effective, and continuous OSH program in accordance with Executive Order 12196.

Consistent with the established intent of the President and Congress, every level of management in the IHS is responsible for the prevention of occupational injuries, occupational diseases, and property damage.

The IHS shall also strive to provide a safe and healthful environment for patients, employees, contractors and visitors.

The following are safe practices:

1. Risking of Life.

   No person is expected to risk his/her life in the performance of any job.  In the event that a life threatening condition develops, the OSH officer, supervisor or designee is authorized to immediately terminate the activity until such time that the hazard is abated.

2. Mandatory Use of Seat Belts and Child Restraint Devices.

   All government vehicle operators and all IHS employees riding in Government or private vehicles on Government business must use seat belts.  Government vehicle operators shall require all passengers to be properly restrained.  Passengers under 40 pounds or under 5 years of age shall be restrained in approved child/infant restraint devices.

3. Safe Working Methods.

   Proper work methods and procedures will be required to ensure that personnel will not be exposed to serious injury or health hazards.  All employees shall be provided on-the-job training in the correct and safe method(s) of performing their assignments.  Additionally, it is IHS policy that all government motor vehicle operators are required to possess a current state drivers license.

4. Physical Fitness and Suitable Equipment.

   Employees will be assigned only to those jobs they are physically qualified to perform safely and will be provided with appropriate equipment to safely carry out their job assignments.  It is the employee's responsibility to be fully aware of the physical requirements of the job as per the position description for that job.  If an employee is injured or becomes unable to meet the physical demands of a particular job, the personnel system requirements and procedures (Civil Service or Commissioned Corps) covering the employee are to be followed.  Pre- employment and fitness for duty physical examinations will be provided by the IHS service unit or designated health care providers.

5. Working Conditions.

   When unsafe or unhealthful working conditions exist, appropriate engineering controls, changes in work practices, or appropriate personal protective equipment will be used to minimize occupational injury or illness.  The use of engineering controls shall be first considered for all hazardous operations.  Where engineering controls are not possible, administrative controls or changes in work practices shall be used; e.g., there shall be a permitting and monitoring program for potentially hazardous confined spaces, as defined in 29 CFR 1910.146.  Where hazards remain, personal protective clothing and equipment (PPCE) must be used by all personnel engaged in hazardous operations.  PPCE shall be provided if determined by the supervisor to be necessary and in the best interest of the Government.  Questions on the need for or types of protective equipment shall be referred to the OSH committee.

   1. Indian Health Service Furnished Items

      Protective equipment not normally owned by workers in non-hazardous occupations will be furnished without cost to the individual.  Examples of personnel protective equipment include: respirators, safety eye wear, hearing protection, helmets, and clothing impervious to blood and other body fluids or chemicals (e.g., aprons, special gloves, and steel-toed footwear).

      Video display terminals shall be equipped with anti-glare screens, if needed, and shall be located within work stations designed for optimal ergonomic considerations.

   2. Employee Furnished Items.

      Personal protective apparel or equipment that is readily adaptable to private use will not ordinarily be furnished.  Examples are coveralls, ordinary gloves, and work shoes.

6. Union Representation.

   A representative of employees shall be given an opportunity to accompany safety personnel during the evaluation of any work place.

1-9.3  GOALS

Goals of the IHS OSH Program and supplement 29 CFR Part 1960 are to:

1. Ensure safe and healthful working conditions for federal employees.

2. Establish and maintain an effective and comprehensive OSH program.

3. Promote specific opportunities for employee participation in the operation of the agency safety and health program.

4. Prevent or minimize the number of occupationally related illnesses and injuries among IHS personnel.

5. Decrease the amount of time lost from duty and workers' compensation claims due to occupational illness and injury.

6. Prevent or minimize the number of injuries and illnesses of patients, consultants, employees of private contractors, visitors, other members of the public and personnel detailed or assigned to IHS operations.

7. Prevent or minimize the number of incidents involving property damage.

1-9.4  DEFINITIONS

The following definitions will be used throughout this chapter.

1. Employee.  Any person employed or otherwise permitted or required to work by IHS.  This includes full and part time workers who are salaried or volunteers.

2. Employee Medical File (EMF).  The employee health record, distinct from a general medical record, is described further in Manual Appendix 1-9-F, Page 1 of 16.  It should include some baseline and all surveillance data, including annual tuberculosis skin testing, and required and recommended immunizations or documentation of their refusal.

3. Employee Health (EH) Specialist.  A nurse, physician, or other health care provider with clinical and administrative duties outlined below (see Section l- 9.1OC.3).  This individual will work with the OSH Officer, Office of Workers' Compensation Program case manager and the Servicing Personnel Office (SPO) as a multidisciplinary management team coordinating all occupational health and safety activities.

