Pueblo, Colorado

June, 1990


Pike & San Isabel/Cimarron & Comanche Supplement No. 1

POSTING NOTICE. Replace superseded pages and place in the front of FSH 6709.11 - Health and Safety Code Handbook.

Page Code Superseced New

1-15 14 15

Digest: Minor changes to the established PSI/CC Accident Prevention Action Plan to supplement the Forest Service Health and Safety Code Handbook. Adds operating procedures for Agency Provided Medical Care.


Forest Supervisor

Accident Prevention Action Plan

Pike & San Isabel/Cimarron & Comanche

Key Words: Safety Attitude Awareness

Safety Responsibilities

Accident Prevention Program

Safety Training

Incentive and Award Program


The primary purpose is to provide an accident free work environment for each of us when we are in the office, in the field or when traveling. This action plan provides each employee of the Forests and Grasslands with information to help eliminate accidents and injuries.

A second purpose is to identify a course of action to be undertaken to develop an accident prevention program (see Section III) to help us achieve an improved safety record.

A third purpose is to emphasize that HEALTH AND SAFETY OF EVERYONE IS THE HIGHEST PRIORITY IN ALL OUR WORK situations, whether it is regular work tasks or an emergency.


Forests and Grasslands Safety Committee Responsibilities:

The Safety Committee is made up of the Management Team (Forest Supervisor, District Rangers and Supervisor's Office Primary Staff) and the Forests and Grasslands Safety Officer (the Forest Safety Officer). The purpose of the Committee is to conduct an on-going review of the safety program and safety record and recommend actions for improvement. The Committee is expected to key on accident trends and supplement, not replace, safety responsibilities outlined in the Regional Accident Prevention Plan.

Individual Health and Safety Responsibilities:


Action Official Due Date

Send out all memo, policies,

and plans that relate to safety; Forest Safety Uear Long

to each District and Staff Group Officer

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Action Official Due Date

Inform all employees of the policies

and direction of emphasis areas District Rangers Year Long

through orientation, safety meetings, Work Supervisors

tailgate sessions. SO Staff

Continue with facilities safety and District Rangers Annually

health inspection programs (FSH Facility Inspectors

7309.11, Chapter 40); identify need Forest Engineer

for training new facilities


Conduct workplace and project safety District Rangers Year Long

inspections on a periodic basis in Forest Safety

accordance with FSH 6709.12, Chapter Officer

10 requirements. SO Primary Staff

Review all existing Job Hazard Analysis District Rangers Year Long

forms to determine if they are adequate. Forest Safety

Share a good Job Hazard Analysis with Officer

all Units. SO Primary Staff

Obtain demonstrations of proper lifting Work Supervisors Year Long

and materials handling procedures

defined in the Health and Safety Code


Horseback riding and use of pack stock District Rangers Prior to

training sessions. Districts are Field

required to provide this training as Season


Obtain training to certify people in Work Supervisors Prior to

proper use of snowmobiles, ORV's and Forest Safety Operating

ATV's. Officer ORV's and


0rientation for all seasonal and new District Rangers At Time

employees with 1st or one of the 1st SO Primary Staff of Hire

messages - Safety.

Conduct driving record check of all District Rangers At Time

seasonal and all new employees. SO Primary Staff of Hire

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Action Official Due Date

Provide Defensive Driving Training District Rangers Annuallyg

(see FSH 6709.12, Chapter 10, Fleet Managers

Mandatory Training) for all Forest

Service drivers and a refresher

course every three years.

**Conduct vehicle road test with all new District Rangers Year Long

employees whose job requires them to Fleet Managers

operate government vehicles.

Ensure people eligible for fires have District FMO Year Long

required safety equipment and are Fire Crew Boss

mentally/physically able to perform

under strenuous conditions.

Provide education in importance of District Rangers Year Long

reporting all vehicle dings, dents Work Supervisors

and accidents. Fleet Managers

Develop resource library of books, video Forest Safety FY90/91

tapes and other materials. Develop Officer

resource list of specialists in health District Safety

and safety from the local community, SO Officers

or RO that can present program to


Accident Reporting Responsibilities:(Send all required information under)

(6700 cover ltr. Atten: Safety Officer)

**All employees - The first step after an accident shall be the immediate care and comfort of any injured person to prevent any additional injury or property damage from occurring. The Unit manager shall notify the Forest Safety Officer or the Forest Personnel Officer within 48 hours of an Occupational Injury/Illness or MVA (Chargeable or non-chargeable). Use of DG is encouraged for this purpose.

