Inspection Page 1 of 1 I·_If • GoB.ck ( ~Prinl Violation Summary ... Inspection Number: 1053446 All Items Final Order: No Opening Conference Date: 04/13/2015 Establishment Name: Callaghan & Callaghan Inc, Final Order Date: Candidate For Follow Up: No Total Penalty Amount: $0.00 RECE\VEO AUG 25 2015 U.S'. DEPT. OF U\BOR SOL CLEVELAND https:llois.osha.gov/portaliserver.pt/gateway/PTARGS_O_ o_223 _201 _0_ 43/servlet/execut... 8123/2015 Callaghan Callaghan / Cal-Clean Table '317840247 , Health l com plaint Open/cro~e. Dates : :Callaghan & Callaghan, Inc. 0453730 ,Charlotte, North Carolina . -, 9/17/2014 - Coding: # Via's lssued: 12 Acclderit Info ClndOpen - Case File Indicates Paid and Abated - Reason Open Unknown Other Info: Initial Penalty Current Settlement Issue Date Penaltv Tvpe Final Order Date 19100147 C04 I 10/17/2014 $4,000 .00 $2,000.00 I: Informal Se 12/11/2014 19100151 C 10/17/2014 $4,000.00 $2,000.00 I: Informal Se 12/11/2014 Standard 01001 Serious 01002 - Serious 317022101 Safety Complaint Open/Clos e Dates: Cal-Clean, Inc. 5/7/2013 - 0423710 6/6/2013 Codillg : Accident Info Jn0 In Compliance Other Info: Stcll1dard # Via's Issued: 0 Initial Penaltv Issue D"lte $0.00 315819946 Safety ' Complaint Date~ : Open/Close Cal-Clean, Inc. 2/18/2012 - --------- Current Settlement Penalty Tyoe Philadelphia, Pennsylvania 11/26/2012 Codi ng: Issue Date Final Order Date $0.00 0317000 Accident Info and Other Info: St;:;fNCOS '9S ... 133(b) and '95",141. 7. The parties agree to bear their own attorneys' fees, costs and other expenses incuned to date in this matter. 8. This Agreement shall be prominently posted at or near such plaoe(s) any violation(s) referred to in the original citation occurred and in close proximity to tbat;original citation. -- This the For the OSH Division: North ~Iina Departmont of~or For the Employer: Callaghan & Callaghan, Inc. --r~~~ Paul M. Sullivan, em District Supervisor Slgnature ~±eVetA.. Printed Name/Title '. --. .; ( North Carolina Department of Labor Inspection Number: 317840247 In~pection Date(s): 9117/2014 - 9118/2014 Issuance Date: 1011 7120 14 Occupational Safety and Health Division Ci.tation and Notification of Penalty Compan,y Name: Call~ghan & Callaghan, Inc. lnspe.e tion Site: 2023 Hasty Street, Monroe, N C 28110 Citation.o1 Item .0.01 Type ofViolation: Serious 29 CFR 1910.147( c)(4)(i): Procedures were not developed, documented and utilized for the control of potentially ~ar.dQus energy when employees were engaged in the activities covered by this section: a) facility, where machine specific energy control procedures were 'not documented or utilized during disassembling and cleaning for equipment with multiple sources of energy, such as the Accufeed, OSSID, and Cone-line mathine. Date By Which Violation Must Be f'\.bated: Proposed Penalty: Citation and Notification of Penalty Page 10 of 12 Immediately U pOD Receipt $4,.000.00 OSHA-2 (Rev 1I14) ''/-11- 0 3 ~: ~~ ..J'J'LV/h~ f;JtPb'1J~ BEFORE THE SAFETY AND HEALTH REVIEW U'\illt~ APR - 7 200J OF NORTH CAROLINA RALEIGH, NORTH CAROLINA COMMISSIONER OF LABOR OF THE STATE OF NORTH CAROLINA CO~LAINANT, v. ) ) ) ) ) ) DOCKET NO.: OSHANC 2002-4101 INSPECTION NUMBER: 304971310 CS~O ID: W1933_1. ~.: ) &J ::2. .· .' ~ L-~ @ m fl' ) CALLAGHAN & CALLAGHAN INC. dba CAL-CLEAN and its successors PO BOX 38935 Greensboro, NC 27438-8935 . RESPONDENT. ) ) ) ) ) ) ) OSHA REVIEW BOARD STIPULATION : '; ; AND NOTICE OF,: i SETTLEMENT ITt21 ,: :. " "9 2003 I'F ' CJ_~. 1 A_ 1 ...... - ._...... : APR ...... 0- . '. ~ NOW COME the parties in the above-captioned action, pursuant to Rule .0701 of the Rules of Procedure adopted by the Safety and Health Review Board of North Carolina, and respectfully show unto the Hearing Examiner as follows: FACTS 1. The respondent is an Ohio corporation which does business in North Carolina and maintains a place of business in Greensboro, North Carolina. 2. I In November, 2001, Jim Wells, an Occupational Safety and Health Officer with the North Carolina Department of Labor, conducted an inspection of the respondent's worksite located at Marshville, North Carolina. 3. On January 17,2002, as a result of the inspection. the complainant issued a citation, carrying the following proposed abatement dates and penalties: ~ .J ., CITATION NUMBER ONE (Serious) Item No. Standard 29 CFR 1910.23(c)(1) 29 CFR 1910.147(c)(4)(i) 1 2 4. Abatement Date 02119/2002 02/19/2002 Penalty $1,375.00 $3,150.00 The respondent submitted a timely Notice of Contest, dated February 21, 2002, contesting the citation and proposed penalties in their entirety. 5. Upon the request of the respondent, the complainant filed a timely complaint on April 8, 2002. 6. The,respondent filed a timely answer to the complaint on April 24, 2002, denying the material allegations of the Complaint and setting forth its defenses. 7. The parties having reached this Settlement Agreement now seek approval of this agreement by the Hearing Examiner. STIPULATIONS Effective upon approval of this Stipulation and Notice of Settlement, the parties to this action hereby agree and stipulate to the following settlement of the matters at issue herein: 8. The parties agree that this Stipulation and Notice of Settlement is a full and fmal settlement of the claims set out in the underlying Citation and Notification of Penalty, and none of the agreements, statements, stipulations and actions taken herein by the respondent shall be deemed an admission by the r~spondent of any of the allegations contained in the ~itation and Notification of Penalty or waiver of defenses; provided, however, that in any subsequent proceeding with respect to matters covered by this Stiplcllation and Notice of Settlement brought directly under the Act by the complainant, this 2 e Agreement shall have the full force and effect of a final order. The agreements, statements, . . stipulations and actions herein are made solely for the purpose of settling this matter economically and amicably without further litigation and shall not be used for any other purpose except for proceedings and matters arising under the Occupational Safety and Health Act and Article 21, Chapter 95 of the North Carolina General Statutes. 9. Citation 1, Item 1 is amended to read as follows: "Citation 1 Item 1 Type of Violation: SERIOUS 29 CFR 191 O.23( c)(l): A platfonn 4 feet or more above the adjacent floor was not guarded by a standard railing (or equivalent as specified in 29 CFR 19 I 0.23(e)(3)(i) through (v», on all open sides: a) plant, an employee was cleaning a poUltry halving machine from a horizontal drip pan, approximately 7' 5" by 7' 2", which was located directly beneath the halving machine; b) the drip pan was more than 4 feet above the adjacent plant floor; and c) the open side of the drip pan was not guarded by a standard railing or equivalent." . 10. The respondent will, within 30 days after the full execution of this agreement by the parties hereto, abate Citation 1, Item 1. Among the methods for the respondent to abate this citation are: a. Ensuring that, if employees perform work while on the drip pan, employees are protected from falling from the drip pan to the floor below by a standard railing or by some other means of fall protection; or b. Continuing to communicate and enforce a work rule prohibiting 3 -------_ employees from performing work from the drip pan. 11. The'penalty for Citation 1, Item 1 is $1,375.00. The respondent agrees to pay this penalty within ten (10) days following the receipt of the Order approving this Stipulation and Notice of Settlement. 12. Citation 1, I~em 2 and its associated penalty are dismissed. The respondent agrees that it will continue its practice of requiring that before employees hand scrub the Foodcraft HM2 halving machine they lock out or tag ou~ the machinery to prevent its unexpected energization. 13. The respondent agrees to continue its present safety program, and the respondent agrees to continue to use its best efforts to comply with the requirementS of the Act. 14. The respondent agrees that by signing this Stipulation and Notice of Settlement and upon approval of said Stipulation and Notice of Settlement by the Hearing Examiner, its Notice of Contest is withdrawn as a matter oflaw. 15. The respondent shall post this Stipulation and Notice of Settlement in accordance with Rules .0107(e), .0107(f), .0107(h), and .0701 (c) of the Rules of Procedure of the Safety and Health Review Board of North Carolina. 16. The parties agree to bear their own attorneys' fees, costs, and other expenses that have been incuned in connection with any stage of these proceedings up to and including the filing of this StipUlation and Notice of Settlement. 17. The parties agree that there are no other matters that remain to be decided, and there has been no employee objection to the reasonableness of any abatement period. 4 ... WHEREFORE, the parties to this action hereby respectfully request approval of this Stipulation and Notice of Settlement. This the lott- day of '::::1a ~ \. U Cl "":k .... ,2003 . ROY COOPER Attorney General rTX'(\0~ \ \. Daniel D. Addison Assistant Attorney General North Carolina Department of Justice . Post Office Box 629 Raleigh, North Carolina 27602 Telephone No. (919) 716-6680 ATTO~~YSFORCO~LMNANT y-0L~ ' . Richard L. Rainey Womble, Carlyle, Sandridge & Rice, LLC One Wachovia Center Suite 3300 301 South College Street Charlotte, North Carolina 28202-6025 Telephone No. (704) 331-4967 ATTORNEY FOR RESPONDENT 5 . ~ NC Department of Labor Inspection Nmnber: 304971310 InspectionDates: 11'113/2001 - 11128/2001 Issuance Date: 0 I /J 7/2002 Division of Occupational Safety and Health Citation and Notification of Penalty Ca~lagban & Callaghan Inc. DBA Cal-Clean 5901 Hwy 74 E, Marshville, NC 28103 Company Name: Inspection Site: Citation 1 Item 1 Type of Violation: Serious 29 CFR I91O.23(c)(1): Open sided f1oor(s) or platforrn(s) 4 feet or more above the adjacent floor or ground ,level were not guarded by standard railings (or the equivalent as specified in 29 CFR 191O.23(e)(3)(i) through (v», on all open sides: . a) plant, such as around the halving machine on line~ one and two . Chation J Item 2 Type of Violation: Serious 29 CFR 1910 .147(c) (4)(i): Procedures were not 'developed, documented ..and utilized for the control of potentially hazardous energy when employees were engaged in activities covered by this section: a) on or about November 11, 2001 the following conditions occurred:employee was cleaning a line driven halving machine and lockout/tag out procedures .were not utiliz¢. District Supervisoi/ for the Director s~ p:!.ges 1 through 6 of this Citation and Notification of Penalty for infonnation on employer and employee rights and responsibilities. Cita..;on and ~otiflcation of Penalty Page i of7 OSlL<\-2 (Rev. 9'93) OS/25/2015 12:31 215597 _ J5 PAGE OSHA 02/17 ... '.~~ ',~ U.S. DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION In the Matter of: CAL-CLEAN INC. OSHA No,(s): 315819946 INFORMAL SEITLEMENT AGREEMENT The undersign.ed Employer and the Undersigned Occupational Safety and Health Administration (OSHA), in settlement of the above citation(s) and penalties which were issued on 08/09/12, hereby agree as follows: 1. The Employer agrees to correct the violations as Cited in the above citations or as amended below, 2. The Employer agrees to submit in writing, a description of how and when the violations as issued above, or as amended below, were corrected', 3. Respondent will pay the amended penalty of $5,445.00 in full within 15 days of the date of this Settlement Agreement. Said payment will be made with a check payabJe to OSHA, U,S. Department of Labor and mailed to the Occupational Safety and Health Administration, Philadelphia Area Office, 200 Chestnut Street, Room 242, Philadelphia, PA 19106 . 4. OSHA agrees that the following citations and penalties are being arn.ended as shown below: ." .',. ~ , Cit'Olltem 001 "Penalty amount reduced to $5,445.00, 47rJ' S'PL to ('{/H{2-,4. 4~~~~ Cit 01 Item 002 - Citation changed to Other that), Serious. t4- ~C'.(. J-.<::!il2.u1- ) t;f.t: lol tt /l-.Jn. . - Total ,n ew penalty amount is $5,445.00 . . ,'. 05/25/2015 12:31 215597 PAGE OSHA 5 5. The Employer, by signing this infonnaI settlement agreement, hereby waives its rights to contest the above citation(s) and penaltic;:s, as amended in paragraph 4 of this agreement. 6. In accor.dance with 29 CFR 1903. 19(c) , within ten (10) calendar days after the abatement date, Respondent shaH certify to the Occupational Safety and Health Administration's (,'OSHA If) Philadelphia Area Office that each citation. has been abated. 7. The employer agrees to immediately post a copy of this Settlement Agreement in a promin.ent place at or near the location of the violation(s) referred to in paragraph 4 above. This Settlement Agreement must remain posted until the violations cited have been corrected, or for 3 working days (excluding weekends and Federal Holidays), whichever is longer. 8. The Employer agrees to continue to comply with the applicable provisions of the Occupational Safety and Health Act of 1970, and the app.licable safety and health standards promulgated pursuant to the Act .. 9. The employer agrees to make improvements to their existing safetY and helath program. Notification of the action taken shall be submitted to the Philadelphia Area Office by 10/2712012. The company now has a safety and health manager. 10. Each party agrees to bear itslhis own attorneys' fees, costs and other expenses incurred by such party in connection with any stages of the above-referenced proceeding inc1uding~ but not limited to, attorney's fees and costs which may be available under the Equal Access to Justice Act, as amended. 11. The employer shall comply with Section l1(c) of the aSH Act, 29 U .S.C. ' 660(c), and shall not discharge or in auy manner discriminate against any employee because the employee has exercised (or jntends to exercise), on behalf of himself or others, any right afforded by the Act, including but not limited to filing an. OSHA complaint, instituting a proceeding under or related to the Act, or testifying in a proceeding under or related C~ ~~ For Occupational Safety and Health Administration ALBERT D'IMPERIO (signature) For the Employe (signature) iC;!'lO/2Date .' 03/17 OS/25 / 2015 12:31 2155'3i j5 PAGE OSHA NOTICE TO EMPLOYEES The law gives you or your representative the opportunity to object to any abatement date set for a violation if you believe the date to be unreasonable. Any contest to the abatement dates of the citations amended in paragraph 4 of this Settlement Agreement m.ust ~e mailed to the U.S. Department of Labor Area Offi.ce at U.S. Customs House - Room 242, 2nd and Chestnut Streets, Philadelphia, PA 19106, within 15 working days (excluding weekends and Federal Holidays) of the receipt by the Employer of this Settlement Agreement. You or your representative also have the right to object to any ofthe abatement dates set for violations, which were not amended, provided that the objection is mailed to the office shown above within the l5-working-day period established by the original citation. J J 04/17 OS/26/2015 12:31 2155'3 U. S. Department of Labor - OSHA u. PAGE OSHA 56 05/17 Inspection Number:J 315819946 InspectionDates:02/18/2012-07/1112012 Issuance Date: 08/09/2012 S. Customs House, Room 242 2nd and Chestnut Streets Philadelphia, PA 19106 Citation and ·Notification of Penalt! Company Name: Inspection Site: CAL-CLEAN INC. Dietz and Watson, Inc.; 5701 Tacony Street, Philadelphia, PA 19135 " Citation 1 Item 1 Type of Violation: Serious 29 CFR 1910. 147(c)(4)(ii): The energy control pro~edUl':es did not clearly and specifically outline the scope~ purpose, authorization, rules, and techniques to be utilized for the control ofhazll{dous energy, .including, but not limited to i.tems (a) through (d) of this section: , a) Jobsite:5701 Tacony Street ~ The employer did nOt have energy control procedures tllat specifically outlined the scope, purpose, authorization. rules, and teChniques to be utilized for th.e control of~dous energy, including, but not limited to items (a) through (d) of this section for aU employees cleaning meat processing equipment. Observed on or about 02/18/12. NOTE: Abatement certification and documentation requked within 10 days after abatement date. The certifiCation shall include a statement that abateJnent is complete, the date and m.ethod of abatement, and state that employees and their J;'epresenfutives were infonned of this abatement. Abatement documen.tation shall include documents dem~)Dstrating that abatem~t is complete, sUch as evidence of the purchaseo\t" repair of equipmw, photographic or video evidence of abatement or other written records. . . See pages 1 through 5 of this Citation and Notification of Penalty for infonnadon on el1lP,loyer and employee right~ and responsibilities. Citation and Notification of Paultry Pa8~ 6 of7 OSJIA-2 (Re\.. 9193) U.S. Department of Labor occupational Safety and Health Administration Violation Worksheet Print Date: 08/23/2015 Inspection Number Opt. Insp. Number 4 Establishment Name Callaghan & Callaghan Inc, DBA Name Cal-Clean Type Of Violation Willful - Serious Citation Number 2 Item/Group Number Exposed 26 No. Instances 1 REC Employer's Relationship to Hazard All Special Enforcement? Standard 1910.147(c)(7)(i) Photo/Video Number Substance Codes Alleged Violation Description 2/ 29 CFR 1910.147(c)(7)(i): The employer did not provide adequate training to ensure that the purpose and function of the energy control program was understood by employees: On or before April 7, 2015, the employer failed to ensure that employees who were trained understood the hazardous energy (lock out/tag out) control program. Recommended Abatement Action Penalty Severity Severity Justification 5 Probability Probability Justification Gravity Gravity based Penalty History Num Times Repeated Multiplier 1 Quick Fix Calculated Penalty 77000.00 Proposed Penalty Proposed Penalty Justification: Based on past history Abatement Details Days to Abate User-entered Abatement 3 Wkg Days Abatement Status Date Abated Due Date Abatement Documentation Required? Yes Date Verified Abatement Completed Description: MultiStep Abatement Type/Other Type Days to abate User entered Abatement Due Date Employer Name and Address Telephone Completed (status) Verify Date Employee Exposure Exposure No. Instance Exposed 7d Duration Frequency Proximity 7d a) Hazards-Operation/Condition-Accident: Employees who are required to lockout all potential energy sources for various production equipment did not get adequate training to understand the purpose and function of the energy control program. b) Equipment: LOTO training c) Location: entire plant 5 .e) Measurements: 23. Employer Knowledge: Cal-Clean recognized the condition as being hazardous . Management representatives were aware of and had observed employees working near and on the hazardous equipment. The employer has a corporate lock out/tag o.u t program that discusses general requirements of lock out/tag out training in section 13.0, to include training for authorized and affected employees. Section 3.0 Authority, sub section 3.1, references 29 CFR 1910.147. Steve Callaghan stated that Mr. Schneider is responsible for the program and aware of the standard. The employer uses Case Farms Processing Inc. LOTO procedures. There is a specific LOTO procedure for this equipment. Cal-Clean has sanitation cleaning contracts with approximately 20 meat processing plants located in North Carolina, Ohio, Pennsylvania, South Carolina, and Virginia. Steven Callaghan (owner) stated We have two categories of injuries where employees get hurt in this industry !! slips and falls and LOTO. Steven stated I go to the OSHA federal website for all Cal-Clean LOTO programs. Nevin (Ned) Callaghan (owner) was General Manager of Ronnell Managed Services LLC, Sanitation Company, for 10-15 years before the Callaghan brothers started Cal-Clean. Steven and Nevin Callaghan will evaluate all the facilities they have contracts with every 30-60 days, more if needed, to include LOTO audits. They rotate going to the facilities at first than after one year they decide who will be the lead at the facility. A Cal-Clean employee was killed during the cleaning of the poultry halving machine which was not LOTO. The citation was deleted by the Safety and Health Review Board of North Carolina, however, in the court settlement item #12 states the respondent will require employees to LOTO this machine before employees hand scrub the machine, to prevent its unexpected energization. Nevin Callaghan was contacted for the opening conference via phone. Ygancio Cruz (Corporate Safety) was present for the entire inspection. This occurred at Pilgrims Pride Poultry processing plant. Ygnacio Cruz (corporate safety) has his OSHA 30 hour certificate. Steven Callaghan (owner) stated: has been with the company since day one. He cleaned first plant as one man crew. Ygnacio Cruz Ygnacio Cruz, Mario Villobos, and Leonardo Aviles are all responsible for training and ensuring employees are utilizing LOTO. All three are part of corporate safety and travel to all Cal Clean contracted locations. They also fill in for onsite managers when they are on leave. Stephen and Nevin Callaghan will evaluate all the facilities they have contracts with every 30-60 days, more if needed, to include LOTO audits. They rotate going to the facilities at first than after one year they decide who will be the lead at