4. Hazard Surveillance Team.  Persons assigned by the health facility administration to identify hazards or deficits in staff knowledge and practice in health and safety.

5. IHS Facility.  Any facility operated, either owned or leased by the Agency, for the purpose of fulfilling the Agency mission.

6. Imminent Danger.  Any condition or practice in any workplace which is such that a hazard exists which could reasonably be expected to cause death or serious physical harm immediately or before the presence of such danger can be eliminated through normal procedures.

7. Incident.  An incident is any event or chain of events, which results in property damage, injury, or illness to any person(s) or interrupts, interferes or has the potential to interfere with the orderly progress of work or for which a tort claim may be possible.

   Categories of Incidents: Injury/Illness/Fatality.

   1. Injury - A wound or other condition of the body caused by external force, including stress or strain.  The injury is identifiable as to time and place of occurrence and member or function of the body affected, and is caused by a specific event or incident or series of events or incidents within a single day or work shift.

   2. Illness/Disease - Physiological harm or loss of capacity produced by systemic infection; continued or repeated stress or strain; exposure to toxins, poisons, or fumes; or other continued and repeated exposures to conditions of the work environment over a long period of time.

   3. Fatality - Death resulting from an injury or illness/disease.

   4. Lost Time Case - See definition, below.

   5. Catastrophe - An incident resulting in three or more Agency and/or non-Agency people being hospitalized for inpatient care.

      Reportable Incident - All incidents regardless of cause, consequence, damage, or location shall be reported to the immediate supervisor on duty.  An Incident Report Form IHS-516 (Manual Exhibit 1-9-A), shall be completed and routed through normal channels to the local OSH officer.  For a description of the "Log of Federal Occupational Injuries and Illnesses," see definition "R" below.

8. Inspection.  A comprehensive survey of all or part of a workplace in order to detect safety and health hazards.  An inspection may also be conducted as part of an investigation of a complaint regarding a specific hazard or conditions in a specific location within a workplace.

9. Lost Time Case.  A nonfatal employee injury (traumatic) that causes disability for work beyond the day or shift it occurred, or a nonfatal employee illness/disease (occupational) that causes disability at any time.

   No Lost Time Case.  A nonfatal employee injury or illness/disease that does not meet the definition of Lost Time Case.

10. Motor Vehicle.  Any mechanically or electrically powered vehicle designed primarily for either the conveyance of passengers or material.

11. Occupational Disease.  A debilitating condition caused by environmental factors, the exposure to which is peculiar to a particular process, duty, or occupation and to which an employee is not ordinarily subjected or exposed outside of or away from such employment.

    "Occupational disease or illness means a condition produced in the work environment over a period longer than a single workday or shift by such factors as systemic infection; continued or repeated stress or strain, or exposure to hazardous poisons, fumes, noise, particulate, or radiation, or other continued or repeated conditions or factors of the work environment." [20 CFR 1.B (16), pg. 12]

12. Occupational Injury.  Any injury suffered by a person which arises out of and in the course of his/her employment.

    "Injury means a wound or condition of the body induced by accident or trauma, and includes a disease or illness proximately caused by the employment for which benefits are provided under the FECA.  The term "injury" includes damage to or destruction of medical braces, artificial limbs, and other prosthetic devices which shall be replaced or repaired; except eyeglasses and hearing aids shall not be replaced, repaired or otherwise compensated for unless the damage or destruction is incident to personal injury requiring medical service." (20 CFR 1.B (15), pg. 12).

13. The OSH Officer.  An IHS service unit staff member who is authorized in writing and qualified by training and experience to carry out comprehensive duties in safety management and occupational health.

    The IHS recommends a team approach in managing the OSH program.  Therefore, the responsibilities for occupational safety officer and EH specialist should be assigned to different individuals.

14. Office of Workers' Compensation Program-Case Manager (OWCP-CM).  The IHS staff member collaterally designated by the service unit director (SUD) as the on-site personnel office liaison of the local employee or claimant to the Area office SPO.  The OWCP-CM is authorized to consult with the EH specialist and OSH officer for the resolution of day-to-day occupational safety and health issues, especially in regard to environmental concerns identified at the time of an employee's illness or injury.

15. Patient.  A person receiving or about to receive medical care in a medical facility or in transit via Government owned, Government personnel operated, or contract operated vehicle for the purpose of seeking medical care.

16. Property Damage.  Includes damage to IHS-owned, rented, or leased property, damage in any amount by anyone to privately owned property used on official business; or damage to any private property by IHS employee(s) while on official business.