For all occupational injuries and/or illness (CA-1 or CA-2 Form) the required documentation shalla be completed and submitted to the Forest Safety Officer within 5 days from the date of the accident. The report shall describe the action(s) taken to prevent recurrence of accident or injury.

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** For all motor vehicle accidents, the required documentaion, (SF-91A, AD-112, AD-872, Written Estimate of Damages (2)), shall be completed and submitted to the Forest Safety Officer within 5 days from the date of the accident. The District Ranger shall recommend whether disciplinary action should be taken or employee be held financially liable.

The Unit Manager may request the convening of the Accident Investigation Team (see FSH 6709.12, Chapter 30) when appropriate for any motor vehicle or other chargeable accident.

Accident Investigation Team Responsibilities:

The Forest Accident Investigation Team will consist of the Forest Safety Officer, the S.O. Staff Officer and a representative from the Unit where the accident occurred. When financial loss of property or personal injury of a serious nature occurs with any accident the Accident Investigation team will review the accident and prepare a report for the Forest Supervisor. (Forest Fleet Manager may be included as necessary.)

The primary function of the Accident Investigation Team is to: 1) provide documentation necessary to analyze the incident; 2) establish a basis for corrective action(s); and 3) provide a means for monitoring and evaluating a Unit's success in carrying out the safety and health program.

The Accident Investigation Team, will determine the following when appropriate:

a. No unsafe act - employee not at fault.

b. Error in judgement - employee exercised precautions but accident still happened.

c. Reasonable safety precautions not taken - employee failed to drive defensibly, poor judgement, attention diverted, fatigue or other breach of safety.

d. Willful disregard of safety or violation of regulations

The Accident Investigation Team shall conduct their accident review and investigation following the guidelines in FSH 6709.12 (Safety and Health Program Handbook), with particular attention to the requirements and guidelines contained in Chapter 30 (Accident Investigation and Reporting).

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The Accident Investigation Team shall conduct their accident review and investigation following the guidelines in FSH 6709.12 (Safety and Health Program Handbook), with particular attention to the requirements and guidelines contained in Chapter 30 (Accident Investigation and Reporting).


Near Miss/Hazard Form - Sharing near miss experiences and knowledge of hazardous situations can be beneficial in helping all of us to avoid accidents. Sharing near misses is a voluntary and no-blame program

designed to bring situations such as hazardous work practices, defective equipment, unsafe work habits and high risk management practices (e.g., improperly operating a chain saw) to management's and work supervisor's attention before an accident happens or an injury occurs.

Near Miss/Hazard forms received by the Forest Safety Officer will be shared with all employees.

Any employee can submit a near miss/safety hazard form in one of three ways: by placing it in the District or Supervisor's Office suggestion box; enclosing the near miss/safety hazard form in a "Personal-Attention For Official Use Only" blue envelope addressed to the Forest Safety Officer; or by forwarding the form to the Forest Safety Officer through her/his immediate supervisor.

The "Near Miss/Safety Hazard Form" is attached as Exhibit A at the end of this publication.

Health and Safety Concerns and Solutions:

The health and safety concerns described below have been identified by the Forest Supervisor and a number of District personnel. These concerns represent the most immediate health and safety problems requiring correction and remedial action by supervisory personnel. This section identifies who is responsible to implement corrective actions necessary to remedy these health and safety concerns.

(1) Concern - Job Hazard Analysis is not being implemented to its fullest in: a) identifying potentially hazardous work situations; b) describing necessary accident prevention measures; and, c) emphasizing importance of safety to work crews.

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Solution - The person responsible for preparing the project work plan shall complete a Job Hazard Analysis (form FS-6700-7) for each new project or change in working conditions, which will identify hazards and personal protective equipment necessary to combat those hazards. The analysis will also identify safety goals for the work crew. A line officer shall approve the job hazard analysis.

Work Supervisors will discuss and explain the Job Hazard Analysis and appropriate information from the Health and Safety Code Handbook to their crews at tailgate safety sessions. Tailgate safety sessions will be held weekly, at the start of each new project, whenever a serious hazard is discovered, when a "near-miss" is reported, or when

poor safety attitudes are observed. Tailgate safety sessions will reinforce management concern for employee health and safety and shall be documented (see Form PSI-6700-1).

(2) Concern - Health and safety rules must be enforced in order to ensure that safe work practices occur and that work crew members wear proper clothing and equipment.

Solution - Work Supervisors are accountable to District Staff Officers or Supervisor's Office Staff Officers for assuring assigned elements of the Unit's Accident Prevention Action Plan are being implemented and that proper personal equipment is being worn when required (e.g., for foot travel, lace boots with a minimum of 8 inch tops and skid resistant soles are required (FSH 6709.11, Pages 36, 61)).