the facili~y. Chuck Schneider, onsite supervisor, worked for Case Farms in sanitation for two years as a sanitation supervisor. Mr. Schneider stated: I manage and oversee the work of the around 25 employees who work here at the plant. I am on the floor supervising and overseeing employees ~ work every day. osed to be off when cleaned. I don ~ t know why the machine was on. H m sure H n the machine live. Training w~ussion. Safety in Spanish!! both vers ns pan. stated in his second interview: _ _ _ fell into the auger he had finished cleaning it. I didn ~ t see the aCCident happen . That specific machine does not need to be turned on to clean so I don ~ t know why it was on. Company management had a heightened awareness of the hazardous condition, the standards which apply, and means to protect employees. This awareness was gained through previous OSHA inspections and citations corporate wide. The employer was cited 1910.147(c)(7)(iv) during inspection #308786730. Corporate wide, Cal-Clean has been cited 13 times for various lock out/tag out violations since 2000. On April 7, 2015 while the #517 Giblet/Liver Chiller Machine located in the first processing chiller/sizing department; exposed to an unguarded Giblet/Liver Chiller instructed to clean the equipment by his machine that was not LOTO, resulting in an am supervisor, Mr. Kenny Cherry (Lead Evisceration supervisor) who would observe his work and be in his work area the whole shift. Mr. Schneider (onsite manager), would observe his work and walk by him daily. Mr. Perez stated: Chuck Schneider and Kenny Cherry have seen me and other employees work this way. Kenny Cherry was with the of the chillers or workers the entire sh 7d 7d According to onsite manager, Chuck Schneider, he stated in his first interview: Machines are supposed to be off when cleaned. I don ~ t know why the machine was on. I ~ m sure I ~ ve seen Orlando and Francisco clean the machine live. Training watch movie/discussion. Safety in Spanish!! both versions English/Spanish. NOTE: LaTa training received stated video not watched. He stated in his second interview: When Francisco fell into the auger he had finished cleaning it. I didn ~ t see the accident happen. That specific machine does not need to be turned on to clean so I don ~ t know why it was on. According to Ken Cherry, Evisceration Lead Supervisor, stated: I ~ ve seen Francisco and Orlando turn on the chiller auger at the end!! after they ~ ve cleaned it to make sure it was clean after that they turn in off. Sometimes they ~ d turn the water on top the auger to make sure it~ s rinsed. It be normal for a new guy to do that, but it doesn ~ t help!! a more experienced cleaner wouldn ~ t do it. 24. Commen~s: 25. Other Employer. Information: DOCUMENTATION OF WILLFUL VIOLATION U.S. Department of Labor Occupational Safety and Health Administration Violation Worksheet Print Date: 08/23/2015 Inspection Number Opt. Insp. Number Establishment Name Callaghan & Callaghan Inc, DBA Name Cal-Clean Type Of Violation Willful - Serious Citation Number 2 Item/Group Number Exposed 6 No. Instances 1 REC Employer's Relationship to Hazard All Special Enforcement? Standard 4 3/ a 1910.147(d)(3) Substance Codes Photo/Video Number Alleged Violation Description 29 CFR 1910.147(d)(3): All energy isolating devices that were needed to control the energy to the machine or equipment were not physically located and operated in such a manner as to isolate the machine or equipment from the energy source(s): On or before April 7, 2015, at Case Farms Processing located at 1925 30th Street Northeast, Canton Ohio, 44705, the employer failed to ensure that the electrical disconnect located at the south wall evisceration area, for the #517 Giblet/Liver Chiller Machine located in the first processing chiller/sizing department, was operated in a manner that did not isolate the energy sources prior to authorized employees performing work, in that locks were not applied to the energy source nor was the energy source relieved, disconnected, restrained, or otherwise rendered safe during cleaning and sanitizing operations. Recommended Abatement Action Penalty Severity Severity Justification Probability Probability J ,,,,t-if'i,.-,,,t-i 5 Gravity Gravity based Penalty Good Faith Num Times Repeated History Multiplier 1 Quick Fix Calculated Penalty 77000.00 Proposed Penalty Proposed Penalty Justification: Ba!:;ed on OSHA history Abatement Details 2 Wkg Days Days to Abate Date Abated User-entered Abatement Due Date Abatement Documentation Required? Abatement Status Yes Date Verified Abatement Completed Description: MultiStep Abatement Type/Other Type Days to abate User entered Abatement Due Date Completed (status) Employer Name and Address Telephone Verify Date Employee Exposure Exposure No. Instance Exposed 7d Duration Frequency Proximity 7d 20. Instance Description: A. Hazard B. Equipment C. Location D. Injury/Illness E. Measurements a) Hazards-Operation/Condition-Accident: The sanitation workers are required to lockout all potential energy sources for various produCtion equipment to include but not limited to: #517 Giblet/Liver Chiller Machine, Pickers, Liver tumbler, Tender tumbler, various other chillers, rehang line. Energy sources include steam, chemical, hydraulic, pneumatic, thermal, mechanical, electrical and gravitational b) Equipment: #517 Giblet/Liver Chiller Machine located in first processing chiller/sizing department c) Location: Through out first processing and second processing in the plant 5 e) Measurements: 480 VAC 23. Employer Knowledge: Cal-Clean recognized the condition as being hazardous. Management representatives were aware. of and had observed employees working near and on the hazardous equipment. Cal-Clean has sanitation cleaning contracts with approximately 20 meat processing plants located in North Carolina, OhiO, Pennsylvania, South Carolina, and Virginia. Steven Callaghan (owner) stated we have two categories of injuries where employees get hurt in this industry !! slips and falls and LOTO. Steven stated I go to the OSHA federal website for all Cal-Clean LOTO programs. Nevin (Ned) Callaghan (owner) was General Manager of Ronnell Managed Services LLC, Sanitation Company, for 10-15 years before the Callaghan brothers started Cal-Clean. , Steven Callaghan stated: my brother is well versed in the industry. Steven and Nevin Callaghan will evaluate all the facilities they have contracts with every 30-60 days, more if needed, to include LOTO audits. They rotate going to the facilities at first than after one year they decide who will be the lead at the facility. Ygnacio Cruz (corporate safety) completed OSHA 30 hour course on April 24, 2012. Steven Callaghan (owner) stated: Ygnacio Cruz has been with the company since day one. He cleaned first plant as one man crew. Ygnacio Cruz, Mario Villobos, and Leonardo Aviles are all responsible for training and ensuring employees are utilizing LOTO. All three are part of corporate safety and travel to all Cal Clean contracted locations. They also fill in for onsite managers when they are on leave. Stephen and Nevin Callaghan will evaluate all the facilities they have contracts with every 30-60 days, more if needed, to include LOTO audits. They rotate going to the facilities at first than after one year they decide who will be the lead at the facility. Steven and Nevin Callaghan will evaluate all the facilities they have contracts with every 30-60 days, more if needed, to include LOTO audits. They rotate going to the facilities at first than after one year they decide who will be the lead at the facility. Chuck Schneider, onsite supervisor, worked for Case Farms in sanitation for ten plus years and as a sanitation supervisor for two years. Mr. Schneider stated: I manage and oversee the work of the around 25 employees who work here at the plant. I am on the floor supervising and overseeing employees ~ work every day. He stated: m sure ve seen Machines are su.ed to be off when cleaned. I don ~ t know why the machine was on. scussion. Safety in Spanish!! both versions clean the machine live. Trainin watch m fell into the auger he had finished cleaning English/Spanish. He stated in his second interview: it. I didn ~ t see the accident happen. That specific m oes not need to be turned on to clean so I don ~ t know why it was on. n n Company management had a heightened awareness of the hazardous condition, the standards which apply, and means to protect employees. This awareness was gained through previous OSHA inspections and citations corporate wide. The employer has a corporate lock out/tag out program that discusses general requirements of lock out/tag out in section 7.1.2 General Information, stating authorized employees will utilize a lock to isolate energy sources. In section 8.0, Lockout and Tagout Procedures it discusses isolating the machines from the energy sources and energy is.olating devices. Section 3.0 Authority, sub section 3.1, references 29 CFR 1910.147. Mr. Schneider is responsible for the program and aware of the standard. The employer uses Case Farms Processing Inc. LOTO procedures. There is a specific LOTO procedure for this equipment that discusses where to isolate the energy sources. The employer had a sanitation standard operating procedure for the Liver Chiller, the machine the sanitation employee sustained an amputation on, that did not discuss isolate the machine or equipment from the energy source(s). On April 7, 2015 while 0 eratin the #517 Giblet Liver Chiller Machine located in the first processing chiller/sizing department; ) was exposed to an u~blet/Liver Chiller machine that was not LOTO, resulting in an amputation. The night of the inciden~ lock was locked on the side hinge of his ladder and not on the LOTO isolating energy source; electrical disconnect located at the south wall in the evisceration area for the Giblet/Liver Chiller machine. Mr. Perez was instructed to clean the equipment by his supervisor, Mr. Kenny Cherry (Lead Evisceration supervisor) who would observe his work and be in his work area the whole shift. Mr. Schneider (onsite manager), would observe his work and walk by him daily. Mr. Perez stated: Chuck Schneider and Kenny Cherry have seen me and other employees work this way. Kenny Cherry was with the workers the entire Mr. 7d 7d According toonsite manager, Chuck Schneider, he stated in his first interview: Machines are supposed to be off when cleaned. I ' don~ t know why the machine was on. m sure ve seen Orlando and Francisco clean the machine live. He stated in his second interview: When Francisco fell into the auger he had finished cleaning it. I didn ~ t see the accident happen. That specific machine does not need to be turned on to clean so I don ~ t know why it was on. Mr. Schneider stated: Kenny, Ivan, Raul, and myself are responsible for ensuring LOTO is utilized/done by employees. n n n According to Ken Cherry, Evisceration Lead Supervisor, stated: ve seen Francisco and Orlando turn on the chiller auger at the end!! after they ~ ve cleaned it to make sure it was clean after that they turn in off. Sometimes they ~ d turn the water on top the auger to make sure it ~ s rinsed . It be normal for a new guy to do that, but it doesn ~ t help!! a more experienced cleaner wouldn ~ t do it. 24. Comments: 25. Other Employer Information : Willful Worksheet 29 CFR Willful Worksheet 29 CFR U.S. Department of Labor Occupational Safety and Health Administration Violation Worksheet Print Date: 08/23/2015 Inspection Number 1 Opt. Insp. Number 4 Establishment Name Callaghan & Callaghan Inc, DBA Name Cal -Clean Type Of Violation Willful - Serious Citation Number 2 Item/Group Number Exposed 13 No. Instances 1 REC Employer's Relationship to Hazard All Special Enforcement? Standard 1910.147(d)(4)(i) Substance Codes Alleged Violation Description 3/ b Photo/Video Number 29 CFR 1910.147(d)(4)(i): Lockout or tagout devices were not affixed to each energy isolating device by authorized employees to include but not limited to: a) On or about April 7, 2015, at Case Farms Processing located at 1925 30th Street Northeast, Canton Ohio, 44705, lockout procedures were not utilized during the cleaning and sanitizing of the #517 Giblet/Liver Chiller Machine. The electrical energy sources were not locked out. Recommended Abatement Action Penaltv Severity Severity Justification Probability 5 Probability Justification Gravity Gravity based Penalty Num Times Repeated History Multiplier 1 Quick Fix Calculated Penalty 70000.00 Proposed Penalty Proposed Penalty Justification: Abatement Details Days to Abate 3 Wkg Days User-entered Abatement Due Date Abatement Documentation Requ ired? Abatement Status Date Abated Yes Date Verified ~ Abatement Completed Description: MultiStep "Abatement Type/Other Type Days to abate User entered Abatement Due Date Employer Name and Address Telephone Employee Exposure Exposure Instance 7d Completed(status) Verify Date 7d B. Equipment C. Location D. Injury/Illness E. Measurements a) Hazards-Operation/Condition-Accident: Machine operators who are required to lockout various production equipment such as the #517 Giblet/Liver Chiller Machine did not apply a lock to potential energy sources. Energy sources include, but are not limited to steam, chemical, hydraulic, pneumatic, thermal, mechanical, electrical and gravitational for 6 hours b) Equipment: #517 Giblet/Liver Chiller Machine c) Location: 5 23. Employer Knowledge : Cal-Clean recognized the condition as being hazardous. Management representatives were aware of and had observed employees working near and on the hazardous equipment. Cal-Clean has sanitation cleaning contracts with approximately 20 meat processing plants located in North Carolina, Ohio, Pennsylvania, South Carolina, and Virginia. Steven Callaghan (owner) stated we have two categories of injuries where employees get hurt in this industry!! slips and falls and LOTO. Steven stated I go to the OSHA federal website for all Cal-Clean LOTO programs. Nevin (Ned) Callaghan (owner) was General Manager of Ronnell Managed Services LLC, Sanitation Company, for 10-15 years before the Callaghan brothers started Cal-Clean. Steven and Nevin Callaghan will evaluate all the facilities they have contracts with every 30-60 days, more if needed, to include LOTO audits. They rotate going to the facilities at first than after one year they decide who will be the lead at the facility. Ygnacio Cruz (corporate safety) completed OSHA 30 hour course on April 24, 2012. Steven Callaghan (owner) stated: Ygnacio Cruz has been with the company since day one. He cleaned first plant as one man crew. Ygnacio Cruz, Mario Villobos, and Leonardo Aviles are all responsible for training and ensuring employees are utilizing LOTO. All three are part of corporate safety and travel to all Cal Clean contracted locations. They also fill in for onsite managers when they are on leave. Steven and Nevin Callaghan will evaluate all the facilities they have contracts with every 30-60 days, more if needed, to include LOTO audits. They rotate going to the facilities at first than after one year they decide who will be the lead at the facility. Steven and Nevin Callaghan will evaluate all the facilities they have contracts with every 30-60 days, more if needed, to include LOTO audits. They rotate going to the facilities at first than after one year they decide who will be the lead at the facility. Chuck Schneider, onsite supervisor, worked for Case Farms in sanitation for ten plus years and as a sanitation supervisor for two years. Mr. Schneider stated: I manage and oversee the work of the around 25 employees who work here at the plant. I am on the floor supervising and overseeing employees ~ work every day. rE~ • • • Machines are supposed to be off when cleaned. I don ~ t know why the machine was on. I ~ m su • • • • • • • • • clean the machine live. Training watch . Safety in Spanish!! both versions English/Spanish. He stated in his second interview: II into the auger he had finished cleaning it. I didn ~ t see the accident happen. That specific ma need to be turned on to clean' so I don ~ t know why it was on. 1 Company management had a heightened awareness of the hazardous condition, the standards which apply, and means to protect employees . This awareness was gained through previous OSHA inspections and cit!3tions corporate wide. The employer has a corporate lock out/tag out program that discusses lockout and Tagout procedures in Section 8.0. It discusses applying lockout/tagout devices to machinery and equipment. Section 3.0 Authority, sub section 3.1, references 29 CFR 1910.147. Mr. Schneider is responsible for the program and aware of the standard. The employer uses Case Farms Processing Inc. LOTO procedures. There is a specific LOTO procedure for this equipment that discusses where to apply your lock. The employer had a sanitation standard operating procedure for the Liver Chiller, the machine the sanitation employee sustained an amputation on, that did not discuss where to affix the lock to each energy source. On April 7, 2015, while 0 eratin the #517 Giblet Liver Chiller Machine located in the first proceSSing chiller/sizing department was exposed to an unguarded Giblet/Liver Chiller machine that was not LOTO, resulting in an amputation. The night of the incident Mr. Perez ~ s lock was locked on the side hinge of his,ladder and not affixed to the energy isolatin'g device; the electrical disconnect located at the south wall in the evisceration area for the Giblet/Liver Chiller machine. Mr. Perez was instructed to clean the eqUipment by his supervisor, Mr. Kenny Cherry (Lead Evisceration supervisor) who would observe his work and be in his work area the whole shift. Mr. Schneider (onsite manager), would observe his work and walk by him daily. Mr. Perez stated: Chuck Schneider and Kenny Cherry have seen me and other employees work this way. Kenny Cherry was with the workers the 7d 7d According to onsite manager, Chuck Schneider, he stated in his first interview: Machines are supposed to be off when cleaned. I don ~ t know why the machine was on. m sure ve seen Orlando and Francisco clean the machine live. He stated in his secan d interview: When Francisco fell into the auger he had finished cleaning it. I dldn ~ t see the accident happen. Th at specific machine does not need to be turned on to clean so I don ~ t know Mr. S'chneider stated: Kenny, Ivan, Raul, and myself are responsible for ensuring LOTO is why it was on . utllizeCl/done by employees. n n n ve seen Francisco and Orlando turn on the According to Ken Cherry, Evisceration Lead Supervisor, stated: chiller auger at the end II after they ~ ve cleaned it to make sure it was clean after that they turn in off. Sometimes they~ d turn the water an top the auger to make sure it ~ s rinsed. It be normal for a new guy to do that, but it doesn ~ t help !! a more experienced li:leaner wouldn ~ t do it. 24. Comments: 25. Other Employer Information : Willful Worksheet 29 CFR U.S. Department of Labor Occupational Safety and Health Administration Violation Worksheet Print Date: 08/23/2015 Inspection Number Opt. Insp. Number 4 Establishment Name Callaghan & Callaghan Inc, DBA Name Cal-Clean Type Of Violation Repeat - Serious Citation Number 3 Item/Group Nu 26 No. Instances 1 REC Employer's Relationship to Hazard All r Exposed Special Enforcement? Standard 1/ 1910.147(f)(2)(i) Substance Codes Photo/Video Number Alleged Violation Description 29 CFR 1910.147(f)(2)(i): When outside servicing personnel were engaged in activities in a facility, the onsite employer and the outside employer did not inform each other of their respective lockout or tagout procedure: On or before April 13, 2015, Callaghan and Callaghan (DBA Cal-Clean) and Case Farms Processing Inc. had not reviewed or discussed with each other their hazardous energy ( lock out/tag out) procedures that are to be used when cleaning and sanitizing Case Farms Processing Inc. Machines included but not limited to: a) Live Dock; First Processing b) Kill and Blood Area; First Processing c) Scalder Area; First Processing d) Picker Area; First Processing e) Paw Room; First Processing f) Evisceration; First Processing g) Reprocess Line; First Processing h) Chillers; First Processing i) Gizzard Area; First Processing j) Debone Area; Second Processing k) Cut-up Area; Second Processing I) Marination; Second Processing m) Wog Area; Second Processing n) Sizing Area; Second Processing Establishment Name Callaghan & Callaghan Inc, 0) Ice Room; Second Processing Callaghan & Callaghan dba Cal-Clean was previously cited for a violation of this occupational safety and health standard or its equivalent standard 29 CFR 1910.147(f)(2)(i) which was contained in OSHA inspection number315819946, citation number 1, item number land was affirmed as a final order on September 6, 2012, with respect to a workplace located at 5701 Tacony Street; Philadelphia, PA, 19135. Recommended Abatement Action Penalty Severity Severity Justification 5 Probability Probability Ju~rlfil~a.rl"ln Gravity Num Times Repeated 1 Multiplier 5 Calculated Penalty 38500.00 Proposed Penalty Justification: Based on history Abatement Details 4 Wkg Days Days to Abate Date Abated User-entered Abatement Due Date Abatement Documentation Required? Abatement Status Yes Date Verified Abatement Completed Description: MultiStep Abatement Type! Other Type Days to abate User entered Abatement Due Date Employer Name and Address Completed( status) Verify Date Employee Exposure Exposure Duration Frequency Proximity Instance - Expgsed I Telephone - I I 7d a) Hazards-Operation/Condition-Accident: Callaghan and Callaghan (DBA Cal-Clean), sanitation contractor, had not discussed or reviewed with Case Farms their hazardous energy (lock out/tag out) procedures that are to be used when cleaning and sanitizing Case Farms machines. As a result of not discussing each other LaTa programs, a Cal-Clean employee suffered an amputation that occurred on April 7, 2015 at the Liver/Giblet Chiller Machine. b) Equipment: Hazardous energy control program (Lock Out/Tag Out) between Callaghan & Callaghan (dba CalClean) and Case Farms c) Location: Case Farms 1925 30th Street North East Canton Ohio 44705 5 e) Measurements: 480 VAC 23. Employer Knowledge: The employer discussed the Cal-Clean Cleaning Agreement for Case Farms Processing, Inc., Canton, OH contract with Sammy Caudle (VP and GM of Ohio Case Farm plants), however, there was no discussion between the two companies about their hazardous energy (LaTa) procedures that are to be used when cleaning and sanitizing Case Farms machines. Nevin Callaghan had worked in the sanitation industry as a GM for Ronnell Sanitation Company for 10- 15 years before starting Callaghan & Callaghan dba Cal Clean with his brother Steve Callaghan . Steve stated that Nevin is very well versed in the industry standards. Cal-Clean started cleaning for Case Farms in Goldsboro, North Carolina in 1996 (approximately), Morgantown, North Carolina in September/October 2013, and Canton, Ohio March 2014. Steve stated that Cal-Clean does have a signed copy between Cal-Clean and Case Farms Processing Inc. in Morgantown, North Carolina. . . Cal-Clean was previously cited for a violation of this occupational safety and health standard or its equivalent standard 1910.147(f)(2)(i), which was contained in OSHA inspection number 315819946, citation number 1, item number 1 and was affirmed as a final order on September 6, 2012, with respect to a workplace located at Dietz and Watson, Inc., 5701 Tacony Street, Philadelphia, PA 19135. This citation was originally classified serious and downgraded to an OTS during the Informal Settlement Agreement. Steven Callaghan( owner) signed the informal settlement agreement. Mario Villalobos and Leonardo Avila, both from Cal Clean corporate safety, were present for the opening conference and walk around. Both of these managers visit all Cal-Clean sites nationwide for safety audits and fill in when onsite managers go on leave. The employer was cited for this violation on inspection 312492903 Philadelphia, PA, which was later deleted at the Formal Settlement dated 6/18/2010. 