17. Public.  Any member of the community at large.  An employee of the Department of Health and Human Service (HHS) may have the same status as a member of the public in connection with claims against the Government. When property owned by an employee is damaged by the act of another employee or is damaged while the employee's property is on Government property, the Government may be liable.

18. Record of the Incident.  All incidents will be recorded and coded for statistical evaluation purposes on the Incident Report Form (IHS-516).  The OSH officer shall maintain a log of all occupational injuries and illnesses at each facility.  The "Log of Federal Occupational Injuries and Illnesses" shall be used within six days after receiving information, to record all occupational injuries and illnesses. [see Manual Exhibit 1-9-A, page 1 of 1, for an example of the log.] All civilian Federal employees are covered by FECA.  Thus all civilian Federal occupational injury or illness must be recorded on the appropriate CA forms [see Manual Appendix 1-9-A, page 6 of 6] to be eligible for continuation of pay or compensation.  Supervisors are responsible for ensuring that the required compensation forms are properly completed, and forwarded in accordance with appropriate procedure.

19. Safety Review.  An evaluation of a safety management program that involves the assessment of systems that detect, monitor, document, and abate hazards in the workplace.

20. SPO.  Is the servicing personnel office for your official duty station assigned the responsibility to receive and review claims as the OWCP-CM for the employees of that Area or service unit.

21. Visitor Injury.  An injury that, occurs to a member of the general public while in an IHS facility or on IHS property.

22. Workplace.  The physical location where the Agency's work or operations are performed.

1-9.5  OTHER FEDERAL LAWS

1. FECA.  In 1916 FECA was passed to provide compensation benefits to United States (U.S.) civilian employees who suffer injury, occupational disease, or death as a result of their employment.  Commissioned Officers of the U.S. Public Health Service are not covered under FECA.  The IHM Part 1, Chapter 8, entitled "Managing the Workers' Compensation Program," deals with FECA in greater detail.

2. Federal Tort Claims Act (FTCA).  Claims for property damage or personal injury due to negligence, wrongful act, or omission of IHS employees acting within the scope of their employment are covered by FTCA (see: 28 U.S.C 2671-2680.)  The Act does not relieve employees, while acting within the scope of their work, of personal liability for negligence contributing to an incident.  Each supervisor should become familiar with Chapter PHS 4-00 and 4-35 of the General Administration Manual.  Procedures outlined in Chapter PHS 4-30 should be implemented promptly.  In addition, the IHS may be held liable for damage to and loss of private property, for personal injury or death due to negligence of IHS employees, and for loss of personal property due to incidents involving any person authorized to enter upon or occupy IHS property.

1-9.6  ESTABLISHMENT OF PROGRAMS

In order to discharge the foregoing policy and responsibilities, a comprehensive OSH program will be established for all IHS Area offices, district offices, service units, field offices, Public Law (P.L.) 93-638 Contract Health Care facilities, and other installations.  Skills that are necessary to implement a comprehensive OSH program include safety, industrial hygiene, occupational health nursing, and occupational medicine.  Conscientious efforts to improve injury prevention and loss management through periodic evaluations and education are an integral part of the IHS OSH program.  Employees shall receive a safety orientation within 30 days of hire on general safety rules and any special precautions to cover local conditions or unusual circumstances pertaining to their particular type of work or place of employment.  Such training shall include information on the Agency OSH program with emphasis on the employee's rights and responsibilities.  Inpatients shall receive appropriate safety instructions from the nursing staff (e.g. exit location, emergency call buttons, bed rail use, or other safety issues) during the hospital stay as soon after admission as possible.

1-9.7  MINIMUM PROGRAM ELEMENTS

The minimum OSH program for the IHS shall include the following elements:

1. Surveys, as required by 29 CFR 1960.25, of all workplaces.  Reports prescribing recommendations for corrective action, and followup surveys to ensure that appropriate actions were taken.  Refer to Manual Appendix l-9-E for a model "Hazard Surveillance Program."

2. Technical assistance, from any competent source, on OSH problems to establish acceptable procedures, work methods, and personal protective equipment, thus integrating sound OSH principles into operational instructions and processes.  This includes but is not limited to support documents and consultations from the National Institute of Occupational Safety and Health, Federal Occupational Health program, American Hospital Association, and JCAHO.

3. Development, promotion, and distribution of educational materials and activities designed for patients, employees, and the general public.

4. Establishment and maintenance of active OSH committees.

5. Employee safety and health orientation and training.

6. Development and implementation of OSH policies and procedures applicable to local operations.

7. Reporting and analysis of injuries, occupational diseases, and property damage incidents.

8. Plan review of new construction, repairs, or improvements for compliance with applicable safety codes and standards (i.e., The National Fire Protection Association and JCAHO).