Employment in hazardous situations will depend upon the possession of required personal safety equipment. Requirements will be documented in the Job Hazard Analysis prior to employment or reassignment.

(3) Concern Occupational Injury/Illness and Motor Vehicle Accident (MVA) reports are not always submitted in atimely manner. Some Occupational Injury and MVA reports are incomplete when submitted and have not been adequately reviewed.

Solution - All Occupational Injury/Illness and Motor Vehicle Accident reports will be compelted and will be reviewed by the District Ranger (or Acting) or Primary Staff Officer (or Acting) and forwarded to the Forest Supervisor within 5 days of the incident. REquired documentation for all MVA's and PI shall be completed and submitted to the Supervisors Office as outlined on pages 3 & 4 under accident reporting responsibilities.

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(4) Concern - Safety meetings or facility reviews have not been scheduled on the Forest (by Forest Supervisor's Staff).

Solution - The Forest Safety Officer will be responsible for scheduling at least 3 Field Health and Safety Reviews during Fiscal Year 1990.

The Forest Engineer will be responsible for scheduling at least 3 Facility Reviews annually.

(5) Concern - Employees are not familiar with the Agency Provide Medical Care procedures.

Solution - Establish manual supplement outlining procedures and include in both permanent and seasonal orientation program. Provide training to District ans S.O. personnel.

(6) Concern - Inconsistent compliance with District safety programs and failure to use safety equipment by volunteers, Campground Hosts, contractors, cooperators and permittees.

Solution - Should any worker refuse to comply with District Staff or Forest Supervisors Office Staff requests to use safety equipment or to follow proper safety directions, the Work Supervisor is required to stop work by the individual(s) involved and return the person(s) to the District or Supervisor's Office. The person(s) involved are not to be permitted to resume work on the job until the safety concern is corrected. The incident(s) should be documented and the information provided to the District Ranger or Forest Supervisor and the Forest Safety officer.

Contractors, cooperators and permittees are covered under Federal OSHA and State safety requirements. If these personnel operate in violation of any safety requirements, notify the appropriate agency for enforcement action (FSM 6715).

(7) Concern - Personal attitudes toward health and safety need improvement.

Solution - Self evaluation is a way to begin improving attitude about health and safety. Conduct frequent self evaluation of your personal attitude by asking yourself the following questions:

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a. How often have I violated a safety practice even for a short duration, such as driving too fast, not wearing gloves or not fastening my seat belt?

b. How often have I observed a violation of a safety practice and not made the other individual aware of it?

c. Is production emphasized before safety in my Unit?

d. Are there different standards for different crew members?

e. Is each person on the crew getting the correct equipment to complete the job safely?

f. Is there enough direction, emphasis and commitment from supervisors?

g. Is safety an everyday part of work or is it just practiced once or twice a month?

h. Does everyone have the right mental attitude and physical ability for the job?

i. Is each person aware of their own physical abilities or limitations well enough to perform their job safely? And those of their fellow workers?


The Supervisor's Office and District Fleet Managers will:

1. Provide orientation and education to all new employees of the importance of reporting all vehicle damage and accidents. Develop attitude of team work in sharing and caring.

2. Daily or once a week, check each vehicle for dings, dents, and cleanliness and track vehicle condition and daily vehicle log use.

3. Provide all Forest Service drivers with defensive driving training (and a refresher course every three years) and orientation for back road driving before authorization to operate vehicle.

4. Periodically provide vehicle safety awareness information to keep safety awareness level high.

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The individual Vehicle Operator will:

1. Monitor vehicle condition for dings, dents and cleanliness and report all new accidents.

2. Develop attitude of SAFETY FIRST!

3. Share information on field conditions, daily road conditions and other safety factors that may change as a result of weather, road construction or repair or any other pertinent situations affecting safety in your area.


Identified Need - Safety in our broad programs of work must receive more emphasis and personal attention. Most accidents are caused by HUMAN ERROR, a poor attitude toward safety, taking inappropriate risks, lack of understanding, failure to pay attention, or making improper assumptions.

Solution - Learn and use Forest Service Health and Safety Manual and Handbook regulations and requirements - Use the Health and Safety Code Handbook(FSH 6709.11); Health and Safety Program Handbook (FSH 6709.12); Safety and Health Program Manual (FSM 6700); Individual Job Hazard Analysis (6700-7); and,

1. Obtain and provide training to specific individuals as necessary for:

-Defensive driving (every 3 years at a minimum) - Required defensive

driving training will be the 8-hour course conducted by the National

Safety Council (or equivalent training).