24. 'Comments: 25. Other Employer Information: OS/25/2015 12:31 j5 21559~ PAGE OSHA 02/17 :-: U.S. DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION In the Matter of: CAL-CLEAN INC . OSHA No.(s): 315819946 INFORMAL SEITLEMENT AGREEMENT The undersign.ed Employer and the Undersigned Occupational Safety and. Health Administration (OSHA), in settlement of the above citation(s) and penalties which were issued on 08/09/12, hereby agree as follows: ·~/, . 1. The Employer agrees to correct the violations as cited in the above citations or as amended below. 2. The Employer agrees to submit in writing, a description of how and when the violations as issued above, or as amended below, were corrected, 3. Respondent will pay the amended penalty of $5,445.00 in full within 15 days of the date of this Settlement Agreement. Said payment will be made with a check payabJe to OSHA, U.S. Department of Labor and mailed to the Occupational Safety and Health Administration~ Philadelphia Area Office, 200 Chestn.ut Street, Room 242, Philadelphia, . PA 19106. 4. OSHA agrees that the following citations and penalties are being am.ended as shown below: .. ~ Cit 01 Item 001 - Penalty amount reduced to $5,445.0Q. 4-7(J, S'~ 10. ( 'l/'LDt Z-.4 ;J~~~~ Cit 01 Item 002 - Citation changed to Other than. Serious. - Total new penalty amount is $5,445.00. t4- &l!.t k;!if;A- ) tIf.<:... to/ £{ /t-tJl'L OS/25/2015 ., 12: 31 , 215597 PAGE OSHA j5 5. The Employer, by signing this infoX1IlaI settlement agreement, hereby waives its rights to CODtest the above citation(s) and penalti~s, as amended in paragraph 4 of this agreement. 6. In accordance with 29 CFR 1903. 19(c) , within, ten (10) calendar days after the abatement date, Respondent shall certify to the Occupational Safety and Health Admini.stration's (,'OSHA ") Philadelphia Area Office that each citation. has been abated. 7. The employer agrees to immediately post a copy of this Settlement Agreement in a prominent place at or near the location of the violation(s) referred to in paragraph 4 above. This Settlement Agreement must remain posted W1tU the violations cited have been corrected, or for 3 working days (excluding ,weekends and Feder.al Holidays), whichever is longer. 8. The Employer agrees to continue to comply with the applicable provisions of the Occupational Safety and Health Act of 1970, and the applicable safety and health . standards promulgated pursuant to the Act. ' 9. The employer agrees to make improvements to their existing safety and helath program. Notification of the action taken shal1 be submitted to the Philadelphia Area Office by 10/27/2012. The company now has a safety and health manager. 10. Each party agrees to bear its/his own attorneys' fees, costs and other expenses incurred by such party in connection with any stages of the above-r.eferenced proceeding including, 'but not limited to, attorney's fees and costs wh.ich may be available under the Equal Access to Justice Act,· as amended. 11. The employer shall comply with Section l1(c) of the OSH Act, 29 U.S.C. ' 660(c), and shall not discharge or in any manner discriminate against any employee because the ' employee has exercised (or intends to exercise), on behalf of himself or others, any right afforded by the Act, including but not limited to filing an. OSHA complaint, instituting a proceeding under or related to the Act, Of testifying in a proceeding under or related ~?:t. C~ For Occupational Safety and Health Administration ALBERT D'IMPERIO (signature) For the Employe (signature ) P/C;/24L Date -' £13/17 OS/26 / 2015 12:31 2155'37 6 PAGE OSHA ....,. .... ..J, ..... NOTICE TO EMPLOYEES The law gives you or your representative the opporrunity to object to any abatement date set for a violation if you believe the date to be unreasonable. Any contest to the a.batement dates of the citations amended in para.graph 4 of this Settlement Agreement m.ust be mailed to the U.S. Department of Labor Area Offi.ce at U.S. Customs House - Room 242, 2nd and Chestnut Streets, Philadelphia, PA 19106, within 15 working days (excluding weekends and Federal Holidays) of the receipt by the Employer of this Settlement Agreement. You or your representative also have the right to object to any of the abatement dates set for violations, which were not amended, provided that the objection is mailed to the office shown above within the lS-working~day period established by the original citation.. J 04/17 05/26/2015 215591 12:31 PAGE OSHA .55 ---'. '- U. S. Department of Labor - OSHA u. S. Customs House, 06/17 Inspection NlI01ber: 315819946 Ill5pectionDates: 02/18/2012 - 07/1112012 Issuance Date.: 08/09/2012 Room 242 2nd and Chestnut Streets Philadelphia, PA 19106 Citation and Notification of Penalty c Company Name: Inspection Site: CAL-CLEAN INC. Dietz and Watson, Inc.; 5701 Tacony Street, Philadelphia, PA 19135 Citation 1 Item 2 Type of Violation: Serious 29 CFR 1910. 147(f)(2)(i); When outside personnel were engaged in activities covered by the scope and application of the standard. the onsite employer and the outsjde employer did not infonn each other of their respective lockout or. tagout procedures: a) lobsite: 5701 Tac.ony Street - Outside per.sonnel, employees of a sanitation service contractor were engaged in activities covered by the scope and application of this standard. The onsite employer and the outside employer did not· inform. each other of their respective loCkout or tagout . procedures. Observed on or about 02/18112. NOm: Abatement certification and docmne:ntation required within 10 days after abatement date. 'The cenification shaU include a statement that abatement is' complete, the date and method of abatement, and state that employees and their representatives were informed of this abatement. Abatement documentation shall include docum.e.u.tS demonstx'ating that abatement is complete, such as evidence of the purchase or repair of equipment, photographic Of' video evidence of abatement or otheJ:' written records. ALBERT D' Area Di(ector c· ERIO o See pages 1 throUgh 5 of this Citation and Notification of Penalty Citation and Notification of Penalty ror information on employer and employee rights and respon.~ibj)ities, Page 7 of7 OSHA·2 (Rev. 9/93) Opening Conference WorkShl~ S U. S. Depart. ') '-l\..\.,c.:, .1t of Labor Occupational Safety and Health Administration Controlling Corp: - 7d Opening Conference Entry OSHA Walk-Around Date Time ~[[)!lr Time Employer Representatives Contracted Inrorm of: Employer . Reason for inspection explained; Here to address complaint items; There will be an opening conference, walk around, and closing conference. OSHA Fed Agency in DOL enforces OSH ACT 1970. We are not state level consultation. If we find violations of the regulations we issue cl lions that can carry a penalty amount that is mandated by congr 8"_ No advanced notice for first visit. OSHA does not divulge the l1arn . of th complainant Against the law to harass, discriminate, or tet · ate ny employee involved in the inspection or you think filed the co plai nfi entia l/Private employee interviews - 8(a)(2) We reserve the right d. .. CtdresS complaint items, plain site hazards{inspection for any violations we see in your facility, issues 'I employees, possible referrals to CSHOs) Closing conference (describe any apparent violations found and other pertinent issues) PPE Requlre~ Safely Goggles 5 0 Tyvek Suite o Other: I l' I . dminislration U. S. Department of Labor . Occupational Safety and Health Administration 9) U. S. Department of Labor a- an- - - .II ?ministration REQIDRED PERSONAL PROTECTIVE EQUIPMENT HAZARD ASSESSMENT Operation Ilob Hazards Required PPE Noise Hearing Protection Chemical resistant Gloves and clothing Safety Glasses (When foaming, or transporting chemicals) Bump Cap Steel-Toed Footwear Water resistant Footwear Rain Gear Chemical Splash Sanitation (Hose Man) lHead Bump Foot Crush Wet Walking Surfaces Water Splash Sanitation (Chemical Mixer) Chemical Splash \ Safety Glasses Face shield Bump Cap Chemical resistant gloves, clothing and footwear REQUIRED PERSONAL PROTECTIVE EQUIPMENT HAZARD ASSESSMENT Sanitation Noise Hearing Protection lHead Bump Bump Cap 2Chemical Splash and High Pressure Water Safety Glasses 2Chemicals Foot Crush Wet Walking Surfaces 3Chemical Vapors ) \ t ) Face Shield Chemical Resistant Gloves Chemical Resistant Clothing Steel-toed Boots Water Resistant Footwear Respirator Process Water, Chemicals Safety Glasses lHead Bump Bump Cap Foot Crush Steel-toed Work Boots Wet Walking Surfaces Water Resistant Boots Offal REQur:REDPERSONALPROTECTIVE EQUIPMENT HAZARD ASSESSMENT i ) NOTES 1- Falling object protection not necessary. Bump caps do not provide the same level protection as a hard hat. 2- Consult MSDS for additional instructions concerning required PPE. 3- Consult MSDS for additional instructions concerning required respiratory protection for specific chemicals, compounds or materials being used. ADDITIONAL NOTES All supervision and management must wear all required PPE related to the operation or area in which they are working. Employees involved in non-routine duties, for example weekend maintenance work or sanitation work, must wear required PPE for that designated operation or area. 1 ) OH1000-SAFE I Y CAL-CLEAN SAFETY TRAINING PROGRAM LOCATION: CASE FAJ RMS J - OHI01000 ; 6:3efWl DATE: 4/24/2~~ START TIME: MANAGER~l~~~~~~e~___________ END TIME:_f.>:' --,~2=--O+r__~'1,-­ TRAINING PROCEDURES COVERED COMUN1CACION DE PEUGROS HAZARDOUS COMMUNICATION ORIENTACION DE-PROTECCION SAFETY ORIENTATION ASEGURAR CON LLAVE Y MARCAR QUIMICOS LOCK OUTI TAG OUT PROTECelON CONTRA aUIMICOS CHEMICAL SAFETY GMP X X TRAINING PROTECCION DE LOS 01005 HEARJNG PROTECTION PROTECCION RESPIRATORIA RESPIRATORY PROTECTION PROTECCION DE OJOS Y PRIMEROS AUXILlQS EVE SAFETY & FIRST AID PERSONAL PROTECTIVE EQUIPMENT REPORTANDO UN ACCIDENTE REPORTING AN INJURY PROTECCION CONTRA CAIDAS FALL PROTECTION REGLAS DE HIGIENE LlMPIEZA DE LA PARTE DE ARRIBA (TECHO) OVERHEAD CLEANING LlMPIEZA DE CORREAS 0 BANDAS HYGIENE RULES PROCEDIMIENTO DE DISCIPLINA CLEANING C9NVEYORS ENTRENJ>;MIENTO EN EL USC DE MANGUERA DISCIPLINE PROCEDURES EVACUACI ON DE EMERGENCIA EMERGENCY EVACUATION HOSE SAFETY TRAINING SEGURIDAD EN LA ESCALERA LADDER SAFETY ACCESORIOS DE PROTECCION PERSONAL ATTENDEES NAME SIGNATURE ====~~--------------------- 7d OH 1OOO-SAFETY CAL·CLEAN SAFETY TRAINING PROGRAM LOCATION: CASE F RMS - OHI01000 . DATE: 4/24/20 ~ MANAGER~~=-~~ __~________________ START TIME: END TIME: g~ 3tO~ q \. ,0f(1:\ TRAINING PROCEDURES COVERED COMUNICACION DE PElIGROS HAZARDOUS COMMUNICATION ORIENTACION DE PROTECCION SAFET.Y ORIENTATION ASEGURAR CON LtAVE Y MARCAR aUIMIOOS LOCK OUlI TAG OUT PROTECCION CONTRA QUIMICOS CHEMICAl SAFETY ACCeSORl0s DE PROTECCION PERSONAL PERSONAL PROTECTIVE EQUIPMENT PROTEcelON CONTRJ;>. CAIDAS FALL PROTECTION REGLAS DE HIGIENE HYGIENE RULES PROCEDIMIENTO DE DISCIPUNA DISCIPuNE PROCEDURES EVACUACION DE EMERGENCIA EMERGENCY EVACUATION GMP X X TRAINING PROTECCI0N DE LOS OIDOS HEARING PROTECTION PROTECCION RESPIRATORIA RESPIRATORY PROTECTION PROTECCION DE OJOS Y PRIMEROS AUX1LlOS EYE SAFETY & FIRST AID REPORTANDO UN ACCIDENTE REPORnNG AN INJURY LIMPIEZA DE LA PARTE DE ARRIBA (TECHO) OVERHEAD CLEANING lIMPIEZA DE CORREAS 0 BANDAS CLEANING CONVEYORS ENTRENAMIENTO EN EL USO DE MANGUERA HOSE SAFETY TRAINING SEGURIDAD EN LA ESCAlERA LADDER SAFETY ATTENDEES 7d FEB-11-201516:54 From:Cas9 Farms r. To:91?~~ ~~?1996 3305883452 OH1 aoa·SAFETY FAX (336) 632-1996 CAL·CLEAN SAFETY TRAINING PROGRAM LOCATION: CASE F RMS - 0 101 000 DATE: 1/23/20 MANAGER:-r~pL~~--~-------------- START TIME: END TIME: J ~RO~ 9- !1I.°f~ TRAINING PROCEDURES COVERED COMUNICACION DE PEllGROS HAZAROOUS COMMUNICATION X GMP TRAINING CHJiMICAl. $AFETY PROTECCION DE LOS OIo0S HEARING PROTECTION PROTECCION RESPIRATORIA RfSPIRATORY PROTECTION PROTECCION DE OJOS Y PRlMEROS AUXILIOS EYJ; SAFETY & FIRST AID ACCESORIOS OE PROTECCION PERSONAl. PERSONA~ PROTEOTlVS I;QUIPMENT PROTECCION CONTRA CAlOAS FALL PROTECTION REOlAS DE HIGIENE: HYGIENE RUI.ES PROCEDIMIENTO DE OISCIPLINA DISCIPLINE PROCEDURES EVACUACION DE EMERGENCIA ~RGENCY EVACUATION Rtf'ORTANOCl UN ACCIDI::NTI: REPOlmNI) AN INJURY I.IMPIW O/OI,A PART" 01; ARRIBA (TIiCHO) OVERHEAD CLEANING l lMPIEZA OE (lORR.EAS 0 BANDAS CLEANINQ CONVEYORS ENll!.ENAMIENTO EN EL uSO DE MANCUERA HOSE SAFETY TRAlNINO ESPACIO CONFINAOO CONFlNED SPACE ORIENTACION DE PROTECCION X &J\FETY ORIENTATION ASEGURAR CON UAVE Y MARCAR QUIMICOS LOCK OUTI TAG OUT PRon;CCION CON"mA QUIMICOS - - ATTENDEES 7d Page:1/43 FEB-1l-201516:54 From:Cas9 Farms To:9) n~I)!5;:\ ?'1996 3305883452 OH100()'SAFETY LOCATION: CASE F DATE: 1/23/201 5 CAlooClEAN SAFETY TRAINING PROGRAM MS - OHI01000 START TIME: MANAGE~.~~-=~~~~_____ END TIME: COMUNICACION DE. PEUGROS HAZARDOUS COMMUNICATION OR1ENTACION DE PROTECCION &~E1Y ORIENTATION ASEGURAA CON ll.Avt; Y MAACAR QI,I/M/COS LOCK OUTI TAG OUT PROYI!CCION O.ONTRA QUIMICOS CHeMICAl. SAfE'N ACCESOA.IOS oa PROTECCION PERSONAL PERSONAL PROTECTIVE EQUIPMENT PROTECCION CONYAA CAlMS FALL PROTEeTlON REGLAS DE HIG/eNE HYGIENE RULES PROCEOIMIENTO DE DISCIPLINA DISCIPLINE PROCEDURES EVACUACION DE EMfRGENClA EMl!RGENCY EVACUATION TRAINING PROTECCION DE lOS OIOOS HtARlNG PROTECTION PRO~CC/ON RESPlRATORlA ResPIRATORY PIlOn:CTION PIlOTECCION OE OJOS Y PRlM6ROS AUXI~IOS EVE SAFE'TY , FIRST AID R~PORTANOO UNACCIDENTE REPORTING AN IU,JURY UMPIEZA DE I.A PAltn: OE ARRllIA (lECHO) Ol/ERKEAO CLEANING LIIIIPIEZA DE CORAeAS 0 BANDAS CLEANING CONVEYORS ENTRENMlIENTO EN El USC DE MANGUJiRA HOSE SAFETY TRAINING !:SPAtIO CONFINADO CONfiNED SrACE X X GMP ATTENDEES 7d Pag9:2/43 FAX (336) 832·1996 HAZARD GOMMUNICATION 1.0 Scope / Aleanee The requirements set forth in this program cover all employees potentially exposed to hazardous chemicals. Los requisitos establecidos en este programa eubre a todos los empleados potencialmente expuestos a sustancias quimieas peligrosas. 2.0 Hazard Detennination / Determinacion de Riesgos For all hazardous and non-hazardous chemicals which are purchased, Cal-Clean will rely in good faith on the hazard detenninations which are made by the manufacturer, importer, distributor, or supplier of the chemical. Para todos los produetos quimieos peligrosos y no peligrosos que se compran, Cal-Clean dependera en buena fe en las determinaciones de riesgos que estan heehas por el fabrieante, importador, distribuidor o proveedor del produeto quimico. 3.0 Duties and Responsibilities / Deberes y Responsabilidades 3.1 The following duties and responsibilities are outlined under this program. Las siguientes funeiones y responsabilidades se describen en este programa. 3.1.1 Operations Manager / Gerente de Operaeiones (a) 3.1.1.1 Overall implementation and enforcement of program. (a) La Implementaeion general y la ejeeueion de los programas. 3.1.1.2 Coordination and technical support for program. (a) Coordinacion y apoyo teenieo para el programa. 3.1.1.3 Review of new chemicals with new or different hazards. (a) Revision de los quimicos eon nuevas a diferentes riesgos. 3.1.1.4 Authorization for program review. (a) Autorizacion para la revision del programa. 3.1.2 Site Manager / gerente de sitio (b) 3.1.2.1 Coordination with customer personnel. (b) Coordinaeion eon el personal del cliente. 3.1.2.2 Assuring ALL Cal-Clean employees are following proper Hazard Communication procedures. (b) Garantizando que todos los empleados de Cal-Clean estan siguiendo adeeuadamente los Proeedimientos de eomunicaei6n de riesgos. I ,-'I 3.1.3 ' Cal-Clean Employees / Empleados de Cal-Clean (b) 3.1.3.1 Ensure all containers have appropriate labels. (b) Garantizar que todos los eontenedores tienen etiquetas adeeuadas. 3.1.3.2 Perform Site specific training regarding hazards. (b) Realizar entrenamiento espeeifieoal sitio sobre los peligros. 3.1.3.3 Ensure chemicals arrive with appropriate labels. (b) HAZARD COMMUNICATION Asegurar que los productos quimicos llegan con apropiadas. 3.1.3.4 Obtaining MSDS sheet for each chemical. (b) Obtencion de hoja MSDS para cada quimico. 4.0 Container Labeling / Etiquetado de Contenedor 4.1 The primary method of container labeling will be to rely on the required manufacturer's label. Each label is required to have the following information. El principal metodo de etiquetado del contenedor sera en base a la etiqueta del fabricante. Cada etiqueta debe tener la siguiente informacion 4.1.1 4.1.2 4.1.3 4.2 Chemical name / Nombre del quimico Appropriate hazard warning(s) / advertencia apropiada del peligro (s) Name / address of the responsible party / Nombre I direccion del responsable The person responsible for receiving chemicals at the facility are responsible for assuring that labels are present prior to placing it in stock for use. La persona encargada de recibir los productos quimicos en la instalacion es responsable de asegurarse que tengan las etiquetas antes de colocarlos en el inventario para el usoldistribucion. Note: If a hazard label is missing or unreadable, we must replace missing / unreadable label prior to use. Nota: Si una etiqueta de peligro no se encuentra 0 es dificil de leer, debemos sustituirla antes de su uso. 4.3 When chemicals are transferred into secondary containers or stationary process containers, one of the two following methods for labeling must be used: Cuando se transfieran productos quimicos a un segundo contenedor 0 a un sitio de procesos, se debe utilizar uno de los dos siguientes metodos de etiquetado: 4.3 .1 An original label can be duplicated or obtained from the manufacturer or supplier and attached to the secondary container. La etiqueta original se puede duplicar U obtener del fabricante 0 distribuidor y se coZoca al contenedor secundario. 4.3.2 The secondary container can be labeled using the Hazardous Material Identification System (HMIS)(Reference Attachment 2). HMIS labels will contain the identity of the hazardous chemical in the container and an appropriate hazard warning. Information from the material safety data sheets will be used in determining the appropriate hazard warning(s) to be used on the HMIS labels. EZ contenedor secundario se pueden etiquetar usando el Sistema de Identificacion de MateriaZes PeZigrosos (HMIS) (Adjunto referenda 2). Las etiquetas HMIS deben traer fa identidad de la sustancia quimica HAZARD COMMUNICATION peligrosa en el contenedor y una advertencia apropiada peligro. La informacion de las hojas de datos de seguridad de materiales sera utilizada para determinar la advertencia de peligro apropiada (s) para ser utilizada en las etiquetas HMIS. 4.3.3 Site Manager will be responsible for assuring that all containers of chemicals within their deparhnent are properly labeled. This includes original containers as well as secondary or stationary process containers. El Gerente de Sitio sera el responsable de garantizar que todos los contenedores de quimicos dentro de su departamento estan etiquetados apropiadamente. Esto incluye los contenedores originales asi como los secundarios y los contenedores de procesos fifos. 