1-9.8  REPORTING, INVESTIGATION, AND ANALYSIS

The supervisor, department head, or OSH officer shall investigate, report, and analyze all incidents which are identify, including all incidents having potential for injury, illness, or property damage.  The objective of reporting and analysis is to develop information and procedures essential to the maintenance and improvement of the OSH program throughout the IHS.  This includes the identification of unsafe and unhealthful working conditions.  (See Manual Appendix 1-9-A for Forms, Procedures, and Standard Format.)

1. General Procedures.

   1. The OSH officer shall maintain a written or computerized record of the causes of occupational injuries, occupational diseases, and property damage incidents.

   2. Each IHS facility shall maintain a system to investigate and evaluate incidents involving non-occupationally affected individuals (i.e., patients, visitors, contractors).

   3. The facility OSH committee shall receive information to initiate and support corrective or preventive action.

   4. The OSH officer shall provide statistical information to evaluate the effectiveness of the program.  The OSH officer shall post the "Log of Federal Occupational Injuries and Illnesses" for a minimum of thirty days, no later than 45 days after the close of the fiscal or calendar year, at each work establishment, as required in 29 CFR 1960.67.

   5. The OSH officer shall provide management with information with which to evaluate the effectiveness of the IHS program.

   6. The department head or supervisor shall provide prompt and factual information regarding occupational injuries/diseases and property damage or allegations thereof.

2. Incident Investigation.

   1. All incidents shall be investigated and the cause(s) identified.

   2. In addition to assisting the supervisor as appropriate, the local OSH officer shall review all incident reports.  Narrative reports may be forwarded on to the facility safety committee for further discussion and recommended actions.

   3. When the possibility of an incident resulting in a property damage claim against the government is identified, then a claims investigation shall be conducted in accordance with Section 20A, Part 4, Chapter 4-30, HHS General Administration Manual.  Claims will be addressed through the designated property management official in the servicing Area Office and forwarded to the PHS Claims Officer.

   4. When an incident occurs that results in a claim against the government, it is the responsibility of the facility director to ensure that corrective action has been taken to remedy the situation, and avoid further injury or illness.  A report of the corrective action taken and disposition of the case will be forwarded to the facility director, with a copy to the OSH officer.

3. Safeguarding Injury Information.

   1. Incident reports prepared in accordance with these procedures are for the improvement of the safety program throughout the IHS.  Every effort should be made to ensure their security for future reference against loss or destruction.  All reports and related information shall be retained within the Agency for a period of at least 5 years following the end of the calendar year in which the incident occurred.

   2. Disclosure of this information should be in accordance with the Privacy Act procedures for IHS employees.

1-9.9  SCOPE OF RESPONSIBILITY

OSH responsibility is a joint obligation of every employee in the IHS.

1. Program Responsibility.

   Program managers in the Headquarters, Area offices, district offices, SUDS, and Tribal health directors are responsible for the protection of patients, visitors, employees, and property under their jurisdiction and for ensuring that all phases of this program are adequately implemented within their operations.  Full support is required as the success of the OSH program is directly associated within their operations.  Full program support is required as the success of the OSH program is directly associated with support from all management levels.

   It is imperative that program managers realize that virtually all of the IHS OSH officers, EH specialists, and OWCP-CM assume these responsibilities in a collateral duty capacity and that the time necessary to conduct the activities pursuant to this policy must be made available.  Additionally, it is the Area Director's responsibility to ensure that appropriate training is available to all OSH personnel to enable them to undertake their OSH responsibilities.

2. Staff Involved in OSH Management.

   Each designated OSH officer, EH specialist, and OWCP­CM is responsible within his/her area of jurisdiction and expertise for each of the components listed below.  The committee chairperson provides overall direction of the OSH program.  Areas that are primarily the responsibility of an individual committee member are suggested below and further elaborated on in 1-9.10 C (2), (3), (4), and 1-9.10 D of this chapter.

   1. Committee leadership.  The committee chairperson provides overall direction of the occupational safety and health program.

   2. Reports.  The OSH officer will accumulate and review reports of injuries, occupational diseases, and property damage for presentation and discussion in OSH committee meetings.

   3. Technical contributions.  The OSH officer, EH specialist, and OWCP-cm jointly will provide technical expertise from their respective disciplines in investigating and reporting occupational injuries and illnesses.  The local committee will work through the Area SPO for direct interaction with outside authorities, such as the Department of Labor.