-Power equipment use (e.g., S-212 for Chain saw operators).

-Basic First-Aid and CPR (First Response).

-Livestock handling.

-Personal protection equipment.

-How to properly conduct and complete a Job Hazard Analysis.

-Proper lifting techniques to avoid slips and falls.

-Environmental hazards and their elimination.

-Accident prevention and investigation.

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-Skiing, avalanches, snow ranger program.

2. Provide specialized licensing.

-Training and licensing required for Off Road Vehicle Use (ATV's, motorcycles, snowmachines, boats, towing trailers) will be made available by District Rangers or Supervisor's Office Primary Staff.

-Annual supervisory review of specialized licensing will be conducted

by District Rangers and Supervisor's Office Primary Staff.

3. Learn use of specialized forms.

-Train supervisors in use and completion of CA-1, CA-2, CA-16, SF-91A and AD-872 forms so that the correct form is completed properly.

4. Improve safety attitude:

-Develop and maintain a Unit health and safety program.

-Provide for supervisory accountability in the health and safety program.

-Seek out and schedule desired training to meet needs of all Unit


-Implement Unit clean up days and health and safety inspections.

-Review and discuss near miss/hazard forms frequently.

-Implement a Unit health and wellness program year-round.

-Add health and safety training needs to individual training plans.

The Forest Safety Officer is available to assist with Unit training or to provide sources of information for your special health and safety needs.


The primary goal of our Health and Safety Program is an accident free work environment on the Forests and Grasslands.

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This goal can be reached when individually and as a TEAM working together, we take the responsibility to develop a positive attitude and act safely in our every day activities.

Positive recognition will be given to Units and individuals who achieve an accident free record. Those who exhibit an exceptional attitude and take an active role towards promoting and implementing their Unit's health and safety program will also be recognized.

A health and safety incentive awards program (FSM 6717.04 and FSH 6709.12, Chapter 10) is a way of giving recognition to Units and individuals for significant achievement in safety and health. It will be the responsibility of each individual Unit to develop an incentive awards program. Funding for these awards will come from the Unit's budget.

A travelling trophy and a plaque (to keep) will be awarded by the Forest Supervisor at the end of each reporting year (June 30) to the Unit on the Forest achieving the best safety record. A $500.00 award will accompany the trophy to be used in a manner that will recognize all individuals on the Unit.

The Forest Supervisor, Forest Safety Officer, Administrative Officer, will decide which Unit receives the annual trophy and cash award. Considerations will include frequency rates of accidents, innovations and other factors. This will reflect the various sizes of Unit personnel staffs and the various levels of job risks.

Frequency rates of accidents indicate the rate of occurrence of accidents and injuries (FSH 6709.12, Chapter 30). To calculate accident frequency rates the method described below will be used.

To Determine:

1. Injury and Occupational Illness Frequency Rate

Number of Chargeable Injury and Occupational Illnesses X 200,000

Number of Hours Worked

2. Motor Vehicle Accident Frequency Rate

Number of Chargeable Motor Vehicle Accidents X 1,000,000

Number of Miles Driven

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The Unit's attitude toward safety as well as their measurable achievement of a better safety record will help determine which Unit of the Forests and Grasslands has won first place each recording year.

The Units are: Supervisor's Office South Platte District

San Carlos District Pikes Peak District

Salida District Comanche National Grassland

Leadville District Cimarron National Grassland

South Park District

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Exhibit A







Thank you for helping to prevent an injury on your Unit or to someone else in the Forest Service!

Send To: USDA, Forest Service

Pike & San Isabel NF and Grasslands

1920 Valley Drive

Pueblo, CO 81008

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1. It is the policy of the Pike and San Isabel NF and Grasslands to provide its employees with timely and efficient medical care for personal injuries which are sustained on the job. In furtherance of this objective, the forest has established Blanket Purchase Agreements (BPA) which provides first aid medical services to our employees for personal injuries. A list of medical providers are shown in Exhibits B and C.

Use of the BPA is authorized only for first aid personal injuries. It is not appropriate for occupational illnesses . When an occupational illness occurs, a CA-2 must be used instead.

2. When an on-the-job personal injury is reported to a work leader, supervisor or manager, he/she will explain the difference between treatment options available (BPA or personal choice physician) and will issue the appropriate forms (CA-1 and FS-6100-16 for BPA and CA-1 and CA-16 for personal choice physician).