5.0 Material Safety Data Sheets (MSDS) / Hoja de Datos Seguridad de Materiales (MSDS) 5.1 A Computerized MSDS Data File is available for quick access on all office computers. This MSDS Data File has sub-folders for each facility deparhnent listing chemicals used by that department. Un archivo de datos MSDS computarizado esta disponible para acceder con mayor rapidez en todos las computadoras de las oficinas. Este archivo de datos MSDS tiene subcarpetas para cada uno de los departamento de la planta con las !ista de quimicos utilizados por dicho departamento. 5.2 Paper copies of MSDS for all hazardous chemicals to which employees may be exposed will be kept and maintained in the following locations: Copias en papel de las MSDS para todos los quimicos peligrosos a los cuales los empleados puedan estar expuestos seran conservados y mantenidos en los siguientes lugares: 5.2.1 Chemical Room / Area - Cuarto de Quimicos IArea 5.2.2 Cal-Clean Safety / SSOP Manual- Cal-Clean Seguridad I SSGP Manual 5.3 A copy of each new MSDS will be given to the Site Manager in order to update the MSDS files and hazardous chemical list. Una copia de cada MSDS nueva sera entregada al Gerente de la planta con elfin de actualizar los archivos de la MSDS y la !ista de quimicos peligrosos. 5.4 The Site manager shall be consulted and provided copies ofMSDS for any process change involving purchasing new chemicals. . El Gerente de la planta sera asesorado y recibira copias de MSDS por cualquier cambio en el proceso que implique la compra de quimicos nuevos 5.5 MSDS will be available to all employees upon request to the Site Manager by at least Los the end of their shift. MSDS estaran disponibles para todos los empleados que se los pidan al Gerente de la planta al menos al terminar su turno. HAZARD COMMUNICATION List of Hazardous Chemicals Utilized! Lista de Qufmicos Peligrosos Utilizados 6.0 6.1 The following is the list of Hazardous Chemicals: La siguiente es la !ista de productos qufmicos peligrosos: 1. AMIH-DACID 2. Gil Acid LF 3. Gil Caustic CIP 4. Gil Chlor-on 5. Gil Chlor-on 12.5 II 6. Gil Cosmo-Terge 7. Gil Dri-Quat 8. Gil FP 9. Gil Grime-A-Way 10. Gil Heavy Duty CIP 11. Gil Hi-Foam 12. Gil Lubrikleen SN 13. Gil Luster 14. Gil PR Acid 2 15. Gil Quatsan-C 16. Gil Save 17. Gil Smokehouse PF 18. Gil Strip Away 19. Gil Sud Z Wash 20. Gil Super CIP 21. Gil Super NP 22. Gil Ultra Foam 23. Gil Wildcat 24. VigorOx LSD 25. Sanidate 5.0 26. AFCO 6008 Millenium Yellow 27. AFCO 5244 Tern 28. AFCO 0251 Chlorilizer Plus 29. AFCO 3341 Fryer Cleaner 30. AFCO 4312 Vigil Quat 31. AFCO 5237 Super Alk HD 32. AFCO 5390 Ultralife BA 33. AFCO 6001 Millenium release 34. AFCO 5539 Lubricon HD 35. AFCO 5249 Scrubbie 36. AFCO 6010 Viceroy Hazardous Non-routine Tasks! Peligrosas tareas no rutinarias 7.0 7.1 Periodically, employees may be required to perform hazardous non-routine tasks. Prior to starting work on such projects, each employee will be given information by their supervisor and/or department manager about the hazardous chemicals to which they may be exposed, or, each employee will receive specialized training in order to perform the task safely. Periodicamente, a los empleados se les requiere realizar tareas peligrosas que no son rutinarias. Antes de comenzar a trabajar en dichas tareas, cada empleado recibira informacion por parte de su supervisor y / 0 gerente de departamento sobre los productos quimicos peligrosos a los que puedan estar expuestos, 0, cada empleado recibira capacitacion especializada para !levar a cabo la tarea con seguridad. 8.0 Informing Customer! Informando al cliente 8.1 Customer will be informed of the existence, location, and availability of this written hazard communication program. MSDS' sheets will be made available to any contractor who may be potentially exposed to hazardous chemicals during the performance of their work. El Cliente sera informado de la existencia, ubicacion y disponibilidad de este programa HAZARD COMMUNICATION de comunicacion de riesgos por escrito. Hojas MSDS estaran a cualquier contratista que pueda estar potencialmente expuesto a sustancias qufmicas peligrosas durante el desempeno de su labor. 8.2 Cal-Clean must provide copies ofMSDS available for any hazardous chemicals Calbrought on site to the Safety Manager for review. Clean debe proporcionar copias de MSDS para productos qu£micos peligrosos presentes en el sitio al Gerente de Seguridad para su revision. Employee Training and Information I Capacitacion de los empleados e Informacion 9.0 9.1 Prior to starting work each new employee will receive information and training on Cal-Clean's hazard communication program as part ofthe orientation process. Antes de comenzar a trabajar cada empleado nuevo, recibira informacion y capacitacion sobre el programa de comunicacion de riesgos de Cal-Clean como parte del proceso de orientacion. 9.2 Employee's may receive additional training by their Site Manager under the Empleado following conditions. puede recibir capacitacion adicional de su Gerente de Sitio bajo las siguientes condiciones: 9.2.1 Upon initial assignment, hazards specific to their department. Tras la asignacion inicial, los riesgos especificos de su departamento. 9.2.2 Assignment or reassignment to an area where certain specific chemical hazards exist. Asignacion 0 re-asignacion a una area donde existan ciertos riesgos qufmicos especificos. 9.2.3 Introduction of a new chemical into their area. La introduccion de un qu£mico nuevo en su area. 9.2.4 Annual Hazard Communication Training as required by OSHA's 1910.1200 Hazard Communication Standard. Entrenameinto Anual de Comunicacion de Riesgos como es requerido por las Norma de Comunicacion de Peligros OSHA 1910.1200. Changes and Reviews I Cambios y revisiones 10.0 11.0 10.1 Changes to this program must be approved by Cal-Clean's Operation Manager. A1odificaciones a este programa deberan ser aprobado por el Gerente de Operaciones de Cal-Clean. 10.2 This program will be reviewed annually by the Operations Manager. Este program a sera revisado anualmente por el Gerente de Operaciones. Food Safe Approved Chemicals I Quimicos aprobados como seguros para alimentos HAZARD COMMUNICATION 11.1 To meet Food Safety and USDA Federation Regulations, Food SQ.,I."..........___Chemicals must be used when potential direct or indirect contact is considered to be a possible food hazard. Para cumplir con la Seguridad Alimentaria y el Reglamento de la Federacion USDA, quimicos que son seguros para alimentos deben ser utilizados cuando un contacto directo 0 indirecto es considerado como posible peligro en los alimentos. 11.2 Food Safe Chemicals are required to be stored separated from Non-Food Safe Chemicals for issue inside the facilities production area. Los Quimicos seguros para alimentos estan obligados a ser almacenados por separado de los quimicos que no son seguros para alimentos para su distribuci6n dentro de las instalaciones del area de producci6n. 11.3 An approved Food Safe Chemical List is provided on the MSDS files for access by all supervisors and managers. Un listado de quimicos aprobados para la seguridad alimentaria esta en los archivos de MSDS los cuales tienen acceso los supervisores y gerentes. NOTE: Any chemical found to have a strong odor / scent is NOT AUTHORIZED! for use without prior approval from Operation Manager or Safety manager. NOTA: eualquier quimico que se Ie encuentre unfiterte olor / aroma NO ESTA AUTORIZADOf para su utilizaci6n sin la previa autorizaci6n del Gerente de Operaciones 0 Gerente de Seguridad. 12.0 Additional Procedures to Prevent Chemical Contamination of Products / Procedimientos adicionales para prevenir la contaminaci6n quimica de los productos 12.1 Mechanic's performing production equipment preventative maintenance task that require use of chemicals or grell;se are required to clean all excess residue from the equipment and ensure that the Sanitation Cleaning Crew is notified to thoroughly clean and sanitize prior to production use. Los Mecanicos encargados de las tareas de mantenimiento preventivo en los equipos de produccion que requieran el uso de quimicos 0 grasa estan obligados a limpiar todo el exceso de residuos de los equipos y asegurarse que el grupo de limpieza de Saneamiento sea advertido de !impiar y desinfectar a fonda antes de su usa en producci6n. HAZARD COMMUNICATION ~STEMA DE DDEtfl1F1CAC1ON DE RlESGOS QUIMICOS C.IIEM1CAL HAZARD IDENTIFICATION SYSTEM O~;CJ?N ox'~' . .:id ,.\ 1).:;11 1 ACID COfTOsi.-c COR ' I", ","0 ViA l"'ER :;:"':\"i,IU\>" Ila (Continua at reverso) E E o U -0 Para mas informacion: OSHA Administraci6n de Seguridad y Salud Ocupacional Departamento de Trl!bajo de los EE. UU. www.osha.gov (800) 321-0SHA (67421 ~ I N ~ N 9 LO 00 M « I Ul o Fichas de datos de seguridad para la comunicaci6n de peligros Secci6n 7, Manipulaci6n y almacenamiento, describe las precauciones para manipular y almacenar con seguridad los materiales, entre otras, las incompatibilidades. Secci6n 8, Controles de exposici6n/protecci6n personal, enumera los Ifmites de exposicion permisibles (PEl) de la OSHA, valores limite umbrales (TLV), controles de ingenieria apropiados, y equipos de proteccion personal (EPP). Secci6n 9, Propiedades fisicas y quimicas, menciona las caracterfsticas del producto quimico. Secci6n 10, Estabilidad y reactividad, describe la estabilidad qufmica y la posibilidad de reacciones peligrosas. Secci6n 11, Informaci6n toxicol6gica, enumera las vias de exposicion, los sintomas y efectos agudos y cronicos relacionados, y las medidas numericas de la toxicidad. Seccion 12, Informacion Seccion 13, Informacion productos* Seccion 14, Informacion Seccion 15, Informacion ecotoxicologica* relativa a la eliminacion de los relativa al transporte* sobre la reglamentaci6n* Secci6n 16, Otras informaciones, incluye la fecha de preparacion 0 de la ultima modificacion. *Nota: debido a que otros organismos regulan esta informacion, la OSHA no exigira el cumplimiento de las secciones 12 a 15 (norma 29 CFR 1910.1200(g)(2)). Los empleadores deben comprobar que los empleados tengan acceso facil a las FDS. Consultar la descripcion detallada del contenido de las FDS en el Apendice D de la norma 29 CFR 1910.1200. Para mas informacion: OSIM Administraci6n de Seguridad y Salud Ocupacional Departamento de Trabajo de los EE. UU. www.osha.gov (800) 321-0SHA (6742) Hazard Communication Safety Data Sheets The Hazard Communication Standard (HCS) requires chemical manufacturers, distributors, or importers to provide Safety Data Sheets (SDSs) (formerly known as Material Safety Data Sheets or MSDSs) to communicate the hazards of hazardous chemical products. As of June 1,2015, the HCS will require new SDSs to be in a uniform format, and include the section numbers, the headings, and associated information under the headings below: Section 1, Identification includes product identifier; manufacturer or distributor name, address, phone number; emergency phone number; recommended use; restrictions on use. Section 2, Hazard(s) identification includes all hazards regarding the chemical; required label elements. Section 3, Composition/information on ingredients includes information on chemical ingredients; trade secret claims. Section 4, First-aid measures includes important symptoms/effects, acute, delayed; required treatment. Section 5, Fire-fighting measures lists suitable extinguishing techniques, equipment; chemical hazards from fire. Section 6, Accidental release measures lists emergency procedures; protective equipment; proper methods of containment and cleanup. Section 7, Handling and storage lists precautions for safe handling and storage, including incompatibilities. (Continued on other side) For more information: 0)SfM. Occupational Safety and Health Administration U.S. Department of Labor www.osha.goY (800) 321-0SHA (6742) '" <; '" Hazard Communication Safety Data Sheets Section 8, Exposure controls/personal protection lists OSHA's Permissible Exposure Limits (PELs); Threshold Limit Values (TLVs); appropriate engineering controls; personal protective equipment (PPE). Section 9, Physical and chemical properties lists the chemical's characteristics. Section 10, Stability and reactivity lists chemical stability and possibility of hazardous reactions. Section 11, Toxicological information includes routes of exposure; related symptoms, acute and chronic effects; numerical measures of toxicity. Section Section Section Section 12, Ecological information* 13, Disposal considerations* 14, Transport information* 15, Regulatory information* Section 16, Other information, includes the date of preparation or last revision. *Note: Since other Agencies regulate this information, OSHA will not be enforcing Sections 12 through 15 (29 CFR 1910.1200(g)(2)). Employers must ensure that SDSs are readily accessible to employees. See Appendix 0 of 29 CFR 1910.1200 for a detailed description of SDS contents. For more information: ()SfM Occupational Safety and Health Administration u.s. Department of Labor www.osha.gov (800) 321-0SHA (6742) SAMPLE LABEL CODE -:-::_ _ _ __ _ __ _ } ProductNam. Product Identifier Hazard Pictograms COmpBnyNamD'_ _ _ _ __ __ StreotAddrBS ..._ _ _ __ _ _ _ } ~;~ta~lc~D7d.-----c:-Ou~_ _ Hazard Communication Standard Labels OSHA has updated the requirements for labeling of hazardous chemicals under its Hazard Communication Standard (HCS). As of June 1,2015, all labels will be required to have pictograms, a signal word, hazard and precautionary statements, the product identifier, and supplier identification. A sample revised HCS label, identifying the required label elements, is shown on the right. Supplemental information can also be provided Emergency PhonB Number Signal Word Danger Keep contoinertighdy closed. Store in a cool, well·ventilated placa1hatis locked. Keep away from heal/sparks/apen Harne. No smoking. Only use non-sparking tools. Use BJCplosian-proaf electrical equipment Take precaudonary measures against static discharge. Ground Bnd band container and receiving equipment Do not breathe vapor$, Woar protective gloves. Do not eat, drink Dr smoke when using this product Wash hands thoroughly after handling. Dispose of in accordance with local, regional, national, intemalional regulations as specified, In Case of Are: USB dry chemicallBC) or Carbon Dioxide (COd on the label as needed. Highly flilmmable liquid and vapor. } May cause liver and kidney damage. Hazard Statements Precautionary Statements Supplemental Information Directions ror USB fire axtinguisharto extinguish, For more information: Occupational (800, 321·0SHA (6742, Safety and Health www.o8ha.gov Administration Supplier Identification Fir5tAld If exposed call Poison Center. Ifon skin jor hairl: Take off immediately any contaminated clothing, Rinse skin with water. Fill weight LDtNumber. ~~:U~~~t-.:===== RII 0118,_'- - - - ETIQUETA DE MUESTRA CclOIGO -:-:-_ -:-_ _ __ _ _ _ } Hombre del ,roducta IdentifiGaeion del producto Pictogramas de peligro Hombre dela empruOl _ _ _ _ __ m,,«i... Etiquetas para la norma sobre la comunicacion de peligros De acuerdo con su norma de comunicaci6n de peligros (HCS, por sus siglas en ingles), la OSHA ha actualizado los requisitos para las etiquetas de los produc,os qufmicos peligrosos. A partir del to de junio de 2015, se exigira que todas las etiquetas incluyan pictogramas, una palabra de advertencia, indicaciones de peligro, consejos de pruden cia, identificaci6n del producto y la identificaci6n del proveedor. A la derecha se presenta la muestra de una etiqueta modificada de acuerdo con la HCS, que indica los elementos obligatorios. La etiqueta puede contener tambien informacion suplementaria segun sea necesario. Para mas informacion: O>SHX Adminlstraci6n de Seguridad y Salud Ocupacio~.1 (800) 321-0SHA (&742) www.osha.gov Cl.d.d E" ' do_ C6diga postal Pafs_ __ _ } IdentiflGDeion dolproveedor Numero de tel8fono do emergencia_ _ _ Mimtenar 81 contenedor hermaticamanta cerrado. Palabra de advertBncia Peligro Guardar en un lugarfresco, bien venlilado Vcerrado bajollll.ve. Mantener alojado de fuentes de calor, chispas 0 llama abierta. Nofumar. Usar s610 con h81ramientas que no uunelen chispas. Usar equipo elActJico a prueba de explosionas. Tornlllr madidas de precaution contra descergas estiticll.s" Rjar Vconactar II tierra 01 oquipo contenedory recaptor. No respirar los vapora!. Ullr guantas protectore!. Abt r.n,u. d, CCl:lJer. beb u olumar cuando ". u.u eft" prodllcto. lavarso muybiBn las manos dSSpU9S de maneiar este producto. Desechar el producto segun las especificacionesy los raglamentos locales, regionales, nilclclllliali II mtllmll!ciQnllroL UquJdo y vapores muy 1nnamables. Puede provocar dafiO$ ,,' hrgado y a 10$ riflanes. } Indicaciones de peligro Consojos de prudeneia Informacion suplementaria InstrucchHles da uso En calO de incendhr. usar lin axtintor de polvo quimico ltipo BCI 0 de biOxido de carbono ICOJI. Primaros aUllilioa Si hay exposicion a oote producto, lIamar al Centro de Conlroldalntoxicacionas. En caSD de contatto con la pial 0 al caballo: quitarse de inmodiato toda la ropa contaminada.l.avarse fa piel con agua. Pasollano:_ _ _ NUmaro de lote'~_ __ Peso bruto:_ _ _ Fecha de lIanado:_ __ Fecha de caducidad·_ _ __ NFPA 704 Placard & Ratings VOlUntarilY t"'fOVloea GHS System and Labels Down in Section 2 SECTtON 1. PRODUCT ANI) COMPANYlDENTlFICAll0N Pr~duct name Synonym_ PraductXYZ 50S Number f"roGuet '-'lUI O_erlpClon compail"Y Chemtroc {Emorgency Co,nnct} Clas.IfI~Uon • r r::':~Hr'.,-:,:.(;r-:~,· t -.n' ? (t:.-:j)I ttl 1_~J on f(.; 11- \Jtl:l~I(;;'_ (::'-'1tIgi.'!"),' i y-.;:"t:l f" ry,H-~ I :.~ ::-tl"£.1;. .. l ()TQ':... :l1 1 nX1; rl,. ~R,:,,!""::-~,-:""'{~"rf f- ....-;j'·"-..-;f.t'--:.".,; r.'_~,c-t.~:_'kt{n~'" ~/~ <'i'l~,q i.2,bH': L;.qd.:.\1 /~1~fJr·-,~,.t on. r-1~.• ;:..{")n1 C ,;,:--" !T'FJ.!:Jf! "fir t'./ ~";':)f,-!;'lrif:, PidDiil rltm. J ~-j).)j:~~ l(tj.~ -; -;'Ull"·-; ~)iS~t'~ SIotI't l!'1'\t~'~/Oq C;_l~(~qfH''''{ i~ \~J;O: : : j ( / (::~:!ttJj/';; F'V"~ fr--r:~.':\'I·'{lrl ·::"·\"'~fF.lf;! 2d ~ r 1::.' '..f.;~ Ii. ~i' I. PLEASE MAKE SURE: YOUR EMPLOYEES ARE TRAINED ON THIS NEW HAZARD COMMUNICATION MATERIALS. 1. NEW HAZARD COMMUNICATION STANDAR PICTOGRAM PICTOGRAMA PARA LA NORMA SOBRE LA COMUNICACION DE PELIGROS 2. HAZARD COMMUNICATION SAFETY DATA SHEETS- OLD MSDS NOW CALLED "SDS" NEW EXAMPLE INCLUDED FICHAS D'E DATOS DE SEGURIDAD PARA LA COMUNICACION DE PELIGROSEJEMPLO NUEVO INCLUIDO 3.HAZARD COMMUNICATION STANDARD LABELS ETIQUETAS PARA LA NORMA SOBRE LA COMUNICACION DE PELIGROS Pictograma para la norma sobre la comunicaci6n de peligros A partir del 1.0 de junio de 2015, la norma de comunicaci6n de peligros (HCS, por sus siglas en ingles) exigira pictogramas en las etiquetas para advertir a los usuarios de los peligros qufmicos a los que puedan estar expuestos. Cada pictograma representa un peligro definido y consiste en un sfmbolo sobre un fondo blanco enmarcado con un borde rojo. La clasificaci6n del peligro qufmico determina el pictograma que muestra la etiqueta. Pictogramas V peligros segun la HCS Peligro para la salud ~ Llama ~ Signo ¢ mBciDn • Carcinogeno • Mutagenicidad • Toxicidad para la reproduccion • Sensibilizacion respiratoria • Toxicidad especifica de organos diana • Peligro por aspiracion • Inflamables • Piroforicos • Calentamiento esponlaneo • Desprenden gases inflamables • Reaccionan esponlaneamenle (aulorreactivas) • Peroxidos organicos • Irritante (piel y oiosl • Sensibilizador cutaneo • Toxicidad aguda (danino) • Efeclo narcotico • Irrilanle de vias respiratorias • Peligros para la capa de ozono (no obligatorio) Botella de gas Corrosion Bomba explotando 0 • Gases a presion Llama sobre circulo ~ • Comburentes ~ • Corrosion 0 quemaduras cutaneas • Lesion ocular • Corrosivo para los metales Medio ambiente (No obligatoriol ~ • Toxicidad acualica ~ • Explosivos • Reaccionan espontaneamente (autorreaclivas) • Periixidos organicos Calavera V tibias cruzadas ~ • Toxicidad aguda (mortal 0 toxical Para mas informacion: Administraeion de Seguridad y Salud Oeupaeional OSIM Departamento de Trabajo de los EE. UU. www.osha.gov (8001 321-0SHA (67421 Hazard Communication Standard Pictogram As of June 1,2015, the Hazard Communication Standard (HCS) will require pictograms on labels to alert users of the chemical hazards to which they may be exposed. Each pictogram consists of a symbol on a white background framed within a red border and represents a distinct hazard(s). The pictogram on the label is determined by the chemical hazard classification. HCS Pictograms and Hazards Health Hazard ~ Flame ~ • Carcinogen • Mutagenicity • Reproductive Toxicity • Respiratory Sensitizer • Target Organ Toxicity • Aspiration Toxicity • Flammables • Pyrophorics • Self-Heating • Emits Flammable Gas • Self-Reactives • Organic Peroxides Gas Cylinder Corrosion 0 ~ • Gases Under Pressure • Skin Corrosionl Burns • Eye Damage • Corrosive to Metals Flame Over Circle Environment (Non-Mandatory) ~ • Oxidizers ~ • Aquatic Toxicity Exclamation Mark 1> • Irritant (skin and eye) • Skin Silnsitizer • Acute Toxicity (harmfull • Narcotic Effects • Respiratory Tract Irritant • Hazardous to Ozone Layer (Non-Mandatory) Exploding Bomb ~ • Explosives • Self-Reactives • Organic Peroxides Skull and Crossbones ~ • Acute Toxicity (fatal or toxic) For more information: ® Occupational Safety and Health Administration U.S. Department of Labor www.osha.gov (800) 321-0SHA (6742) OSHA Click http:lANww.guidechem.com!cas-87187.90·1.htmlforsuppliers