   4. Incident follow-up.  The OSH officer will initiate follow-up corrective action regarding reported incidents, or may delegate parts of this task, when appropriate.

   5. Incident data.  The OWCP-CM will maintain local case files, and process and summarize data on all incidents to meet the requirements of this policy.  Another locally designated individual may be appointed by the SUD (e.g., a representative of the safety, risk management, or quality improvement staff) to assume all or part of these responsibilities.  This designee or the OWCP-CM should always be available to report on these data to the appropriate investigating authorities.

   6. Reports on actions.  The OWCP-CM will provide results of investigations and corrective actions to the Area and/or IHS Claims Officer, when appropriate.

   7. The OSH committee member training.  The EH specialist and OSH officer have joint responsibility to provide or acquire health and safety training for personnel within their jurisdiction.  In addition to development and implementation of relevant and effective personnel training, regular assessment of knowledge and practice of the principles presented in OSH training must be conducted.  All staff in the management of OSH programs shall receive appropriate initial and continuing education necessary to perform their duties.

   8. Committee liaison.  Primarily the OSH officer will serve as a liaison between the occupational safety and health committee and the respective program managers.

   9. Health services.  The EH specialist will provide or coordinate appropriate health care and medical surveillance for Federal employees.  By definition, this is a primary duty of the EH specialist.

   10. FECA claims and case followup.  The EH specialist will outline work task and duty hour/time limitations in the management of each FECA claim.  The EH specialist is responsible for recommending to the OWCP-CM all activity restrictions, light duty designation, and workplace reentry activities on a case-by-case basis.  The EH specialist may arrive at these recommendations for convalescent time periods, either independently or in collaboration with the employee's personal healthcare provider.  The recommendations should be mutually agreed upon by the EH specialist and OWCP-CM.

       Also see Section 1-9.10 c of this chapter for specific duties of local OSH staff.

   11. Supervisors.

       Each Supervisor is responsible for:

       1. Prevention of injuries to patients and employees under his/her supervision and to patients or visitors on the premises, as well as for the protection of property under his/her administrative control.

       2. Ensuring that all incidents meeting the criteria stated in the definition section of this chapter that occur or are discovered in his/her area of responsibility or involve employees in his/her organization are investigated and reported.  The supervisor's responsibilities include reporting all incidents to the OSH Officer through prescribed reporting channels and taking corrective action or advising higher authority of the need for such action when the required action is beyond his/her scope of authority or ability to perform.

          Supervisors will investigate all circumstances related to each claim, will secure written statements from witnesses, if any, and will controvert continuation of pay whenever the circumstances warrant controversion.  (See The IHM, Part 1, Chapter 8, entitled "Workers' Compensation Program.")

       3. Complying with and enforcing all applicable OSH standards, rules, and regulations and the orders issued by competent authority pertaining to the activities immediately under his/her jurisdiction.

       4. Reporting to the property officer, if applicable, incidents where property is damaged (including motor vehicles) in accordance with property board-of-survey procedures in the IHM, Part 5, Chapter 12, entitled "Personal Property Management Manual."

       5. Counseling employees on their FECA rights and responsibilities; preparing all necessary Office of Workers' Compensation Program forms in accordance with the IHM Part 1, Chapter 8, entitled "Workers Compensation Program" before reviewing and forwarding for SPO action on all OWCP claims forms.  In consultation with the EH specialist or other clinicians, arrange for light duty assignments and participate in improved FECA management and monitoring programs.

       6. Notifying employees of the results of monitoring, testing, or safety inspections that were conducted in the work area.

       7. Developing safe work practices based on a job safety analysis.

       8. Instructing employees under his/her supervision in the procedures to be followed, including use and distribution of reports, when reporting incidents.

       9. Providing each new employee with a job-specific or department-specific safety orientation.

3. Employees.

   The OSH is an integral part of every job and requires the effort and support of every person involved.  Each employee is expected to comply with all OSH standards, rules, regulations, and orders issued under the Act that apply to his/her own actions and conduct on the job.  Each employee is responsible for keeping his/her equipment in safe working condition, maintaining good housekeeping in the specific work areas, and remaining alert to injury-producing situations.  All employees are responsible for reporting all potential injury hazards to their supervisor and correcting them promptly, if possible.  Employees (including both part/full-time civilians and members of the commissioned corps) are responsible for reporting to their supervisors all incidents, no matter how slight.

   Employees are also responsible for immediately advising their supervisors of on-the-job injuries; for filing FECA claims and providing medical reports within prescribed deadlines; for returning to regular duties as soon as they are able; for exploring and accepting appropriate light duty assignments; for reporting medical evaluations, when directed, and for reporting for rehabilitative therapy or vocational rehabilitation counseling and training as directed.  Under normal circumstances, an initial FECA claim form must be submitted within 3 workdays following an injury.