3. The FS-6100-16 is suthorization for the medical facility to treat the employee using first aid measures. Part A must be completed by each unit. A sample FS-6100-16 has been included a spart of these instructions (see Exhibit D). Part B must be completed by the medical facility before payment can be authorized. These authorizations shall be numbered with the units first two letters in a numerical sequence as follows:







Change these numbers each fiscal year. At the time an authorization is given to the medical facility, send an information coy to the Budget and Finance Section. The CA-1, completed FA-6100-16 or CA-16 shall be forwarded to the Forest Safety Officer. At the end of the month the medical facility will bill the Budget and Finance Section for all services. If a CA-16 is issued, it will be processed through OWCP for payment. If a unit is not covered by a BPA, and an employee is treated for a first-aid type injury, payment through imprest fund or issuance of an AD-744 is appropriate.

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4. Part B of the FS-6100-16 must be reviewed before the employee is permitted to return to work. If the attending physician's report restricts or limits the duties that can be performed, the unit shall determine if there is a job available that the employee can perform within the restrictions. If not, the employee shall be placed in either continuation of pay, annual or sick leave status. At this point the injury becomes chargeable.

5. If a prescription needs to be filled as a result of the injury, the cost of the prescription shall be charged to project management code and paid from imprest funds. The imprest fund cash payment shall be documented by reference to the name of the employee treated, and date of injury. A copy of the prescription shall be a part of the case file.

6. There are three categories of first aid type injuries. In all cases they are to be reported to the Supervisor's Office. They are as follows:

a. The first group includes cases where the employee obtains no medical treatment at all, or obtains medical care only on the date of injury. In these cases no medical treatment is obtained after the date of injury, no time loss is charged to either lease or continuation of pay (COP). Notice of injury for such cases should continue to be retained in the employees OPF and not reported to OWCP.

b. The second group includes cases where medical expense is incurred but no time loss from work as represented by a charge to leave or COP, is charged. Such cases must be reported to OWCP but are not chargeable.

c. The third group of cases are those now designated as first aid injuries. They include cases which require one or more visits to a medical facility for examination or treatment during working hours beyond the date of injury, as long as no leave or COP is charged to the employee and no medical expense is incurred. First-aid injuries are also defined as examination or treatment during off-duty hours beyond the date of injury, agains as long as no leave or COP is charged and no additional medical expense is incurred. Any injury meeting this definition must be reported to OWCP but are no chargeable.

For example, a case involving treatment at a medical facility on the date of injury during working hours will be considered a first-aid injury and one or more follow-up treatments at the same facility during non-duty hours will be considered a first-aid injury and must be reported, even if no COP or leave is charged. It is not an OWCP chargeable injury under these conditions.

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(CURRENT AS OF 5-1-90)

BPA NO. Facility Unit

12-136-88 Salida Hospital Leadville/Salida

PO Box 429

First & B Street

Salida, CO 81201


12-137-88 Buena Vista Medical Clinic PC Leadville

36 Oak, PO Box 1742 Salida/

Buena Vista, CO 81221 South Park


12-138-88 Leadville Medical Center Leadville/Salida

825 West 6th Ave.

Leadville, CO 80461


12-139-88 St. Josephs Hospital San Carlos

600 W. 3rd

Florence, CO 81226


12-140-88 St. Thomas Moore San Carlos

1019 Sheridan

Canon City, CO 81212


12-141-88 Custer County Medical Clinic San Carlos

5 & Rosita

Westcliffe, CO 81252


12-142-88 Robert Campbell Medical Clinic San Carlos

PO Box 52

Colorado City, CO 81019


12-143-88 Plum Creek Medical Center South Platte

Box 1360

1001 S. Briscoe St., Ste #010

Castle Rock, CO 80104




12-145-88 Crow Hill Family Medical Center South Platte

The Healthcare Center/Conifer

10791 Kitty Dr., Ste A

Conifer, CO 80433


12-146-88 Morton County Hospital Cimarron

PO Box 937/445 Hilltop

Elkhart, KS 67950


12-147-88 Southeast Colorado Hospital Comanche

373 E. 10th Street

Springfield, CO 81073


12-148-88 Springfield Clinic Comanche

9 & Church Street

Springfield, CO 81073


12-149-88 Emergicare Medical Center Pikes Peak

1535 Briargate

Colorado Springs, CO 80918


Emergicare Medical Center

3095 Boychuk

Colorado Springs, CO 80910


Emergicare Medical Center

4083 Austin Bluffs Pkwy

Colorado Springs, CO 80907


12-150-88 Colo Centers for Occupational Medicine Pueblo SO

1825 W. Hwy 50

Pueblo, CO 81008