oflhis product Trichloroisocyanuric acid (cas 87-90-1) MSDS MSDS.1RICHLORaSOCY/>NURIC PCID(TCCA) PUY/>NG CLEPNWAY CHEMCJIlS LID. Mll.TERIJIl SPFETYDATASHEEf Updated: Oct. 1, 2006 Version 1.1 Section 1 - Product and Company Information Product Name 1RICHLORaSOCY/>NURIC PCID, 90% Product Number Brand CLEl>NWAY CompanyPuyang CleanwayChemicals Ltd. Mdress Huanghe Xi Road, Puyang,Henan,China Ted-mical Phone: +86.393.4616168 Fax: +86.393.4638678 Emergency Phone: +86.393.8948256 Section 2 - Composition, Information on Ingredients Substance Name CAS # trichloroisocyanuric add 87·90-1 SYNa-JYMS: Trichloro-s-triazinetrione; Trichlor, 1,3,5-Triazine-2,4,6(1 H,3H,5H}-trione, 1,3,5-trichloro-; S)mdosene; TCCA Section 3· Ha2ards Identification NFPA RATINGS (SCJIlE 0-4): HEJIlTH=2 ARE=O REPCTI\i11Y=2 HMS RATINGS (SCJIlE 0-4): HEJIlTH=3 Fl..Jll'vMA8IL11Y=O REPCTI\i11Y=2 POTENTIJIl HEJIlTH EFFECTS: INHPlATIa-J: SHORT TERM EXPOSURE: irritation (possiblysel.ere), bums La-JG TERM EXPOSURE: not a likely route of e>q:lOsure, ulcers SKIN Ca-JTPCT: SHORT TERM EXPOSURE: irritation (possibly sel.ere), bums La-JG TERM EXPOSURE: dermatitis EYE Ca-JTPCT: SHORT TERM EXPOSURE: bums, e~ damage, blindness La-JG TERM EXPOSURE: e~ damage, blindness Phone:+86.393.4616168 Fax: +86.393.4638678 Email: admin@:jeanwaychem.com -1M3D5-lRlCHLCRCASOCYMIURlC PCID(TCCA) INGESTleN: SHCRTTERMEXPOSURE: not a likely route of e~osure, irritation (possiblysewre), bums LeNG TERM EXPOSURE: not a likely route of e~osure, ulcers CARCINOGEN STA1US: OSHA: No N1P: No II'RC: No Section 4 - First.Aid Maasures INHPLATleN: If adloerse effects oq:;ur, remow to uncontaminated area. Giloe artificial respiration if not reathing. If breathing is difficul~ o~en should be administered by qualified personnel. If respiration or pulse as stopped, haloe a trained person administer Basic Life Support (Cardio-PulmonaryResuscitationlPutomatic Jdemal Defibrillator) and CPlL FCR ENERGENCY SERVICES IMNEDIATELY. SKIN CeNTPCT: Immediately flush contaminated areas with water. Remoloe contaminated clothing, jewelry,and shoes immediately. Wash contaminated areas with soap and water. Thoroughly clean and drycontaminateddothing and shoes before reuse. IF IRRITAllCAII OCCURS, GET NEDICPl ATTENTleN. EYE CeNTPCT: Immediatelyflush ej.es with a directed stream ofwaterforatieast 15 minutes, forcibly,olejing ej.eHds apart to ensure complete irrigation of all ej.e and lid tissues. Washing ej.es within sewralseconds is essential to achieloe maximum effecti\eness. GET NEDICPl ATTENTlCAIIIMliEDIATELY. INGESTleN: Ne\er giloe an~ing by mouth to an unconscious or conwlsiw person. If swallowed, do not induce I.Omiting. Giw water.lfl.Omiting occurs spontaneously, keep airwaydear. Giw more water when I.OmiUng stops. GETMEDICPl ATTENTleNlMliEDIATELY. NOTE TO PHYSICIMI: Probable mucosal damage may contraindicate the use ofgasbic lavage. Section 5 - Fire Fighting Maasures FIRE MID EXPLOSleN H.AZJ!RDS: Negligible fire hazard. If heated by outside source to temperatures ENERGENCY OVERVIEW: CC4..CR: white PHYSICPl FCRM crystals, granules ODOR: chlorine odor Ml\JOR HEPlTH H.AZJ!RDS: CCRROSIVE. CMJSES IRRE\£RSIBLE EYE DPM'GE. r.lAY CMJSE BURNS TO IVOIST SKIN IF NOT PROI'vPTlY Phone:+86.393.4616168 Fax: +86.393.4638678 Email: admin@:jeanwaychem.com -2MSD5-TRICHLOROISOCYMIURIC PCID(TCCA) REMJVED. IIA/IYSE FATPl IF INHPlED. HPRM'UL IF SWPlLOM:D. PHVSICPl HAZPRDS: Strong olq:Jlosion hazard. EXTlNGUISHING rvEDIA: Aood with water: Do not use dry chemicals, carbon diolidizing state. Contact ~hem tor instructions for handling and disposal ot damp material. Keep out atwater supplies and sewers. Releases should be reported, if required, to appropriate agencies. Section 7 - Handling and Storage STORPGE: Store and handle in accordance with all current regulations and standards. (NFPAOJddizer Classification 1.) Do not allow water to get in container. It liner is presen~ tie after each use. Keep container tighdydosed and properly labeled. Store containers on pallets, Keep away from tood, drink and animal feed. Keep separated from incompatible substances. HANDLING: Do not get in e~s, on skin , or on dothing. AloOid breathing vapors or dust when opening container. AloOid creation of dust Wash thoroughly after handling. Ne\er add water to this product.lllways add product to large quantities of water. Use dean, dry utensils. Do not add the product to any' dispensing de~ce containing residuals at other products. Phone:+86.393.4616168 Fax +86.393.4638678 Email: admin@:leanwa)d1em,com-~ MSD5-TRICHLOROSOCYPNURIC PCID(TCCA) Section 8 - Bcposure Controls, Personal Protection EXPOSURE LlMTS: Chlorine maybe found in slight amounts in the'f1ead space of containers ofTCCAProducts. TRICHLORO-5-TRIAZINETRIONE: 0.5 mg/m3 recommended 1WA8 hour(s) (intemal Occupational E>cposure Limit) 1.5 mg/m3 recommended STEL 15 minute(s) (intemal O::cupational Bcposure Limit) CHLORINE: 1 ppm (3 mg/m3) OSHAceiling 0.5 ppm (1 .5 mglm3) OSHA 1WA(vacated by58 FR 35338, June 30, 1993) 1 ppm (3 mglm3) OSHASTEL (vacated by58 FR 35338, June 30,1993) 0.5 ppm PCGIH 1WA 1 ppm PCGlH SlEL 1 ppm (3 mg/m3) lI.£XICO 1WA 3 ppm (9 mg/m3) IIiEXICOSTEL VENTlLATlON: Use only in well Ioentilated areas. Pro\1de local elpnea, frothy sputum, cyanosis, and dizziness. Phy.>ical findings mayindude moist rales, low blood pressure and high pulse pressure. Sewre cases may be fatal. CHRO\IIC ~OSURE: Depending on the concentration and duration of e~sure, repeated or prolonged e~osure may cause inflammatory and ulceratiloe changes in the upper respiralorytract. Skin Contact ACUTE EXPOSURE: Direct contact with wet material or moist skin may cause seloere irritation, pain, and possibly bums. This material is not considered to be skin sensiti:2254 mg/kg oral-N. Bobwhite LD50; >10,000 ppm inhalationMIllard duck LCSO; 72S3 - >1 0,000 ppm inhalation-N. Bobwhite LC50 Section 13 - Disposal Considerations Use or reuse if possible. This material is a registered pesticide. Dispose in accordance with all applicable regulations. Do not put product spilled product or filled or partiallyfilled containers into the trash or waste compactor. Contact with incompatible materials could cause a reaction and fire. DO NOT trans port wet or damp material. Damp material should be neutrali:red to a non-Olcidi2ing state. Contact ~hem for instructions for handling and disposal of damp material. See product label for container disposal information. Mlybe subjectto disposal regulations: Hazardous Waste Number(s): 0003. Section 14 - Transport Information PROPER SHIPPING NM/E: Trichloroisocyanuric acid, dry 10 NUM3ER: UN2468 H.AZAAD CLASS OR DIV1SION: 5.1 PPCKlNG GROUP: II lP8ELlNG REQUIRBv£NTS: 5.1 SecHon 15 - Regulatory InforrnaHon CERCLASECTlONS 102a11 03 H.AZAADOUS SUBSTPNCES (40 CFR 302.4): Not regulated. SPRATlll.E III SECTlON 302 EXlREM:LYH.AZAADOUS SUBSTPNCES (40 CFR 355.30): Not regulated. ACUTE: Yes CHRONIC: No FIRE: Yes REPCTlVE: Yes SUDDEN RELEASE: No Section 16 - Other Information DISCL...AIIVE For R&D use only. Not for drug, household or other uses. Phone:+86.393.4616168 Fax +86.393.4638678 Email: admin@deanwa}dlem.com -7IVSDS-TRICHLOROISOCYPNURIC ACID(TCCA) WPRRPNTY The abol.e information is beliel.ed to be correct but does not purport to be all indusil.e and shall be used only as a gUide. The information in this document is based on the present state of our knoWledge and is applicable to the product with regard to appropriate safetyprecauHons.1t does not represent any guarantee of the properties of the product Puyang Cleanway Chemicals Ltd., shall not be held liable for any damage resulting from handling or from contact with the abol.e product Copy Right(2004-2006) Puyang Cleanway Chemicals Ltd. Phone:+86.393.4616168 Fax +86.393.4638678 Email: admin@deanwa}dlem.com-8- S#0251 DEGREE OF HAZARD 4=EXTREME 3= HIGH 2= MODERATE 1 = SLIGHT 0= INSIGNIFICANT MATERIAL SAFETY DATA FLAMMABILITY =================================================== SECTION I - IDENTIFICATION ========================================~========== IDENTITy . ..... . . .. . . . .... AFCO 0251 CHLORILIZER PLUS MANUFACTURER'S NAME . .. . . . ALEX C. FERGUSSON ADDRESS .. . .. . . . . . .... ... . 800 DEVELOPMENT AVENUE CHAMBERSBURG, PA 17201 SPECIAL HAZARD EMERGENCY PHONE NUMBER .. . 717-264-9147 (AFCO BUSINESS HRS) 1-800-424-9300 (CHEMTREC 24 HRS) DATE PREPARED .. .......... 01/02/2014 =========================================================================== SECTION II - HAZARDOUS INGREDIENTS =========================================================================== EXPOSURE LIMITS PPM HAZARDOUS COMPONENTS OSHA PEL ACGIH TLV OTHER LIMITS CAS NO. PCT SODIUM HYPOCHLORITE NA NA NA 7681-;-52-9 10 SODIUM HYDROXIDE NA 1310-73-2 0.8 THE SPECIFIC CHEMICAL IDENTITY OF THE NON-HAZARDOUS INGREDIENTS IN THIS PRODUCT ARE BEING WITHHELD AS A "TRADE SECRET". =========================================================================== SECTION III - PHYSICAL/CHEMICAL CHARACTERISTICS ======= === === ================== ==== ======================================== BOILING POINT . .. .... . .... .. . DECOMPOSES VAPOR PRESSURE (mm HG ) . . .. . . ND VAPOR DENSITY (AIR = 1) ... .. ND SOLUBILITY IN WATER .... . .. .. COMPLETE APPEARANCE/ODOR .. ... . ...... . PALE YELLOW-GREEN LIQUID; CHLORINE ODOR SPECIFIC GRAVITY (HP = 1) .. 1. 2 MELTING POINT .. . .. .. . .... .. . NA EVAPORATION RATE .. ... ...... . ND =========================================================================== SECTION IV - FIRE AND EXPLOSION HAZARD DATA ====== = ================ ======== ==== ======================================== FLASH POINT . .. .. .... . ....... NONE FLAMMABLE LIMITS . .... .... . . . NA LOWER EXPLOSION L I MIT . . . .. .. NA UPPER EXPLOSION LIMIT . ...... NA EXTINGUISHING MEDIA . ... .. . . . USE WATER SPRAY, FOG, FOAM, DRY CHEMICAL, OR CARBON DIOXIDE FOR MATERIALS IN SURROUNDING FIRE . SPECIAL FIRE FIGHTING PROCEDURES . . . . IF AFCO 0251 IS LOCATED NEAR FIRE, WEAR SELF-CONTAINED RESPIRATOR SUITABLE FOR CHLORINE GAS AND FULL PROTECTIVE CLOTHING. UNUSUAL FIRE AND EXPLOSION HAZARD . . MATERIAL IS A STRONG OXIDIZER. CONTACT WITH COMBUSTIBLE MATERIAL MAY PROMOTE COMBUSTION. SODIUM HYPOCHLORITE SOLUTIONS DECOMPOSE WHEN HEATED. DECOMPOSITION PRODUCTS MAY CAUSE CONTAINERS TO RUPTURE OR EXPLODE. 1 .. · I MATERIAL SAFETY DATA SHEET - S#0251 ========================;=;---~--==~~================= ===================== SECTION V - REACTIVITY DATA =========================================================================== STABILITY: UNSTABLE STABLE -X CONDITIONS TO AVOID . . . ..... TEMPERATURES ABOVE 160°F, LIGHT, AND METALLIC IMPURITIES. INCOMPATIBLE MATERIALS . . ... .. ORGANICS, ACIDS, AMMONIA, AMINES, CYANIDES, REDUCING AGENTS, ALUMINUM , ZINC. DECOMPOSITION OR BYPRODUCTS . . CHLORINE GAS WHEN MIXED WITH ACIDS. HAZARDOUS POLYMERIZATION: MAY OCCUR WILL NOT OCCUR -X CONDITIONS TO AVOID ... . ... . NA =========================================================================== SECTION VI - HEALTH HAZARD DATA =========================================================================== PRIMARY ROUTES OF ENTRY INHALATION ? . . . . . . . . .. . . YES SKIN ? .. . . . . . . . . . . . . . . .. YES INGESTION ? . . . . . . ...... . NO HEALTH HAZARDS (ACUTE AND CHRONIC) ACUTE . . . . . . SKIN: SKIN CONTACT MAY CAUSE SEVERE IRRITATION OR BURNS. EYES: EYE CONTACT MAY CAUSE SEVERE IRRITATION, BURNS, OR CORROSION. INHALATION: INHALATION OF FUMES MAY CAUSE SEVERE RESPIRATORY TRACT IRRITATION AND PULMONARY EDEMA. INGESTION: INGESTION MAY CAUSE PAIN AND INFLAMMATION OF THE MOUTH AND DIGESTIVE SYSTEM, BURNS, AND PERFORATION OF THE ESOPHAGUS OR STOMACH, VOMITING. CIRCULATORY COLLAPSE, CONFUSION, AND COMA . CHRONIC ... . . . . . . . . . . . . . . . CHRONIC LOCAL EFFECT MAY CONSIST OF PRIMARY IRRITANT DERMATITIS. 2 .,1__ ..." -+. ~ . --~ ' --:;\ - ? - . .. - ; V MATERIAL SAFETY DATA SHEET - S#0251 =lSIC=====-=:a::•• CARCINOGENICITY NTP ? .. . . . . . . . . . . . . . . . . . NOT LISTED IARC MONOGRAPHS ? . . . . ... NOT LISTED OSHA REGULATED ? . . . . . .. . NO SIGNS AND SYMPTOMS OF EXPOSURE . ... . . CORROSIVE AND STRONGLY IRRITATING TO THE SKIN, EYES, AND RES~IRATORY TRACT. INHALATION OF FUMES MAY CAUSE PULMONARY EDEMA. INGESTION MAY CAUSE BURNS TO THE MOUTH AND DIGESTIVE TRACT . MEDICAL CONDITIONS GENERALLY AGGRAVATED BY EXPOSURE . . . . . MAY EXACERBATE AN EXISTING DERMATITIS. EMERGENCY AND FIRST AID PROCEJDURES . .. SKIN: FLUSH CONTACT AREA WELL WITH WATER FOR 15 MINUTES. REMOVE CONTAMINATED CLOTHING AND SHOES. WASH CLOTHING BEFORE REUSE. IF IRRITATION OCCURS, GET MEDICAL ATTENTION. EYES : IMMEDIATELY FLUSH EYES WITH WATER FOR AT LEAST 15 MINUTES WHILE HOLDING EYELIDS APART TO ENSURE COMPLETE IRRIGATION OF ALL EYE AND LID TISSUE . WASHING EYES WITHIN ONE MINUTE IS ESSENTIAL TO ACHIEVE MAXIMUM EFFECTIVENESS . SEEK MEDICAL ATTENTION IMMEDIATELY. INHALATION: REMOVE TO FRESH AIR, IF BREATHING IS DIFFICULT ADMINISTER OXYGEN. IF RESPIRATION STOPS, GIVE MOUTH-TO-MOUTH RESUSCITATION. GET MEDICAL ATTENTION IMMEDIATELY . INGESTION: IF SWALLOWED,DO NOT INDUCE VOMITING. GIVE LARGE QUANTITIES OF MILK OR GELATIN SOLUTION. IF THESE ARE NOT AVAILABLE, GIVE LARGE QUANTITIES OF WATER. IF VOMITING OCCURS SPONTANEOUSLY, KEEP AIRWAY CLEAR AND GIVE MORE MILK, GELATIN, OR WATER. GET MEDICAL ATTENTION IMMEDIATELY. =========================================================================== SECTION VII - PRECAUTIONS FOR SAFE HANDLING AND USE =========================================================================== STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED . .. DO NOT ALLOW SPILLED MATERIAL TO ENTER SEWERS OR STREAMS. CONTAIN SPILL IN DIKED AREA WITH ABSORBENT SUCH AS CLAY OR SAND . DILUTE WITH WATER AS MUCH AS POSSIBLE. THEN PUMP SPILLED MATERIAL INTO POLYETHYLENE CONTAINERS FOR PROPER DISPOSAL ~ AVOID HEAT AND CONTAMINATION WITH ACID MATERIAL. DO NOT USE COMBUSTIBLE MATERIAL SUCH AS SAWDUST TO ABSORB SPILLED MATERIAL. MATERIAL IS TOXIC TO AQUATIC LIFE INCLUDING FISH. SELF-CONTAINED BREATHING APPARATUS SUITABLE FOR CHLORINE GAS MAY BE NEEDED. WASTE DISPOSAL METHOD . . . . . CONSULT LOCAL GOVERNING AUTHORITIES CONCERNING DISPOSAL OF SODIUM HYPOCHLORITE SOLUTIONS. 3 AI,III, ~~ A4f!J 2L: .,' ...a- ....., •••,: ~ _____ .lIllImw.~ MATERIAL SAFETY DATA SHEET - S#0251 =- PRECAUTIONS TO BE TAKEN IN HANDLING AND STORING . . .. KEEP CONTAINER CLOSED WHEN NOT IN USE. AVOID EXCESSIVE HEAT. STORE IN A COOL, DRY AREA AWAY FROM DIRECT SUNLIGHT . DO NOT MIX WITH OR CONTAMINATE WITH AMMONIA, ACIDS, ALCOHOLS, HYDROCARBONS ,ETHERS, OR ANY OTHER ORGANIC MATERIALS. OTHER PRECAUTIONS ..... . NA ====================================================== ===================~= SECTION VIII - CONTROL MEASURES =========================================================================== RESPIRATORY PROTECTION (SPECIFY TYPE) . . . NOT REQUIRED. IF MIST IS GENERATED USE NI OSH/MESA APPROVED RESPIRATOR IF NEEDED. VENTILATION LOCAL EXHAUST ........... SPECIAL . . . .. . ... .. .. . . . . MECHANICAL .... .. .. . .. . .. OTHER . .. . ..... ... .. .. .. . . AS NEEDED TO ELIMINATE MISTS . NONE . ACCEPTABLE . NONE PROTECTIVE GLOVES .... .. . . .. RUBBER OR NEOPRENE EYE PROTECTION . ... . . ....... CHEMICAL SAFETY GOGGLES OTHER PROTECTIVE CLOTHING AND EOUIPMENT . .. COVERALLS, CHEMICALLY RESISTANT SHOES, SHOWER AND EYE WASH FACILITY. '~ WORK!HYGENIC PRACTICES .... . WASH THOROUGHLY AFTER HANDLING. DO NOT MIX WITH ACIDS. ========================================================================== SECTION IX - ADDITIONAL INFORMATION ================ === ======== === == =========================================== SECTION 313 SUPP,LIER NOT I FICATION THIS PRODUCT DOES NOT CONTAIN ANY CHEMICALS SUBJECT TO THE REPORTING REQUIREMENTS OF SECTION 313 OF THE EMERGENCY PLANNING AND COMMUNITY RIGHTTO-KNOW ACT OF 1986 (40CFR 372) . SARA TITLE III SECTION 311/312 CLASSIFICATION .... .. . . IMMEDIATE (ACUTE) HEALTH HAZARD FIRE HAZARD REACTIVE HAZARD WHMIS Class: Class E - Corrosive TDG Classification: Hypochlorite solution, more than 7 percent available chlorine, Class 8; UN 1791, PG II. AFCO 5380 PONI ACID GENERAL DESCRIPTION: AFCO 5380 Poni-Acid is a concentrated inorganic blend of acids, especially designed for elP cleaning and for rapid soil removal. Poni - Acid is designed for use in Dairy and Food Processing Plants for removing scale, milkstone, and stains. PHYSICAL PROPERTIES: Appearance Odor pH (1%) Density Foam Rinsing DIRECTIONS FOR USE : clear red liquid slight acidic odor 1.7 10.4 lbs./gallon very low complete Poni-Acid should be used at a concentration of to 1.0 oz. per gallon at a temperature up to 150°F for up to ten minutes which is recommended for most soils. Surfaces are brightened using 1 ounce per gallon of water at 110°F for 15 to 20 minutes. ~ ACID RINSE: Use 1 ounce per 5 to 10 gallons of water in final rinse cycles. SAFETY: Safe on stainless steel when used as directed. Contact with ferrous and light metals should be avoided; will produce harmful gases. DANGER: Highly acidic. Avoid contact with skin and eyes. For skin contact, flush with plenty of water. For eye contact, flush with water for 15 minutes and get medical attention. NOTE : Poni-Acid is accepted by the U.S.D.A. for use in federally inspected plants. 5380: 01/12 Alex C. Fergusson 5000 Letterkenny Road· Ch 90000 mg/kg Hldr6xido de Potasio (1310-S8-3) LD50 Oral Rat I 214 mg/kg ATE (oral) 1 333.000 mg/kg body weight Penta sodium Trifosfato (7758-29-4) lDSO Oral Rat , 3100 mg/kg -, > 7940 mg/kg lDSO Dermal Rabbit Hlpoclorito de Sodio LDSO Oral Rat (7681-S2-9) 18200 mg/kg , > 10000 mg/kg LDSO Dermal Rabbit Hlpoclorlto de Sodlo IARC Group 03/ 18/2014 (7681-52-9) 13 • EN (Enghsh US) 6/11 Millennium Yellow (AFCO 6008) Safety Data Sheet according to Federal Register / Vol. 77, No. 58/ Monday, March 26, 2012/ Rules and Regulations SECCION 12: INFORMACION ECOLOGICA Toxicidad Ecologra - General: Perjudiciales para la vida acuatica con efectos duraderos. Hldr6xido de sodio LCSO Fish 1 Hipoclorito de Sodio LCSO Fish 1 (1310-73-2) 40 mgjl (7681-52-9) ECSO Daphnia 1 LC 50 Fish 2 EC50 Daphnia 2 0.06 (0.06 - 0.11) mgjl (Exposure time: 96 h - Species: Pimephales promelas [flowthrough]) 0.033 - 0.044 mgjl (Exposure time: 48 h - Species: Daphnia magna [Static]) 4.5 (4.5 - 7.6) mgJl (Exposure time: 96 h - Species: Pimephales promelas [static]) 0.033 (0.033 - 0.044) mgjl (Exposure time: 48 h - Species: Daphnia magna [Static]) I I 6xido de lauri! Dimetilamina (1643-20-5) 0.11 mgjl (72 hour) ErC50 (algae) Persistencla V Degradabilidad Millennium Yellow (AFCO 6008) Persistencia y Degradabilidad Puede causar efectos adversos a largo plazo en el medio ambiente. Potencial Bioacumulativo Millennium Yellow (AFCO 6008) Potencial Bioacumulativo J No establesido Hidr6xido de Potasio (1310-58-3) Log Pow 1 0.65 Movilidad en el Suelo: No disponible Otros Efectos Adversos Otra Informacion: Evitar la Iiberaci6n al medio ambiente. SECCION 13: CONSIDERACIONES SOBRE LA ELiMINACION Recomendaciones sobre la Ellminaci6n de Deshechos: Eliminar el material de desecho en conformidad con todas las regulaciones locales; regionales, nacionales, provinciales y territoriales y las normas internacionales. Ecologia - Materlales de Desechos: Este material es peligroso para el medio ambiente acuatico. Mantenga fuera del alcantarillado y vfas navegables. SECCION 14: INFORMACION DE TRANSPORTE 14.1 En Conformidad con DOT Nombre Propio de Envio LfQUIDO CORROSIVO, BASICO, INORGANICO, N.O.S. (Hidr6xido de potasio, Hidr6xido de sodio, Hipoclorito de sodio). Clase de Peligro 8 UN3266 Numero de Identiflcacion C6digos de Etiqueta 8 Grupo de Envio III Contamlnante Marino Marine pollutant Numero ERG 154 14.2 En Conformidad con IMDG Nombre Propio de Envio LfQUIDO CORROSIVO, BASICO, INORGANICO, N.O.S. (Hidr6xido de potasio, Hidr6xido de sodio, Hipoclorito de sodio) Clase de Peligro 8 Numero de Identificacion UN3266 Grupo de Envio III C6dlgos de Etiqueta 8 EmS-No. (Fuego) F-A 03/18/2014 EN (English US) 7/11 Millennium Yellow (AFCO 6008) Safety Data Sheet according to Federal Register / Vol. n, No. 58/ Monday, March 26, 2012/ Rules and Regulations : S-B Marine pollutant EmS-No. (Derrame, Contaminante Marino 14.3 En Conformidad con lATA LfQUIDO CORROSIVO, BAsleO, INORGANICO, N.O.S. (Hidr6xido de potasio, Hidr6xido de sodio, Hipoclorito de sodio) Nombre Propio de Envio III Grupo de Envio Numero de Identification Clase de Pengro C6dlgos de Etiqueta 8 8 ERG Codlgos (lATA, 8L UN3266 14.4 En Conformidad con TOG LfQUIDO CORROSIVO, BAslCO, INORGANICO, N.O.S. (Hidroxido de potasio, Hidroxido de sodio, Hipoclorito de sodio) Nombre Propio de Envio Grupo de Envio Clase de Pellgro Numero de Identification Codigos de Etiqueta III 8 UN3266 8 SECCION 15: INFORMACION REGlAMENTARIA Regulaciones Federales de Estados Unidos I Millennium Yellow (AFCO 6008, I SARA Section 311/312 Clase de Peligro I Peligro inmediato (grave) para la salud I Agua (7732-18-5' I Enlistado en el inventario (Acta de control de sustancias toxicas) TSCA de Estados Unidos I Hidr6xldo de Potasio (1310-58-3, I Enlistado en el inventario (Acta de control de sustancias t6xicas) TSCA de Estados Unidos I Hldr6xido de sodio (1310-73-2' I Enlistado en el inventario (Acta de control de sustancias toxicas) TSCA de Estados Unidos I Penta sodium Trifosfato (7758-29-4) I Enlistado en el inventario (Acta de control de sustancias toxicas) TSCA de Estados Unidos I Hlpoclorito de Sodio (7681-52-9) I Enlistado en el inventario (Acta de control de sustancias toxicas) TSCA de Estados Unidos I Pollacrllato de Sodio (9003-04-7) I Enlistado en el inventario (Acta de control de sustancias t6xicas) TSCA de Estados Unidos I 6xido de fauril Dimetilamina (1643-20-5) I Enlistado en el inventario (Acta de control de sustancias toxicas) TSCA de Estados Unidos I I Regulaciones Estatales de Estados Unidos Hldroxido de Potasio (1310-58-3) u.s. - New Jersey - Prevencion de descarga • Lista de sustancias peligrosas U.S. - New Jersey - Derecho a conocer la lista de sustancias peligrosas U.S. - New Jersey - Usta especial de sustancias de peligros para la·salud U.S. - New York -Informes de emisiones parte 597 - Lista de sustancias peligrosas U.S. - Pennsylvania - RTK (Derecho a conocer) - Lista de riesgos ambientales U.S .