1-9.10  MANAGEMENT RESPONSIBILITIES

1. Headquarters - IHS.

   The Institutional Environmental Health Officer, Environmental Health Services Branch, Division of Environmental Health, shall serve as the IHS OSH Manager.  This individual is responsible for administration of the IHS OSH Program.  At periodic intervals, Area operations will be evaluated by the OSH Manager to determine the general effectiveness of the overall occupational safety and health program.  Technical assistance will be available to Area/Program Offices for establishing effective OSH programs.  The IHS OSH Manager will coordinate the reporting activities, consolidate the annual IHS OSH Report, and recommend system changes, when necessary.

   Headquarters staff must carefully review both the annual OWCP billings (final billings from the fiscal year 2 years earlier) and periodic quarterly OWCP billings (furnished quarterly on current year cases currently being paid by OWCP) to ascertain whether each FECA case listed is actually IHS responsibility or whether it should be reassigned to another agency.

2. Area/Program Offices.

   The IHS Area Director (AD) has the authority and responsibility for developing and implementing the Area OSH program and designating an Area OSH officer/manager to discharge this responsibility.  It is required that an individual qualified by previous OSH training or experience be selected.  The OSH officer functions as principal advisor to the AD on safety and occupational health matters and as consultant and technical advisor to the SUD, health directors, administrative officers, and facility OSH officers.

   An employee health specialist shall also be appointed.  This individual's duties will depend on the number of employees and location of the office.  See Section 1-9.10C.3 of this chapter for a list of potential duties.

   An Area OSH Committee shall be appointed to assist the Area OSH officer in reviewing safety inspections and reports, setting Area policy, discussing and evaluating any special problems, and recommending corrective action or program modification. The Area OSH program shall address the following:

   1. Each Area shall make the necessary modifications to Headquarters policy to meet local conditions.

   2. Each Area shall conduct management control reviews of service unit OSH programs.  Area personnel should not conduct detailed inspections of individual institutions, with the exception of highly specialized surveys, e.g., radiation protection or industrial hygiene, for which Area personnel have the necessary expertise.

      Area staff should determine the presence or absence of the necessary programs for hazard recognition, evaluation, and control at each service unit.

   3. Each Area shall provide or arrange for field staff training.  If the local OSH staff are untrained to do one or more of the required tasks (e.g., hazard recognition, data evaluation, and control), the Area must identify this need and take appropriate action, (e.g., provide or arrange for training).

   4. Area OSH personnel must function as a part of an Area team to monitor service unit compliance with OSH program requirements.  This team may be composed of facility management, nursing, laboratory service, pharmacy, quality assurance, biomedical engineering, and top management.  This team should provide a liaison function between service units and the AD.

      The ADS are also responsible for monitoring and controlling all personnel management aspects of the FECA program.  Each AD will:

      1. Publish guidelines defining personnel management responsibilities of managers and supervisors in establishing light duty assignment programs.

      2. Establish procedures to insure cooperation in the exchange of data and injury/illness investigative results on a routine basis between the FECA program management and OSH program management.

      3. Ensure that the SPO seek second medical opinions; request investigations of suspected waste, fraud and abuse; approve separations from HHS rolls of permanently, totally disabled FECA recipients, and monitor recovery status of former Area/service unit employees receiving FECA compensation.

   5. Each AD will establish a system for periodic review of all FECA cases for which the IHS is billed but where the recipient is no longer on HHS rolls.

      1. The AD will arrange for on-site reviews of the case file at the appropriate OWCP district office.

      2. Where it appears that a new medical report might reveal partial recovery sufficient to allow a light duty or alternative work assignment, the AD will authorize the appropriate service unit OWCP-CM to request the OWCP district office to arrange for a fitness-for-duty physical.  If qualified, the EH specialist may perform this assessment.

      3. Any report of partial recovery will be returned to the SPO for renewed action to consult with the SUD on joint efforts to attempt to locate appropriate light-duty or alternative work assignments for which rehiring would be offered to the employee.

3. Service Units, Hospitals, Clinics, Field Health Stations.

   1. Designation of OSH officer, EH specialist and OSH Committee.

      The SUDS are responsible for the local OSH program and shall designate qualified individuals to serve as the OSH officer and EH specialist for the purpose of carrying out the requirements outlined in this chapter.  The SUD will ensure that the OSH team's professional qualifications are maintained through specialty training and other forms of continuing education offered at least annually.

      Program managers shall also designate additional responsible individuals to serve on the local OSH committee.  Membership of the OSH committee shall include the following: clinical services, e.g., a nursing representative; support services, e.g., a facilities management representative; the SUD or administrative officer; the OSH officer; EH specialist; and the OWCP-CM.  If available, representation from the local bargaining unit is required, and representation from the environmental health function is encouraged.  The size of the committee will be determined by the size of the activity, but in no case consist of less than three members.

   2. Responsibilities and Duties of OSH Officers

      OSH officers will function as staff advisors to program managers in safety and health matters.  Their activities include:

      1. Conducting, monitoring, and evaluating safety and health programs; facility safety inspections/surveys; internal and external drills; and informing the SUD/administrative officer and OSH Committee of the results of such programs and activities.

      2. Consulting with or assisting supervisors in preparing and maintaining safety manuals and other OSH publications for local information and accreditation purposes.

      3. Ensuring that reports are submitted promptly and accurately.

      4. Consulting with or assisting supervisors in conducting job safety analyses of operations, consulting in, or developing safe working procedures, and requiring the correction of unsafe conditions.

      5. Coordinating all OSH programs to whatever extent necessary to ensure accomplishment of objectives.

      6. Providing for, or conducting and evaluating, appropriate safety educational efforts.  This may be accomplished by using bulletin boards, contests, awards, news releases, etc.

      7. Maintaining current information, reports, regulations, and safety files.

      8. Conducting studies that may be required to provide accurate and timely information of safety problems for which supervisors require assistance and guidance.

      9. Contributing to the successful operation of the safety committees by maintaining records and followup on committee recommendations where appropriate.

      10. Consulting with supervisors on obtaining and maintaining personal protective equipment.

      11. Monitoring the regular inspection and testing, by department/branch staff, of safety equipment to ensure compliance with existing standards and required inspection and testing frequencies.

      12. Reviewing plans and specifications of construction repairs and improvements for compliance with Life Safety and other applicable standards and codes.

      13. Coordinating and promoting staff OSH orientation and training, in conjunction with clinic personnel.

      14. Consulting with other IHS OSH program personnel, as necessary.

      15. Performing other OSH duties, as necessary.

   3. Responsibilities of EH Specialists:

      1. Providing emergency evaluation and first treatment of injury or illness.

      2. Providing definitive treatment or referral for occupationally-acquired illness or injury (NOTE: All employees who are seeking care for an on-the-job injury should be seen by a clinician, if available, before being referred to a private doctor).

      3. In conjunction with SPO, ensuring that OWCP forms are appropriately filled out, and following up on employees who are referred for treatment of occupational injury or illness.

      4. In conjunction with SPO, recommending light duty , if medically indicated, and coordinating early return to duty.

      5. Ensuring that all occupational health medical records are maintained as described in Manual Appendix l-9-F "Employee Medical File System."

         Any medical record generated as a result of treatment for occupational illness or injury, as well as medical surveillance information, will be maintained in a separate medical record entitled "Employee Health Medical Record" or "Employee Medical File (EMF)."  The information in an employee's medical record is kept in strict confidence, however, a copy of his/her record can be obtained by the employee or by his/her representative designated in writing.

         NOTE:  The OSHA representatives may also examine and/or copy medical records or medical information from the medical record which may bear directly on exposure to toxic materials or harmful physical agents.  Arrange for or conduct annual surveillance examinations for employees, as necessary.

4. Functions of the OSH Committee.

   The OSH committee chairman or OSH officer, shall intervene whenever conditions are identified that pose an immediate threat to life or health or pose a threat of damage to equipment or buildings.

   1. Headquarters.

      The Committee shall comply with the requirements for committee function listed in 29 CFR 1960.37, with the exception that the Committee Chairperson will be appointed by the Director, IHS.

      The membership of the Committee shall, at minimum, consist of the following:

      Director, Division of Facilities Management (DFM), OEHE
      IHS OSH Manager, Division of Environmental Health, OEHE
      Director, Division of Management Policy, OAM Risk Manager, OHP
      Representative, Division of Nursing, OHP
      Representative, Pharmacy Services, OHP
      Representative, Dental Services, OHP
      Director of Medical Imaging, OHP
      Representative, Biomedical Engineering, DFM, OEHE
      Representative, Office of Human Resources
      Representative, Division of Resources Management, OAM
      Representative, Office of Planning, Evaluation, and Legislation
      Representative, Office of Tribal Activities
      Representative, Office of Information Resources Management
      Representative for the Federal employees bargaining unit(s)
      

      Each committee member shall designate an alternate to ensure representation at meetings.

      The Headquarters OSH Committee shall meet at least annually.