• Pennsylvania - RTK (Derecho a conocer) Usta U.S. - Texas - Los Efectos de Investigaci6n a Largo Plazo U.S. - Texas - Los Efectos de Investigacion a Corto Plazo Hldroxido de sodio (1310-73-2) U.S. - California - SCAQMD - Contaminantes t6xicos del aire - No- Causa Cancer agudo 03/18/20l4 EN (English US) 8/11 Millennium Yellow (AFCO 6008) Safety Data Sheet according to Federal Register / Vol. 77, No. 58/ Monday, March 26, 2012/ Rules and Regulations u.s. - California - Contaminantes toxicos del aire (AB 1807, AB 2728) U.S. - New Jersey - Prevencion de descarga - Lista de sustancias peligrosas u.s. - New Jersey - Derecho a conocer la list a de sustancias peligrosas U.S. - New Jersey - Lista especial de sustancias de peligros para la salud u.s. - New York - Umites de exposicion ocupacional- TWAs U.S. - New York -Informes de emisiones parte 597 - Lista de sustancias peligrosas U.S. - Pennsylvania - RTK (Derecho a conocer) - Lista de riesgos ambientales U.S. - Pennsylvania - RTK (Derecho a conocer) Lista U.S. - Texas - Los Efectos de Investigacion a Largo Plazo U.S. - Texas - Los Efectos de Investigaci6n a Corto Plazo Pentasodium Trifosfato (7758-29-4) U.S. - New Jersey - Prevencion de descarga - Lista de sustancias peligrosas U.S. - New York -Informes de emisiones parte 597 - Lista de sustancias peligrosas U.S. - Pennsylvania - RTK (Derecho a conocer) - Lista de riesgos ambientales U.S. - Pennsylvania - RTK (Derecho a conocer) Lista U.S. - Texas - Los Efectos de Investigacion a Largo Plazo U.S. - Texas - Los Efectos de Investigacion a Corto Plazo Hipoclorito de Sodio (7681-52-9) U.S. - New Jersey - Prevencion de descarga - Lista de sustancias peligrosas U.S. - New Jersey - Derecho a conocer la lista de sustancias peligrosas U.S. - New Jersey - Lista especial de sustancias de peligros para la salud U.S. - New York - Informes de emisiones parte 597 - Lista de sustancias peligrosas U.S. - Pennsylvania - RTK (Derecho a conocer) - Lista de riesgos ambientales U.S. - Pennsylvania - RTK (Derecho a conocer) Lista U.S. - Texas - Los Efectos de Investigacion a Largo Plazo U.S. - Texas - Los Efectos de Investigacion a Corto Plazo Poliacrilato de Sodio (9003-04-7) U.S. - Texas - Los Efectos de Investigacion a Largo Plazo U.S. - Texas - Los Efectos de Investigacion a Corto Plazo 6xido de lauril Dimetllamina (1643-20-5) U.S. - Texas - Los Efectos de Investigacion a Largo Plazo U.S. - Texas - Los Efectos de Investigacion a Corto Plazo . . Ree:ulaclones Canadlenses Millennium Yellow (AFCO 6008) WHMIS Clasificacion I Clase E - Material Corrosivo @ Agua (7732-18-5) Aparece en el inventario DSL canadiense (lista de sustancias domesticas). Producto No controlado segun criterios de la clasificacion WHMIS WHMIS Clasificacion I Hidr6xido de Potasio (1310-58-3) Aparece en el inventario DSL canadiense (!ista de sustancias domesticas). Aparece en la Lista de Registros de Ingredientes Canadienses. WHMIS Clasiflcacion Clase D Divisi6n 1 Subdivision B - Material't6xico que causa efectos t6xicos graves e inmediatos Clase E - Material Corrosivo I Hidroxido de sodio (1310-73-2) Aparece en el inventario DSL canadiense (Iista de sustancias domesticas). Aparece en la Lista de Registros de Ingredientes Canadienses. 03/18/2014 EN (English US) 9/11 Millennium Yellow (AFCO 6008) Safety Data Sheet according to Federal Register / Vol. 71, No. 58/ Monday, March 26, 2012/ Rules and Regulations [ WHMIS Clasificaci6n I Clase E - Material Corrosivo Pentasodium Trifosfato (7758-29-4) Aparece en el inventario DSL canadiense (lista de sustancias domesticas). Producto No controlado segun criterios de la c1asificacion WHMIS WHMIS Clasificaci6n (7681-52-9) Hipoclorito de Sodio Aparece en el inventario DSL canadiense (lista de sustancias domesticas). Aparece en la Lista de Registros de Ingredientes Canadienses. Clase C - Material oxidante WHMIS Clasificaci6n Clase E - Material Corrosivo Clase F - Material Peligrosamente reactivo Poliacrilato de Sodio (9003-04-7) Aparece en el inventario DSL canadiense (lista de sustancias domesticas). Clase 0 Division 2 Subdivision 8 - Material Muy toxico que causa otros efectos toxicos WHMIS Clasificacion 6xido de lauril Dimetilamina (1643-20-5) Aparece en el inventario DSL canadiense (lista de sustancias domesticas). Aparece en la Lista de Registros de Ingredientes Canadienses. Class E - Corrosive Material WHMIS Clasificacion Este producto ha sido clasificado de acuerdo con los criterios de riesgo de las Regulaciones de Productos Controlados. La MSDS contiene toda la informacion requerida por la CPR. SECCION 16: OTRA INFORMACION, INCLUYENDO LA FECHA DE LA PREPARACION 0 LA ULTIMA REVISION Fecha de Revision: Otra Informacion: 03/18/2014 Este documento ha sido preparado segun los requisitos de 50S del estandar de comunicacion de peligros de (La Administraci6n de Seguridad y Salud Ocupacional) OSHA 29 CFR 1910.1200. Frases de texto Completo de GHS: Acute Tox. 4 (Oral) Toxicidad Aguda (oral) categoria 4 Aquatic Acute 1 Peligroso para el medio ambiente acuatico - Grave Peligro Categoria 1 . Aquatic Acute 3 Peligroso para el medio ambiente acuatico - Grave Peligro Categoria 3 Aquatic Chronic 1 Peligroso para el medio ambiente acuatico - Peligro Cronico Categoria 1 Eye Dam. 1 Graves danos en los ojos/irritacion ocular Categoria 1 Eye Irrit. 2A Graves danos en los ojos/irritacion ocular Categorfa 2A Met. Corr.1 Corrosivo para Metales Categoria 1 Skin Corr. lA Corrosion/irritacion de la Piel Categoria 1A Skin Corr. 18 Corrosion/irritacion de la Piel Categorfa 18 STOTSE 3 Toxicidad especffica en determinados organos, (exposicion repetida) Categorfa 3 H290 Puede ser corrosivo para los metales H302 Nocivo en caso de ingestion H314 Provoca quemaduras graves en la pie I y lesiones oculares graves. H318 Provoca lesiones oculares graves. H319 Provoca irritacion ocular grave. H335 Puede irritar las vias respiratorias. H400 MUYToxico para la vida acuatica H402 Nocivo para los organismos acuaticos. H410 MUY T6xicos para la vida acuatica con efectos duraderos 03/18/2014 EN (English US) 10/11 Millennium Yellow (AFCO 6008) Safety Data Sheet according to Federal Register / Vol. n, No. 58/ Monday, March 26, 2012/ Rules and Regulations NFPA Riesgo para la Salud NFPA Pellgro de Incendio NFPA Reactlvidad 3 - La exposicion de corta duraci6n pueden causar graves lesiones temporal 0 residual, aun se halla dado atenci6n medica inmediata. 0- Es un material que no ardera. 1- Normalmente estable, pero. puede volverse inestable a presiones y temperaturas elevadas 0 puede reaccionar con el agua 0 con algunas liberacion de energia, pero no violentamente. HMIS III Evaluacion de Salud Flamable Fisico 3 Riesgo Grave - Las lesiones graves son menos probable $1 se toman medidas rapidamente y se ofrece atencion/tratamiento medico. o Riesgo Minimo 1 Riesgo Leve EI Responsable de la Preparacion de Este Documento Alex C. Fergusson, llC. 800 Development Avenue Chambersburg, PA 17201 800-345-1329 Esta informacion se basa en nuestro conocimiento actual y esta destinada a descrlbir el producto, a los efectos de la salud, la seguridad y los requisitos ambientaies. Por tanto no debe interpretarse como garantia de ninguna propiedad especfjica del producto. North Amerfca GHS 03/18/2014 us 2012 & WHMIS 2 EN (English US) 11/11 Brode, Erzsebet - OSHA Brennan, Joseph Wednesday, June 17, 2015 11:55 AM Brode, Erzsebet - OSHA Emails from Case Farms to Cal-Clean re Failure of Cal-Clean employees Cal-Clean Email to Case Farms Safety Team 11-22-14.pdf; Cal Clean Removal of Employee 11-22-14.pdf From: Sent: To: Subject: Attachments: Cindy, Attached are the em ails you requested from Tim More. These emails were generated after Tim witnessed Cal-Clean employees failing to Lockout and walking on machines. As you will see, after seeing these failures on more than one occasion, Case Farms had the employee removed. Let me know if you have any additional questions. Thank you, -Joe Joseph J. Brennan Attorney at Law jbrennan@laborlawyers.com I 0: (440) 740-2132 9150 South Hills Boulevard I Suite 300 I Cleveland, OH 44147 FISHER & PHILLIPS vCard I Bio I Website UI' '"'' Representing employers nationally in labor and employment matters Atlanta I Baltimore I Boston I Charlotte I Chicago I Cleveland I Columbia I Columbus I Dallas, Denver, Fort Lauderdale Jld.";:; t Gulfport, Houston ,Irvine, Kansas City, Las Vegas, Los Angeles, Louisville, Memphis, New Jersey I New Orleans ." Orlando, Philadelphia' Phoenix I Portland, San Antonio, San Diego' San Francisco I Seattle, Tampa, Washington, DC This message originates from the law firm of Fisher & Phillips LLP and may contain legally privileged and confidential information intended solely for the use of the addressee. If you are not the intended recipient and have received this message in error, please notify us at postmaster@labor/awyers.com and please delete this message from your system. Any unauthorized reading, distribution, copying, or other use of this message or its attachments is strictly prohibited. 1 Tim More From: Sent: To: Cc: Subject: Tim More Saturday, November 22; 2014 10:28 AM Nevin Callaghan . Charles Schneider (cschneidercalclean@gmail.com); Kevin Grubbs; Billy Holland (bholland@casefarms.com) RE: Cal - Clean Safety Concerns Ned, Steve At approximately 8am today I witnessed Jose again inside Picker #2 without unit being locked out. This is the second time in four weeks that he has been witnessed not following LOTO procedures. As I mentioned below this will not be tolerated, he has been removed from the premise and is not allowed back on Case Farms property. Thank You, Tim More Safety Manager Case Farms - Canton 0- 234.521. 7324 C- 330.931.8711 AFETV MAKB A CASE - OUT O F fT From: Nevin Callaghan [mailto:nrc1953@aol.com] Sent: Sunday, October 26, 20148:52 AM To: Tim More Cc: Charles Schneider (cschneidercalclean@gmail.com); Kevin Grubbs Subject: Re: Cal - Clean Safety Concerns Chuck, Let's do a full team safety meeting on logo. Written warning to all concerning locking out equipment. Ned Sent from my iPhone On Oct 24, 2014, at 4:49 PM, Tim More wrote: Ned, Steve, Chuck, As a follow-up to my conversation with Steve, Chuck and Ken Today at approximately 330pm, I witnessed two Cal-Clean employees phYSically inside the picker units without being locked out .... I immediately advised them to get out of the pickers and contacted Ken Cherry who came out and addressed the situation. Jose and Miguel of calclean were identified as the employees; Ken had them retrieve their locks (which were back at lockers?) and apply immediately. There was also another chemical pump sprayer without any chemical id tags on it, which was corrected by Ivan? And witnessed another employee walking across the top of the pickers. We CANNOT express enough (as you are aware), the IMPORTANCE of safety especially as it relates to LOTO. Disciplinary here at Case for this specific incid~nt would be immediate termination. Moving forward if we witness any severe safety infractions, we will be asking the employee to leave the property. If I can be of any assistance with your safety programs please let me know, I am more than willing to help where I can. Call me anytime to discuss, Thank You, Tim More Safety Manager Case Farms - Canton 0- 234.521.7324 C- 330.931.8711 This message has been scanned for malware by Websense. www.websense.com Click here to report this email as spam. 2 Tim More From: Sent: To: Subject: Attachments: Tim More Saturday, November 22, 2014 1:54 PM Billy Holland (bholland@casefarms.com); Tyler Parlier; Gary Holzworth FW: Cal - Clean Safety Concerns BIZHUB_C314112211270.pdf All, I permanently removed a Cal-Clean employee from Case Farms Canton, for failure to follow LOTO procedures X2 times .. he was witnessed again by me this morning, attached is his personnel information in the event he filters down to NC .. Thank You, Tim More Safety Manager Case Farms - Canton 0- 234.521.7324 C- 330.931.8711 AFETV MAK e A CASE - OUT OF tT From: Nevin Callaghan [mailto:nrc1953@aol.com] Sent: Sunday, October 26,2014 8:52 AM To: Tim More Cc: Charles Schneider (cschneidercalclean@qmail.com); Kevin Grubbs Subject: Re: Cal - Clean Safety Concerns Chuck, let's do a full team safety meeting on logo. Written warning to all concerning locking out equipment. Ned Sent from my iPhone On Oct 24, 2014, at 4:49 PM, Tim More wrote : Ned, Steve, Chuck, As a follow-up to my conversation with Steve, Chuck and Ken Today at approximately 330pm, I witnessed two Cal-Clean employees physically inside the picker units without being locked out .... I immediately advised them to get but of the pickers and contacted Ken Cherry who came out and addressed the situation. Jose and Miguel of calclean were identified as the employees; Ken had them retrieve their locks (which were back at 1 lockers?) and apply immediately. There was also another chemical pump sprayer without any chemical id tags on it, which was corrected by Ivan? And witnessed another employee walking across the top of the pickers. We CANNOT express enough (as you are aware), the IMPORTANCE of safety especially as it relates to LOTO. Disciplinary here at Case for this specific incident would be immediate termination. Moving forward if we witness any severe safety infractions, we will be asking the employee to leave the property. If I can be of any assistance with your safety programs please let me know, I am more than willing to help where I can. Call me anytime to discuss, Thank You, Tim More Safety Manager Case Farms - Canton 0- 234.521.7324 C- 330.931.8711 This message has been scanned for malware by Websense. www.websense.com Click here to report this email as spam. 2 LOCKOUT/TAGOUT PROCEDURES 1.0 Purpose This procedure establishes the requirements for lockout and tagout of energy sources whenever servicing is done on machines or equipment in the production plant. It shall be used to ensure that the machine or equipment is stopped, isolated from all potentially hazardous energy sources, and locked out before employees perform any servicing of equipment where the unexpected energization, start-up, or release of stored energy could cause Injury. 2.0 Scope This Lockout and Tagout Program provides specific procedures, which shall be executed and enforced when employees are performing their duties on or near equipment or machinery that may potentially have stored energy (e.g., steam, chemical, hydraulic, pneumatic, mechanical, and gravitationaL). The elements outlined in this Lockout and Tagout Program applies to all employees, managers, and visitors. 3;0 Authority 3.1 3.2 4.0 29 CFR 1910.147 The Control of Hazardous Energy (LockoutiTagout) . 29 CFR 1910.333 Selection and Use of Work Practices (Electrical Safety-Related Work Practices) Compliance Employees are expected to comply with all government regulations and all the components within this program. Failure to comply will result in disciplinary action. 5.0 Definitions Affected Employee: An employee whose job requires himlher to operate or use a machine or equipment on which servicing is being performed under lockoutltagout, or whose job requires himlher to work in an area in which such servicing is being performed. Authorized Employee: A person who locks or implements a tagout system procedure on machines or equipment to perform servicing on that machine/equipment. An authorized employee and affected employee may be the same person when the affected employee's duties also include performing service on a machine or equipment, which must be lo~ or have a tagout system implemented. LOCKOUT I TAGOUT PROCEDURES Servicing: Work place activities involved in the sanitizing procedures outlined in CalCleans SSOP manual. These activities may expose an employee to the unexpected energizing of, or start-up of the equipment or release of hazardous energy. Tagout: The placement of a tagout device on an energy-isolating device, in accordance with an established procedure, to indicate that the energy isolating device and the equipment being controlled may not be operated until the tagout device is removed. Tagout Device: A prominent warning device, such as a tag and a means of attachment, which can be securely fastened to an energy isolating device in accordance with an established procedure, to indicate that the energy isolating device and the equipment being controlled may not be operated until the tagout device is removed. This tag cannot be attached with a string, it must be attached with a self-locking device. Lockout: The placement of a lockout device on an energy-isolating device, in accordance with an established procedure, ensuring that the energy isolating device and the equipment being controlled cannot be operated until the lockout device is removed. Lockout Device: A device that uses a positive means such as a lock, either key or combination type to hold an energy isolating device in the safe position and prevent the energizing of a machine or equipment. 6.0 Responsibility 6.1 7.0 It is the responsibility of all Cal-Clean employees to establish, implement, maintain and enforce the Lockout/Tagout Program. The following members of Cal-Clean staffwill carry out the duties listed. Sanitation Manager Program Administrator, conducts employee training and evaluation of LOTO procedures Supervisors Monitor employees to insure correct LOrO practices are be implemented Employees Authorized!Affected employees are responsible for understanding their roles, as well as following the guidelines set forth in Cal-Cleans Lockout and Tagout Program. General Information 7.1 The following information reflects general safe working practices that Cal-Clean employees must follow and enforce when lockout and tagout of an energy source is necessary. They include: LOCKOUT I TAGOUT PROCEDURES 7.1.1 All equipment and machinery shall be locked out and tagged out to protect employees against accidental or inadvertent operation during any servicing or maintenance activity. 7.1.2 Authorized employees will utilize a lock to isolate energy sources. 7.1.3 Any employee operating or attempting to operate or otherwise tampering with any switch, valve or other energy isolating device that is locked or tagged out will be disciplined up to and including termination. 7.1.5 Locks and tags covered in this program will be singularly identified and . indicate the identity of the employee applying the device(s). 7.1.6 Locks and tags outlined in Cal-Cleans's Lockout and Tagout Program will not be used for any other purpose. 7.1.7- Locks and tags covered in this program will be standardized with the use of color locks, as well as tags that are the same size and shape. 7.1.9 The locks, tags and lockout devices that have been selected for the DEITZ & WATSON facilities are capable of withstanding the environment to which they are exposed. 7.1.19 Cal-Celan will provide its employees with locks, tags and lockout devices (e.g., chains, plug locks, fuse lockouts, circuit breaker lockouts, ball and gate valve lockouts, self locking fasteners) or other hardware, as applicable, for isolating, securing or blocking machines or equipment. 8.0 Lockout and Tagout Procedures 8.1 When locking and tagging out an energy source needs to take place, the following procedure will be followed and enforced by all effected and authorized employees, within the facilities. 8.2 In preparing for lockoutltagout, the authorized employee(s) must evaluate the machine or equipment to be serviced to ensure that they are aware of energy isolating devices (including switches, valves or other energy isolating devices), types and magnitude of energy, associated hazards and the appropriate machine specific lockoutltagout procedure. 8.3 Once the authorized employee understands all of the hazards associated with the locking and tagging out of the machine or equipment involved, he/she will notify all affected employees that they will be performing a lockout or tagout to isolate the energy sources identified. LOCKOUT/TAGOUT PROCEDURES 8.4 The authorized employee(s) will shut down the machine or equipment by utilizing the normal shut off procedures. 8.5 Once the authorized employee(s) have shut down the machine or equipment, he/she will then de~activate, lock and tag the machine or equipment from its energy source(s). 8.6 After applying the lockout and tagout devices, the authorized employee will try and start the equipment to make sure he/she isolated the correct energy source(s). 8.7 The equipment is now properly locked out or tagged out. 8.8 After completing the servicing of the equipment, the authorized employee(s) is now ready to turn it back over to production. However, before removing lockout and tagout devices, he/she must check the area around the machines or equipment to ensure that no one is exposed, all tools have been removed, and guards have been reinstalled. 8.9 Verify that the controls are in neutral before removing any lockout or tagout devices. 