      Similar committees shall be established at IHS Headquarters West, Albuquerque, New Mexico, and the Clinical Support Center, Phoenix, Arizona.  Information shall be exchanged between the Headquarters East and other Headquarters committees.

      Committee minutes or other special reports shall be shared with the IHS Director, Associate Directors, Area Directors, and Division Directors.

   2. Area and Service Unit Committees.

      1. The membership of Area committees should be similar to that of Headquarters. Service unit committees should be structured as defined in JCAHO standards, with the exception that membership must include a representative of the local bargaining unit, if present.

      2. Committees shall meet periodically, at least quarterly, or at a prescribed frequency as outlined by a review authority (i.e. JCAHO) to:

         1. Review the results of hazard surveys.

         2. Develop, maintain, and review epidemiological information relative to incident occurrences, internal/external disaster drills, and reports.

         3. Discuss special problems.

         4. Recommend corrective action and followup, as appropriate.

      3. Other responsibilities of the Committees include:

         1. Reviewing procedures for evaluations, recording, reporting, and developing educational programs in the interest of OSH.

         2. Developing or assisting in developing safety policies and procedures.

         3. Requesting inspection, by competent individuals, of special equipment or systems to ensure that proper safety protection is provided, maintained, and used.

         4. Soliciting and reviewing employee suggestions for improving OSH.

         5. Requesting assistance of qualified persons concerning special problems, such as radiological safety, fire protection, hazardous materials, ventilation, elevator, boiler, and emergency power concerns.

         6. Reviewing OWCP claims to ensure appropriateness of case handling, followup, and return to duty.

5. Servicing Personnel Offices.

   1. Each SPO will be responsible for monitoring and controlling all personnel administrative aspects of FECA provisions as they relate to employees of the service unit including:

      1. Establishing an FECA case monitoring file for each case forwarded to the SPO by a supervisor, health unit medical officer, safety officer, or other OSH program officials.

      2. Informing supervisors that an initial FECA claim submitted by an employee or prepared by the supervisor must be forwarded to the SPO within 5 workdays following the injury.

      3. Review the claim for completeness and accuracy before forwarding it to the Area office and the OWCP district office.

   2. The SPO will assist supervisors in the controversion of apparently non-meritorious claims.

   3. The SPO will assist in the development of a light duty assignment program and coordinate finding light duty assignments.

   4. The SPO will counsel supervisors to advise all employees receiving FECA benefits that physician's reports certifying continued disability are required:

      1. Once every 2 weeks after the initial 45 day period of an FECA claim.

      2. Less than once every 2 weeks only when authorized by the OWCP district office.

   5. The SPO will monitor each currently active FECA case and consult with the supervisor biweekly regarding:

      1. Light duty or alternative work assignments in the supervisor's area of responsibility.

      2. Grounds for seeking second medical opinion.

      3. Grounds for seeking an investigation of possible fraudulent claims.

      4. To insure that claims forms protecting the employee's entitlement are being completed and forwarded to the SPO in a timely manner.

   6. The SPOs are responsible for counselling a permanently injured employee whom OWCP has determined to be unable to perform the critical elements of the regular position and who is eligible for either an annuity under civil service retirement or long term compensation from OWCP.

   1-9.11  INCIDENT ACCOUNTABILITY

   1. Incidents involving employees while on detail to other organizations are reported by and charged to the activity to which the employee is detailed.

   2. Commissioned Corps and civilian personnel on temporary tour of duty to other Federal agencies will report all occupational injuries and illnesses to their parent organization and will be included in OSH surveillance system of that organization.

   3. Incidents involving employees while visiting another activity for official purposes (on official travel) are to be reported and charged to the activity carrying the injured employee on its payroll.  Property damage will be reported through the activity that owns, leases, or otherwise manages the property.

   4. Employees injured while in a permanent change of station status will be reported by the gaining activity and charged to its injury surveillance.

   1-9.12  SUPERVISOR'S RESPONSIBILITY ON CLAIMS FOR COMPENSATION

   1. The OSH Program, supervisors, and safety officers should be aware of the information regarding Claims for Damage or Injury, and Penalties for Supervisors Added to the Compensation Act, which can be found in Manual Appendix l-9-C.

      Each supervisor must see that prompt treatment is given to employees and that required compensation forms for civilian employees (see the IHM, Part 1, Chapter 8) are properly completed and forwarded in accordance with established procedures.

   2. Allegations of Reprisal.

      It is the policy of the IHS that no employee will be subject to restraint, interference, coercion, discrimination, or reprisal for filing a report of unsafe or unhealthy working conditions or because of other participation in OSH activities.