8.10 Remove lockout and tagout devices and restore energy to the machine or equipment. 9.0 Personnel or Shift Change Procedure 9.1 In the event of a personnel change, authorized personnel assuming control of the lockoutltagout must apply hislher lock and tag onto the energy source(s) prior to the off going personnel takes hislher lock and tag off the energy source(s). 10.0 Group Lockout / Tagout Procedures 10.1 Cal-Cleans Lockout and Tagout Program allows for group lockout and tagout when multiple employees are to perform services on equipment or machines at the same time. The following are the specific procedures that will be followed and enforced when a group lockout and tagout takes place: 10.1.1 The"Authorized" employee( s) will identify and control all energy sources to the equipment presenting the potential hazard. 10.1.2 The control of the energy sources will be performed by the use of a hasp/multi-lock device being placed through the energy control point (e.g. switch, handle, etc.) and then each authorized persons lock placed and secured to the hasp/multi-lock device. 10.1.3 Everyone associated with the group lockout and tagout is responsible for LOCKOUT/TAGOUT PROCEDURES verifying that all lockout devices have been controlled and secured and that the equipment has been brought to a "zero energy state". 11.0 Procedures For Removing Another Employees Lockout and Tagout Device 11.1 It is Cal-Cleans policy to have the employee who applied the lock and tag on energy sources to remove it. However, in situations where an employee has forgotten to remove hislher lock (e.g., at the end of a shift, involved In a emergency situation, etc.), the following procedures will be followed: 11.1.1 The Sanitation Manager / Supervisor must verify that the authorized employee who applied the device is not physically in the facility; 11.1.2 The Sanitation Manager / Supervisor needs to assess whether or not the machine or equipment is needed to run production. 11.1.3 If the supervisor deems it necessary that the equipment is needed, then the supervisor must try to contact the employee who applied the lock and tag and verify that the work has been completed Every reasonable effort must be made to contact the employee. 11.1.4 If the supervisor was unable to reach the employee, then he/she must conduct a complete walk through of the machine or equipment to verify that tools have been removed, guards replaced, etc. 11.1.5 The Sanitation Manager I Supervisor will contact the Maintenance Manager and ask him for authorization to remove the lock and tag from the energy source(s). 11.1.6 The supervisor must provide the Maintenance and Safety Managers with a completed copy of the Lock and Tag Authorization Removal Form for their ftles. 11.1.7 When the authorized employee, who placed the lock, returns to the facility, the Sanitation Manager I Supervisor must inform them that their lock has been removed. 11.1.8 It is Cal-Cleans policy not to make this procedure a common practice, and if an individual is identified as failing to remove hislher lock and tag on an ongoing basis; the Sanitation Manager will respond with appropriate disciplinary action. 12.0 Periodic Evaluations 12.1 The effectiveness of Cal-Cleans LockoutlTagout Program will be evaluated by LOCKOUT/TAGOUT PROCEDURES Sanitation Managers I Supervisors and will include the following: 12.1.1 Observe an "Authorized" employee lockout and/or tagout machinery or equipment. (Reference Attachment - 4 Lockout/Tagout Evaluation Form). 12.1.2 Deviations or inadequacies noted during the evaluation will be documented and corrected immediately. 12.1.3 ALL authorized employees shall be evaluated on an annual basis. 12.2 Cal-Clean Sanitation Manager will maintain completed inspection reports. 13.0 ' Training 13 .1 Awareness training will be provided for all employees to ensure that the purpose and function of Cal-Cleans Lockout and Tagout Program is understood and followed. Additionally, Authorized and Affected employees will receive specific training that will include the following: 13 .1.1 All "Authorized" employees will receive training in the recognition of applicable hazardous energy sources, the type of magnitude of the energy in the workplace and the methods and means necessary for energy isolation and control. 13.1.2 All "Affected"- Employee employees will be instructed in the purpose and use of the energy control procedure. 13 .1.3 Training will also take place for ALL new employees during their Employee Orientation Training 13.2 The Sanitation Manager I Supervisor will provide refresher training on ALL "Authorized" employee on an annual basis or when changes are made to the existing Lockout and Tagout Program. 13.3 . Retraining for all employees will take place whenever there is: A change injob assignments; A change in machines, equipment, or processes that present a new hazard; A change in energy control procedures; A noted deviation or inadequacy in the employee's knowledge or use of the energy control procedures, on the inspection report; 13.3.5 A need for additional individualized training. 13.3.1 13.3.2 13.3.3 13.3.4 13.4 13.1 All training, retraining and periodic evaluation documentation will be properly filed and maintained by the site Sanitation Manager. The Cal-Clean Safety Manager will verify and document that the Cal-Clean's Copy of the machine specific LOTO procedures is current and up to date. PERIODIC INSPECTION OF LOCKOUT I TAGOUTPROCEDURES Employee Name: _ __ _ _ _ _ _ _- '_ _____D , ate________ ----I Employee Signature (Pinna del vllJJJJ.\',au'u)- -- - - - - - - - -- -------4 Inspector's Signature (Firma del EquipmentlMachine Name_ _ _ __ _ __ _ _ __ _ __ __ _ _ _ __ --+ • Observe the individual(s) locking out equipment and complete this form. • Note deviations with lockout policy and correct immediately. a o • Observe al empleado bloquear / rotular la maquinaria y complete esta forma Note las deficiencias con el procedimiento de hloquear / rotular y corrija/as imPlelfiOl'al1ite'tte Inspections to be performed by a supervisor or authorized employee. o • Las inspecciones deben hacerlas un supervisor 0 Ull empleado autorizado Fax: this form to Cal-Clean office and keep original in your Safety Manual o Mallde por fax la forma a la oflcilla de Cal-Clean y tellga el original en su Manual de ." P ,r111,'lflll'I' General Lockout Procedures Yes No 1. Affected personnel were notified before shutting down equipment? Se Ie aviso al personal afectado antes de apagar la maquillaria? 2. Correctly identified all energy sources? Identifico correctamente todas las Fuentes de energia? 3. Correctly shut down equipment? Apago la maquillaria correctamente? 4. All necessary energy control and lockout devices applied? Se aplicaroll todos los dispositivos que son Ilecesarios para bloquear la energia? 5. Each affected person is protected by a personal lock? Cada persona que es aJectada esta protegida con Ull can dado persollal? 6. A test was performed to ensure the equipment was locked out? Hizo una prueba para asegurarse que fa maquinaria si esta bloqueada? 7. Notify affected employees that lock out will be removed? Notifico a los empleados afectados que el hloqueo sera removido 8. Check operating controls to assure they are in off position? Chequeo los controles de operacion para asegurarse que estan en fa posiciOlI Apagado (of/position)? 9.Remove Locks and Tags? Removi6 los candados y los rotulos 0 etiquetas? If "NO" answered above, identify deficiency and comment on the retraining performed. Si cOlltesto "NO" a algunas de las preguntas, identifique la deficiencia y comente en el re-em~re'la/J"iej~'lo "echo. Revision #1, Dated: 10/2/13 Created By: Yolonda Kirkman Authorized By: NRC CAL-CLEAN LOCKOUTffAGOUTTEST _ _ __ _ _ _ _ __ __ _ has demonstrated knowledge of the Cal-Clean LockoutiTagout Program and the proper use ofhislher lock and warning tag. He/she will now act as an authorized employee in the LockoutiTagout Program and will assume the safety responsibilities of his area. (A demostrado conocimiento del Programa de Bloqueo y Etiquetado y el uso apropiado de su Candado y Etiqueta de bloqueo. Empleado actua como empleado autorizado en el programa de Bloqueo y Etiquetado y asume fa responsabilidad en su area de trabajo) _ __ HAS DEMONSTRATED PROPER LOCKOUTffAGOUT PROCEDURES (Ha demostrado Saber los Procedimientos de Bloqueo y Etiquetado) _ _ _ HAS DISPLAYED KNOWLEDGE OF THE LOCKOUT/ TAGOUT PROGRAM (Ha demostrado conocimiento del Programa de Bloqueo y Etiquetado) ENWLOYEENAME ___ __ _ _ _ __ __ _ _ TRAINER NAME _ _ __ _ _ _ __ _ _ __ _ INTERPRETERNAME._ _ __ __ _ __ _ __ LOCATION _ _ _ __ __ __ _ __ _ __ DATE _ _ _ _ _ _________________ CAL-CLEAN LOCKOUT~AGOUT-Qmz~--------~ ________ Name of Employee: Circle T for True or F for False T F L 2. T F ., T F 4. T F .J. 5. T F 6. T F 7. T F 8. T F 9. T 10. T 11. T 12. T 13. T 14. T 15. T F F F F F F F 16. T F 17. T F 18. T F 19. T F 20. T F Th~ unexpected release of energy is a major hazard during servicmg-9 mamtenance ./ OSHA estimates that lockoutltagout protects approximately 3.3 milll , n employees each year A person who locks out machine or equipment is an Authorized emp oyee An employee that works is areas where energy control procedures ar · used but is not part of the process is called an Affected Employee The four main types of energy discussed were electrical, mechanical hydraulic, and turbine Turning off a machine does not necessarily stop all energy to the mj hlne Lockout is a means of keeping equipment from being started Lockout is just turning a machine off and unplugging it before performing maintenance · Locks used for lockout can only be used for lockout and nothing e~e Locks must be standardized within the facility by color, size, or s e Tagout can be used instead of lockout whenever an employer want to Tagout prevents the accidental energizing of equipment Employers must have a written policy that defines the lockout pro ess The lockout process is a six-step procedure Before starting work on a machine that has been locked out, the Authorized employee must confirm the isolation of energy to the achine Only the Authorized Employees that applied the lockout device s ould remove the lockout devices A lockout device can be removed by an employer when the empl yee that placed the device is not present When a group lockout is necessary, one crew II!-ember is given p responsibility of the crew There must be continuity of protection between work shifts group lockout When an outside contractor is used, their lockout procedures m . be I dJ· taught and complied with by the on-site employees I understand the information contained in this program and have passed the q . regarding LockoutlTagout Signature Date /0 L(A '- - C l.ed-0 -L S SANJ.l'ATION STANDARD OPERATING PROCEDURE LIVER CIDLLER PURPOSE: Assure proper cleaning of specified equipment and an effective verification and monitoring system Safety Precaution Insure that all associates have been trained how to properly use chemicals and sanitation equipment. Lock OutlTag Out Insure that all associates have been trained how to properly perform Lock-out / Tag-out procedure Personal Protective Equipment (PPE) Safety glasses, gloves, apron, and rubber boots should be worn. Pre-Cleaning Before beginning the cleaning process, remove all product and/or packaging material from the area to be cleaned. FREQUENCY: This procedure shall be performed daily after the equipment is used, before the next production run occurs. / RESPONSIBILITY: The Sanitation Supervisor is responsible for the implementation and maintenance of this procedure. The designated Sanitation employee is responsible for conducting this procedure. Recommended Cleaning Procedure Remove all trash and place in designated collection bin. Disassemble equipment as necessary and place parts in designated location for cleaning. Remove large food soils and place in condemned container. Rotate agitators to remove soil from all sides. Thoroughly rinse the equipment from top to bottom to remove soil. Foam the surface of equipment with AFCO 6008, AFCO 0251, or AFCO 5244 until the entire surface has been covered with foam, by using a side-to-side motion from bottom to top of the equipment. Allow cleaner to stand 10 - 15 minutes. 7. Use a scrub pad to scrub heavily soiled areas with desired dilution of AFCO 6008, AFCO 0251, or AFCO 5244. 8. Thoroughly rinse equipment and parts from top to bottom to remove all foam and soil. 9. If any food contact part touches the floor during finals rinse, re-clean and s~tize that area. 10. When necessary foam or hand scrub with an Acid Cleaner to remove any mineral deposits or oxidation. Repeat step 8. 11. After inspection, sanitize equipment and parts with AFCO 4312 or AFCO 0251. 1. 2. 3. 4. 5. 6. Revision #1, Dated: 3/1/14 Created By: Yolanda Kirkman Authorized By: NRC SANl1'ATION STANDARD OPERATING PROCEDURE INSPECTION AND MONITORING: 1. All equipment cleaned according to this procedure will be inspected by the Sanitation Supervisor before release to production. Any areas found to be unacceptable will be immediately corrected. 2. Quality Assurance will monitor cleanliness of the equipment after cleaning, as well as monitoring fmal sanitation for compliance with this procedure. Any area found to be unacceptable will be rejected for use until appropriate corrective action has been taken. 3. Equipment microbial counts will be performed by Quality Assurance to verify the effectiveness of this procedure. CORRECTIVE ACTION: 1. Equipment determined by either the Sanitation Supervisor or Quality Assurance not to have been cleaned and sanitized according to this procedure will have the cleaning procedure repeated until the equipment is in acceptable condition. 2. The Sanitation Supervisor will retrain the responsible employee in the performance of this procedure. 3. Equipment microbial counts found to be above the set action levels will be reviewed with the Sanitation Supervisor. Quality Assurance will work with the Sanitation Department to attempt to determine a cause and institute corrective action. RECORD KEEPING: 1. Pre-Op Inspection Checklist will be completed by the Quality Assurance department. Necessary corrective action will also be recorded on the checklist. This report will be filed in the Quality Assurance office. 2. Equipment microbial counts will be recorded as soon as results are available. This report will be filed in the Quality Assurance office. CHEMICALS: AFCO 6008, AFCO 0251, AFCO 4312, AFCO 0251, AFCO 5244 Revision #1, Dated: 3/1/14 Created By: Yolonda Kirkman Authorized By: NRC DISCIPLINARY ACTION RECORD EMPLOYEE: DATE: 11/30/14 Perdo Cordero SUPERVISOR: Raul Flores POSITION: Cleaner Record of: __ Verbal Waming __ Counseling __ Written waming + suspension Last Chance _x_Written Warning __ Discharge Nature of unsatisfactory performance/violation; Severity of offense/deficiency: Not following lockout tagout procedures- hurt his hand in liver tumber Summary of corrective action plan; Period of monitoring; Oay(s) suspension to be taken if applicable: Was sent home, and suspended 1 day. Pedro has been monitored for 1 week to make sure using lock Supervisors walk and check employees to make sure USing proper ppe. It is expected that the condition above will be corrected immediately. In the event this condition is not corrected or another offense (in the same or a different category) occurs, you may be subject to further disciplinary action as outlined in Company policy. Employee comments: EMPLOYEE SIGNATURE: SUPERVISOR_: cc: file Pedro Cordero.-----:..,....--_ __ _ _ _ _ _ _ __ Chuck Schneider_ _ _ _ __ _ _ _ _ _ _ __ __ _ __ ~· "l E=· A ~' ~#=\. ~ F-I ~I::~ ·.~I; ·~ DISCIPLINARY ACTION RECORD DATE: 10-24-14 EMPLOYEE: Jose Rodriguez SUPERVISOR: Ivan Marcano POSITION: Cleaner Record of: __ Counseling __ Written warning + suspension __ Verbal Warning Last Chance _x_Written Warning __ Discharge Nature of unsatisfactory performance/violation; Severity of offense/deficiency While cleaning picker he was walking on top Summary of corrective action plan; Period of monitoring; Oay(s) suspension to be taken if applicable: No climbing on machines, ladders must be used. Suspension may occur if employee continues walking on machine It is expected that the condition above will be corrected immediately. In the event this condition is not corrected or another offense (in the same or a different category) occurs, you may be subject to further disciplinary action as outlined in Company policy. Employee comments: EMPLOYEE SIGNATURE: _ _ _ __ _ _ _ _ _ _ _ __ DATE: _ _ _ _ _ _ __ SUPERVISOR: _ _ __ __ _ _ _ _ _ _ _ _ _ __ DATE: _ _ _ _ _ _ __ cc: file DISCIPLINARY ACTION RECORD EMPLOYEE: Miguel Castillo DATE: 10-24-14 SUPERVISOR: Ivan Marcano POSITION: Cleaner Record of: __ Counseling __ Written warning + suspension _ _ Verbal Warning Last Chance _x_Written Warning __ Discharge Nature of unsatisfactory performance/violation; Severity of offense/deficiency: Didn't lock out Pickers before going inside to clean Summary of corrective action plan; Period of monitoring; Oay(s) suspension to be taken if applicable: Employee will lock machine before going inside to clean. Employee will follow loto procedures. Suspension will occur if employee continues to not follow loto procedure. It is expected that the condition above will be corrected immediately. In the event this condition is not corrected or another offense (in the same or a different category) occurs, you may be subject to further disciplinary action as outlined in Company policy. Employee comments: EMPLOYEE SIGNATURE: _ _ _ _ _ _ _ _ __ __ _ _ _ DATE: _ __ _ _ _ __ SUPERVISOR: _ _ _ _ _ _ _ _ _ _---"'_ _ _ _ __ _ DATE: _ _ _ _ _ _ __ cc: file -' FOLLOWING PAGES ARE 7d CAL-CLEAN SAFETY MEETING , .- PLANT (planta) DATE (pecha): O/J. -(cCca :212 , 9/5 Two safety videos were watched: - STARTED (Empezo): ~ ~O{Jt?t-Yi , FINISHED (Termino): (j~ atJ/'j tJ u I.fdei)- d lSc.u'j,c'ED 1. Hazard Communications Safety Training Video 2. Lock-Out- rrag-out Training Video Following each video, there was a 10 minute discussion for any questions or concerns Also discuss: 1. PPE: Personal Protection Equipment • What is required & When it is required 2. Proper use of Ladders 3. Stepping on or Standing on equipment is not acceptable Dos Videos de seguridad fueron vistos: 1. El Video de Comunicacion de Riesgos 2. El video de como Bloquear y Etiquetar la maquinaria Inmediatamente despues de cada video,hubo 10 minutos para discutir preguntas Tambien se discutio: 1. Uniformes de Proteccion Personal • Lo que se requiere y cuando se requiere 2. La manera correcta de usar escaleras 3. Parandose or subiendose en la maquinaria no se accepta \. I : 0 dudas. CAL-CLEAN SAFETY MEETING PLANT (planta) DATE (Fecha): Q(+.f(){)O ~~ STARTED (Empezo): :!:&!Jf"i FINISHED (Tennino): C;~ tJO/1 cA-., j I 1. Hazard Communications Safety Training Video 2. Lock-Out- Tag-out Training Video Following each video, there was a 10 minute discussion for any questions or concerns Also discuss: 1. PPE: Personal Protection Equipment • What is required & When it is required 2. Proper use of Ladders 3. Stepping on or Standing on equipment is not acceptable Dos Videos de seguridad fueron vistos: 1. EI Video de Comunicacion de Riesgos 2. EI video de como Bloquear y Etiquetar la maquinaria Inmediatamente despues de cada video,hubo 10 minutos para discutir preguntas Tambien se discutio: 1. Unifonnes de Proteccion Personal • Lo que se requiere y cuando se requiere 2. La manera correcta de usar escaleras 3. Parandose or subiendose en la maquinaria no se accepta Print your name (Escriba su nom 0 dudas. INSPECTION LOCKOUT-TAGOUT P.ROCEDURE T"'~RIODIC • • • • vidual(s) locking out equipment and complete this fOIm. al empleado bloquear / rotular La maquinaria y complete esta forma .u.~'VI-"> with lockout policy and correct immediately. o Note dejiciencias con el procedimiento de bloquear I rotular y corrijalas inmediatamente Inspections be performed by a supervisor or authorized employee. o Las lI~;De,C:C:lon,f1~ deben hacerlas un supervisor 0 un empLeado autorizado Fax this form to office and keep original in your Saf~ty Manual fax la forma a la ojicina de Cal-Clean y tenga el original en su Manual de Seguridad General Lockout Procedures Yes No were notified before shutting down equipment? --L' personaL ajectado antes de apagar la maquinaria? all energy sources? cOJ"rel~IaJ~l. e.me todas las Fuentes de energ[a? equipment? mqrqu.l1lU'rlU correctamente? control and lockout devices applied? todos los dispositivos que son necesarios para bloquear la energfa? / . is protected by a personal lock? _ '_ nl!r:~nl:'n que es ajectada esta protegida con un candado personal? ",p,rt'n'm'li·rI to ensure the equipment was locked out? Hizo una para asegurarse que La maquinaria si esta hloqueada? 7. NotifY affected loyees that lock out will be removed? Notifico a empleados ajectados que el bloqueo sera removido 8. Check operating s to assure they are in offposition? Chequeo In.(·il'Il''ltl"J)J.,,.~ de operacion para asegurarse que esttin en la posicion ? Apagado 9.Remove Locks and los ~anfJlrl(J(.,s y los rotulos 0 etiquetas? identify deficiency and comment on the retraining performed. Si contesto "NO" a a~g.ll1l{lS de Las preguntas, identijique la dejiciencia y comente en el re-entrenamiento hecho. 1. Affected pel~SOIIlD.(~~\ CAL-CLEAN LOCKOUT/TAGOUT TEST . s demonstrated knowledge of the Cal-Clean P p . use ofros/her lock and waming tag. He/she will • • now act as. an ~uthorized employee in the Lockout/Tagout Program and will assume the safety responsibilities of his' area. (A demostrado conocimiento del Programa de Bloqueo y ~ t;> Etiqlletado y elllSO apropiado de su Candado y Etiqueta de bloqueo. Empleado actua como empleado autorizado en el program a de Bloqueo y Etiquetado Y asume la responsabilidad en su area de t;abajo) ( / HAS DEMON~TRATED PROPER LOCKOUT/TAGCiU1'P~OCEI)'L.WES-. • LL:de~ostrad~ Saber los Procedimientos de Bloqueo y Etiquetado) . ., .... ' _---!...- . HAS DISPLAYED. .KNOWLEDGE OF THE LOCKOUT! TAGOu:;r";!E~O~RAM (Ha . 10 " : .del11ostrado conO'Cimiento del Programa de Bloqueo y Etiquet\Qdo) •b€:" IN~ERPRETER .. :.. •• ~.:: .;:-! : NAME,_ _ _ _ _- - - - - - ," DATE __~/~I---~2~.a~~---~/-.~~/-------------------. " • :r ... , ~., • I ... .... . ~: . ~ . I ·· 'I 1 . . .j .. _ ..... _. _ _ _ ....---0--- - : .. .........--- .. - ~ .. .. ": ,. :' .' . • .. 0' --~ ... - -~ .... ~- . _ -. • _:t: __ .. ....... c. ! .: I I • • ~ '. '- ' . ~ , . • .... . . CHEMICAL SAFETY ORIENTA nON ORIENTACION DE PROTECCION CONTRA QUIMICOS I am employed by Cal-Clean and I have been given instructions and th(: necessary information about the use of cleaning materials and procedures in my normal working activities. I have been instructed in and understand the section on: Chemical Safety, Safe Chemical Handling Checklist, and Chemical First Aid. And I have been shown the MSDS's for the cleaning chemicals and the hazards with using suth materials. Soy empleado de Cal:Clean y he recibido instrucciones, y la informacion necesaria sobre el usa de materiales de limpieza y procedimiento en mis actividad~ ~'oi~~ie~~ae' iiabajo. He recibido instruccion y .e~tiel).~o la secel-on.en: "Quiihi2a:'cbYi Seguridad." La lista de chequeo de man~Ias de . tra~arpropuctQgAuimiCQ,s con$.eguridad, Primeros Auxilio~co11. Qp.i.rp,icps,\. re9ib.faQ "LasHojas De Seguridad de productos quimicos de limpieza y los peligros del use de esos pro~uctos. H~ ori~~titf6p::~P' • • .. .. l _. ' _ .. _ . .. _ _ I Ma,t~riaJ~s~_de)Q~" : : I . ",~" '... , ~. ...--0---- --... . ... _ •.•• • i ...... •• _ ••.• t: --' -'- .. r =. _=__.=_.=,-.= ...._•.",__ -----.,- -~---_,.-._c_. ..... .. -.. - ~_""""~~ "-----'-' -- -' CAL-CLEAN ORIENTATION DE PROTECCION t ACq;;~10S PARA PROTECCION PERSONA!,. ....;. /VESTIMENT A- No pueden usar canllSetas Sin mangas 0 pantalones cortos --// CASCO- Se requiere para lodos los empleados ~ BOTAS DE HULE NEGRAS-Se requieren para lodos los empleados .1/ UNIFORME DE HULE- Use de acuerdo a las reglas de la planta -L GOGGLES-Gafas para proteccion de los ojos,- Debe usarlas a tad a hora cuando este trabajando con quimicos TAPON PARA OIDOS-Usar de aCllerdo a las instrucclones GUANTE.S:DE HULE-Se requieren para todos los empleados -:- uSo DE }v1ASCARA DE RESPIRAR- (Programa separado) -fj' cnmT S TRABAJOS PELlOROSOS Y SUS TECN I ~<\.S OE PROTECCION , CORREAS 0 BANDAS MOYIENDOSE-Procedimiento de limpieza aproptado . / N~hc, x< .~, < -/--~L , \,-:::8+, Cl>.~_)' . . -. . :....>o.~(_·"'--, ," ... '.. , I ,£..I c.6., ' .L..j ' . ~ ' ! "- .. , , .-. -.•.•~ .. - --~-..--:=--.. - - . ~,...,- . ".. .- . -,,'. ," .' .l , . t :" . - --' '- . . . _ . • _• . :._ "'~_ . ~. , • _ _ • '''-_:_--:-.._,,,--,.~_=_=_'="=,"'-.. . .. p c-=--- t" ' ." . . t~~7.;:·L~~k.'\,:_, ~ ~~~~4-:~ .;1~_.•7~~ ~.:.::).~ _._----..,...---,' ; " ~-. , .... ' _' ' - ...L _ _ _ _,- • • •. : - - ' ..................... _ _ ....-- . _ __ _ EJ. ..LPLOYEE TRAINING & VERIFICATION • be in area at pre-op time . '.L...,\"" .....'u must be completed before anyone is allowed to leave and area must be ....V..l.~u-.. know and understand the following proper steps of cleaning; l. 2. 3. 4. 5. 6. 7. 8. 9. ........,.'!! ..,~ : Remove all trash and large debris in area worker is to de-energize equipment when necesassary. : Equipmen if necessary to clean properly. High pressure wash removing 90% of all meat & soils. .......IJ.~&J"'" ...... ~ '.... Scrub: Foam equipment using proper techniques. Scrub when necessary .. .L'-LU;;>'~' Rinse area removing the remaining debris and chemicals. ImmEtCn!On: Inspect your area. Use flashlight when necessary. Re-clean any areas found dirty. "'QJ.uu~:,v your are with the appropriate sanitizer. I have been ~hn,um or translated to me, and understand the cleaning procedures for the r~s:po:nsl ble to clean. I will use the above infonnation and the infonnation from pmem assigned to me. Date: ' ) _ 1- /1.; Date: Signature Date:- - - - - - - - Signature \,oJ~LU.!-,"'V JJ Date:- - -- - - -- Signature l brn'010y(~e Date:- - - - -- - Date:- - - - - - - - Signature \""'. .-u I.n'v Date:._ - - - -- - - Signature Date:- - - - - -- - Signature \.LJA-U!-"LV'1 Date:- - - - - - - - PER )NAL PROTECTION & SAFl. Y WITH CHEMICALS PROGRAM & VERIFICATION 1. 2. ",.r", ..·", who enters the Chemical Room must wear Safety Glasses. n /n,~I1""' ''' must use extreme caution when using chemicals and always utilize while ....u,.~.u.., .... a.'-") the following items: • • • • ~,"\II. U U'''J. .... ll<;,UJ,J' ... q..L" gloves shields - (See MSDS when dispensing chemicals from barrels) glasses Gear come in contact with the skin, wash the affected area with cool water for 15 Chemical Room must have an emergency shower and an eyewash station. been instructed on safety while handling, carrying or always use rubber gloves and safety glasses. signature), verify that I have observed the approved methods for safely handling chemicals in the (Date)?> .. f,- 14 (Supervisor Initials) (Date) (Supervisor Initials) (Employee's Name) (Date) (Supervisor Initials) (Employee's Name) (Date) (Supervisor Initials) Name) (Date) (Supervisor Initials) Name) (Date) (Supervisor Initials) Name) . (Date) (Supervisor Initials) s Name) (Date) (Supervisor Initials) (Employee's Name) (Date) (Supervisor Initials) (Employee's Name) (Date) (Supervisor Initials) ODMANUFACTURING PRACTICES VERIFICATION G GMP PROGRAM & VERIFICATION 1. Employees 2. No food, dri drink products 3. No production their assigned 4. All personnel wear smocks, rooms, in the 5. All personnel before sta An employees 6. low all personnel, hygiene, and uniform policies. ,gum, candy, and tobacco are allowed in the production area. Store all food and : n designated racks in break rooms. Store only personal effects in lockers. will enter or exit through the front doors but will enter or exit through NO employee is to be in the opposite break room at anytime. wear a clean, buttoned smock in the production area. No employees may ves, aprons, and sleeves outside of the plant, in the bathrooms, in the break area, in the offices, or the maintenance department. st wash and sanitize their hands when entering their assigned room and/or the line, after returning from break, and after returning from the restroom. sanitize their shoes upon entering production areas. bands (no stones) and medical alert identification are allowed in No fingernail polish, artificial nails, wrist watches, and other jewelry are the locker areas. nets must be worn beyond employee locker rooms and cannot be worn 7. must restrain all hair and cover ears. Beard nets must cover any hair that is lip, all neck hair, and sideburns. No artificial eye lashes are permitted. with no bill are allowed past the locker rooms. Hoods worn over the smock 8. rn,:1e>'r·.,.,rI with a hairnet, or if the hood is worn on the head, separate hairnets will cover head. rn, will be sanitized upon entering the RTE areas. 9. rubber shoe covers must be worn in the production area, and footwear utilized areas cannot be worn beyond the paved area in front of the break room doors. 11. No clothing arts, tank tops, etc) that exposes the legs, mid-riff, back, or armpits can be worn beyond the t offices and locker areas. Pants, dresses, and skirts must sit at the waist and be ankle length moell1l1! worn beyond the front offices or locker room. 12. No cell phon are allowed in the production area (including in maintenance, distribution, box room areas, in pockets of clothing), except for management. 13. Employees are sick or have openj infected wounds or sores will not be permitted to work Plant ent will make the judgment. visitors will wear disposable gloves in RTE and RTC areas when contacting 14. All emp ct surfaces and must keep them in good, sanitary conditions at all times. product or Gloves shou intact, not be Visibly soiled, and should be changed when soiled, torn, or after touching clo body, face, hair, or non-product surfaces. be clearly identified and have MSDS on file . 15. All chemicals SMO KING inside the plant. Smoking is only allowed in designated areas. 16. Absolutely 17. J , I E. .. ,ERGECY ACTfON PLAN VERIFICATION , 'J I (employee's have been presented with the facility floor plan that nd secondary exit routes, the location of fIre alanns, , gn y ( ), been properly trained by the On~Site ~~lanager on t,o do in the event of an emergency. (Yo recibi los Pianos de la planta que identifican fbs salidas, las prim eras rutas y las segundas rutas de salida, ellugar donde estan las (J1f,rr1'1'.ln~· de fuego, La area donde nos debemos congregar y he sido entrenado ·el supervisor de mi area en que es 10 que tengo que hace en caso de una ! . Training Completion (Entrenamiento de Orientacion de seguridad) =>--_ _ (employee's signature) 3~ r- lit (date) or employee responsibility I emergency action plan changes o responsabilidad del empleado/ Cambios en el plan de emergencia GUlJL.J.UGUj .................u.tt<~o"" SelVer Weather THE SIGNAL FOR AN EVACUATION IS THREE SHORT TONES FROM PA FOLLOWED BY A SHORT MESSAGE ON THE ALERT T8 E PERMlmNG AN OUCE SHELTER lOCATIONS I OR iN CASE OF POWER FAILURE, BYWORD OF MOUTH Ammonia Leak If an Ammonia Smell is detected: The Alarm for an Ammonia evacuation is three (3) long tones over the PA followed by an announcement telling you which doors to exit the building through. Fire Alarm System The building is equipped with a fire alarm system that will sound through the PA, horns, and AVs (Alarm and Visual devices) to alert of a potential fire in the plant. The sound that is used is a continuous wail through the PA system. The alarm system will also notify the fire department of an emergency however You must still call 9 - 911 . C:Ct.S-e fQ rtk.) L~/f'D Appendix C (p~ ~( 1l~ ~ CASE FARMS Canton Plant LOCKOUT/TAGOUT PROCEDURE The following procedure must be used when locking out energy isolating devices in order to perform servicing or maintenance on machines or equipment. Department chilI/sizing Date Machine title #517 giblet/liver chiller Operators Controls Type Location main disconnect/start stop push buttons south wall evisceration lab led gib chillers / disconnect located next to motor 111712012 Energy Sources Type Type Location Location 480vac Shutdown Procedures a. b. c. electrical room #169 fed from SDP2 panel breaker #7 follow the LOTO six step procedures as list in appendix A ofLOTO plan push stop button operate disconnect to off position Application of Lockout Device Location disconnect south wall eviceration Location Device Device lock and tag Control of Stored Energy Type Method Method Type Verification of Equipment Isolation Energy 480vac Energy Start Up Procedures a. b. Method Method operate start push button/verify zero energy with meter follow the LOTO six step procedures as list in appendix A ofLOTO plan push start button ~ --CAL-CLEAN SAFETY ORLENT AnON ORiENTAnON DE PROTECCrON ACCESGRIOS ('ARA I'ROTECCIGN PERSONAL f-".. VI3STlM!;NT1\.- No Pu.edcn ussr cnmiselas sin mangus () panlallln~S conos CASCO- SI: reqwcrc pata lodos los empleados I . -, ' , BOTAS?B !-IUI.I: NOORAS-&I rct\uicren para lodDS los.cmplcad$'¥, ,- '~/ UNIFORME DE HULE- U$~ de mruerdo " las rtglas deJ a phml:l . L OOO·GLES.Gnlas para PIVICCC~O)I de los ojos.- Dube usarlas IIlodn horn cuanpc) cslc Irabajando coOn quimico~ -? TAJ'ON PARI\. OIDOS·Usa!' de llcuerdo !\ las inslruccione!; GUANTES DE HULl3.se fC()uicren pal'lliudos los elllpleados _ IJSO DE MASCARA DE RHSfllRt\R- (Progrnmn scparado) l'ERSONAL.PROTECTJVE EQUIPM'ENT C.LOTHING - No tank ooflS or cut- 0 BANDAS MOVIENDOS~-I'rot~imienlo de Iimpi!1/J1 spropiado. _/ l'Iunea tralo de uteWlzar por uenU'o Quando In maquinn !!SIll en movlmi.cnto iALADROS 0 DROCAS QUE ES'I'AN PRENDtD1\S·I'roccdlmiento do l!mpieza upropiado. Nuncu tr.ue de alcun7.llr [lor denim cuando Ia nmquinB csta en r movimienlo --L AIRE. Manguerns de agua ..L PISOS RCSSAI..OSOS Y MAQUINARIA .£ APUCACION DE QUrMICOS ..L AJ'I..ICACION DE ACE1'l'E '£" RF.lNSTALACI.ON DE PROTI!CTOReS DGSPUes OF. LlMI'IADOS r L1MI'IEZA DE BOTA.C; Y MAQUlNARlA CON -MANOUERAS DE AQUA CALIENTE ~: SlJBIDA ()E ESCALERAS Y MAQULNAS t. '-/ JUGAR Y CORREl'- t~MERG\!'NCIA BOTONES DE ljMEI~(j ENCIA PARA PARAR- (Propos ito .. UbiCllciqnl £. ASEGURAR CON LLA VE Y I'I1.OCEDIMlENTO pARA MARCM coN ROTULOS (l'rogran:Ja separado) IMMBDIA'TAMENTe o:mos Oli.TALLES.QUE 5E DEBEN CUBltIR YES (Matqu~ uno) EI or1C}lwdor ha revisado CDII usted el Progran'la de Comullicacion de ProtecciOIl y Peligros? NO ' ,/ YO «'ECI8~ . Y E'N'}lENDOLAIN1?QRMAC10N E.')CRlTA AltlUSA: I UAVI~ IU~CEIVE() AND UNDERSTAND TAE ABOVE INI'ORMATION irF.CHA. ' (DAllt) " AIR • Water hoses. SLIPPERY FLOORS ANI) EQUIPMENT C~EMICAL AI'PLICATION 011. APPLICATION REINSTALLAllON Of GllARDS AF1ER CLEANING CLEANING DOOTS & EQlllPMENT WITH H:OT WATER HOSES CLIMBING ON LADDERS AND MACHINES HORSEPLAY .,wD RUNNING EMERGENCV EMERGENCY STOP BUTTONS (purpose . locations) LOCKOt)T AND TAG PROCEDURE (separate program) , N tOCEOIMmN1'O PAllA:. REI!ORTAR LESIONES O'IfF:RIDAS . •/ REPOR1'E TdDtIS LAS-WSIONES 0 I-1ERIDAS A SU SUPERVISOR ./ RUNNING BELTS - Proper oJeanillg procedure. Never reach inside moving equipment RUNNING AUGERS· l>mpcr cleaning pr(jCcdurc. Never rcueh inside moving eqUipment. OTHr~R OTROS " ~ SP(~CfFIC JOB HA>Z...tRDS AND SAW JOB TECHNrOUES 9/z(rY f INjURY~EP.ORTIN(; rROCEllURE •._ _ _ REPORT ALL INJUlUES TO FOJmMAN IMMEDIATELY OrIiEiRffEI't'lS QIo-·CQVERAGE Yes No (mnrk onel Hns the Oricn!crrcyjewed the Hazardous Communication Safely Program wilh __ __ you? 1\ '~~lnMA DEL ~ '(EMI'LOYEE SIGNA SJGNATUREOI"PER~ON GIVING ORU\NTA .' ENWLOYEESKILLLEVEL &EQUWMffiNTCLE~G TE:" __~f--/...L.;'l-f-!./r_S-__ ENIPLOYEE NAME: EQUIPMENT OBSERVED #1:_--+--L..--'-----'l-...=L..---'--_ _ _ _ _ _ _ _ _ __ EQUIP:MENT OBSERVED #2:___ g~f-(.e-C-~------------EQUIPMENT OBSERVED #3:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ #1 #2 ~ /' DISASEMBLY OF EQUIPMENT ./ /' PROPER LOTO PROCEDURE / / PROPER PRE-RINSE / /' / ~ ,/ TASK OBSERVED D!~.Y PICK-UP PROPER FOAMING TECHNIQUES USE OF SCRUB PAD PROPER POST RINSE TECHNIQUE PRE-OP AREA WI FLASHLIGHT SANITIZE PROPERLY ~. r/ #3 ../ / .,-~.\- / A check mark (~ ) indicates that the employee properly followed Cal-Clean procedures for cleaning the corresponding numbers equipment for the given task. An (X) indicates the employee failed to properly follow Cal-Clean approved methods for the given task observed and that further training is required. All employees are to be evaluated on an annual basis. ~ . . :;" ....:..)~ _ __l_H_(A~ .s _L_t~,l' COMMENTS:_ _ _J.:;t "_ _ _ _ _ _ _ _ _ _ _ __ OBSERVED BY:---l,;:~~~~+_->--------- DATE:_-=-z+-'II~J4~(-r- Revision #2, Dated: 4/21/14 Created By: Yolonda Kirkman Authorized By: NRC ENCIERR,E LA "V" POR VERDADERO 0 "F" FALSO: F Laliberaci¢n inesperada de energfa es uno de los grandes riesgos durante el servicio: 0 mant¢nimiento. F OSHA estima que la norma de bloqueo/etiquetado protege aproximadamen,e 3.3 mlllones de:empteados cada alio. Una persona que btoquea las maquinas Q equipos es un Empleado Autorizado Un empleado que trabaja en areas donde se usan los procedimientos de control de energia pera el no es parte del proceso. es lIamada Empleado Afectado . LQS cuatro tipos principales de energJa mencionados son, electrica, neumatica, hidraulica y e6lioa. EI apagado de la maquina no eHmina necesariamente toda la 'energia de la misma. El bloqueo es un media para prevenir que la maquina arranque. Bloque? signifiea so~o~ apagar la maquina y desconectarla antes de real~ar. ~el mail~enimiento. Los ca~da(j~s '~t1ii~dP~ para el bloqueo puedan ser utilizados Sdl~ment~J)~ra }~,~.fu~~i6n:y no para otra cosa. . Los candado deben seguir el estimdar de las instalacrones en color, tamafto 0 forma. EI etiqlletado puede ser utilizadb en vez de bloqueo siempre que al empleador 16 dese'e. EI etique1acto previene la energizacion accidental delequipamientd. LEis companias deben tenet una politica escrita que defina los procedimientos de bloqueo. EI proceso de bfoqueo es un procedimiento de seis pasos. Antes de comenzar atrabajar en una maquina que he side bloqueada, el i:mpleado Aulonzado debe confiHriar el aislamiento de la energia que va hacia la maquina. Solo lOS Einpleados Autorizadbs que aplicaron los dispositivos de bloqueo deben remover los dispositivos de bloqueo. Undispositivo de bloqueo puede ser removldo per un supervisor cuando el emplasdo que aplic6 el dispositiv~ no esta presente. . 1t(9 F 1V 2U ClJan!dO es necesario realizar el bloqueo grupal, uno de los miembro$ de la Guadrill~ es el respenseble principal delgrupo. F Debe haber una eoi'1tinuidad en laproteccion de tos empleados entre los ttirnos cuando se re::lliza el bloqueo Grupal. . , F Cuan.do se utmta uncontratista del exterior, sus procedimientos de btoqueo deben seretlseliados Y cl;JmpJiaos per los empleados internos. Yo entiendo 1.9 informacion en este programa y pase la prueha de BloqiJeo y Etiquetadopara control d~ la energia t - _._- _._-- - - --------------- - - - ENWLOYEESKILLLEVEL &EQUW~NTCLE~G EMPLOYEE EQUIPMENT EQUIPMENT EQUIPMENT TASK OBSERVED #1 /" DRYPICK·UP #2 /' ./ ,........, PROPER LOTO PROCEDURE ./ ./ PROPER PRE·RlNSE r/ /' PROPER FOAMING TECHNIQUES / ./' USE OF SCRUB PAD /"" DISASEMBLY OF EQUIPMENT /' ./ PROPER POST RINSE TECHNIQUE PRE-OP AREA WI FLASHLIGHT / ~ /' ./ ./ /' /' /' /" /' ~ V SANITIZE PROPERLY #3 /" / A check mark (,j ) indicates that the employee properly followed Cal-Clean procedures for cleaning the corresponding numbers equipment for the given task. An (X) indicates the employee failed to properly follow Cal-Clean approved methods for the given task observed and ,that further training is required. All employees are to be evaluated on an annual basis. COMMENTS: ();~) fkf~(U > uJltf - Mr;-, - > c:'/W...-r!- OBSERVED BY Revision #1, Dated: 3/1/14 Created By: Yolanda Kirkman Authorized By: NRC Cal-Clean PLANT <1> ft .. (j)o~ PO Box 38935 Greensboro, NC 27438 336-632-1338 EMPLOYEE SKILLS LEVEL Employee Name: Demuestra el U so Apropiado de la manguera Demonstrates Rinse Gun Use Demuestra Aplicacion Apropiada de Quimicos Demonstrates Chemical Puede Inspeccionar la Maquinaria para Preop for Can Demuestra Procedimiento Correcto de Esterilizar Procedure Demonstrates Correct .. , Lev~l Three Requirements: Seis meses de Experiencia Six Months of on the Job I."v'... ~r'i .. Assignment and List _L.:..;._...:...:.=_---.::::..+-~:;,::;..._ Canton Division i\ ITENOi\NCL:: ROSTER !· :,.:il;ly-,-_ C lIS!.' Farl1l.~_ Canlon O h i o , Instrul;lllr !. Print)_..LLL...~ 1 l)~parrl1li.'llt(~) 7,~;~V'~/i\J_~~ /:~, ~~~~~~~~ll1strllclOr Signmure i "',':uion oj' 5, ,t?.T~f5'1.~~g..,.-$-, TH j 19-1 VQC WM (YQcllltY\~ a t:kl( V'e.UU!·W pktanq \r\~~ Left V\QV\.~ l ~ K. uP J Sv(Vdia.l'lC:C:: .Pz:.ofq~l(' ~now5 u",cll!( 8t;a.(du'Cf G CY\b:. ~\- ~k(~ e 6'; '-fY:·()lr..Q Q€pLVl 0,+ S :1-{4 ~ l~ 9.k )~".hi(:k t~J +{(IM' 8cg~ 'n (' 'IS \0: -\-I)c S ~ ~ct+ ·tc u l h::u:k a -f4 J,I .-/-0 rD~;J M. (} DL\1 -r -Ptfuc[) a u d ftI; /Lr QrwA(l ,'(\ ~hc:.. t QR'J~a..a to he fX1'tA tht"VJ ~rcl.t breq k:.&b~· wA-Ll'{J ", If..) ...;... _ V C LI " '" L '\ = " ([! 5, ~ 5 .' bl.o Qflt\ ___________ m ~iYw Safety Manager's signature: ----=: S :..L ' m _- _ 1_ INCIDENT REPORT: EMPLOYEE SECTION A ~Incident - (I am reporting a work related event that caused injury to me, damage to equipmenUbuilding or product loss/damage or product contamination) D Near Miss - (I am reporting a \NOrk related event that could have caused injury to me, damage to equipmenUbuilding Employee: Date of report: --=0+/.......l.:(......:J../'+/~ ~O--..:'~:::o... - __ Date of incident: 8/~ Lt jc1 () / .;, Nature of injury (cut, bruise, sore, pain etc.) C. c.d: 5,4~ Time of report: _"--______ @.lp.m. ~ ,m . Time of incident: _b'43 _ _ _ _ _ _~.Ip ~(k-=fr:..----/' '~2 ' The prior statement has been made by me and is true and correct. I understand that falsifying this document can lead to disciplinary action including discharge. I understand that it is my responsibility to advise the company's HRI safety department of any and all changes in my diagnosis, medical treatment, or other information pertinent to this report. Medical release: Under current workers' compensation law, the employer is entitled to a signed medical release. I hereby authorize any person(s) who have in the past or will in the future medically attend, treat or examine me, or any person who may have information of any kind which may be used to reach a decision in any claim for injury or disease arising from the injury/illness described above, to disclose such information to my employer and/or Compensation Management, Inc. (representative of employer). A copy of this form will serve as the original. ere y au Of ze any oc or, OSpl a , or 0 er me Ica tacTli y an or Insurance company 0 re ease an meaical records, medical reports, records of medical expenses paid, or settlements relating to this injury or any other illness or injury to my employer or my employer's representative. Employee Sig :f3/Q W/! S- Time: ?.' I q PIl1 Employee Incident Report Page 1 of 5 SECTION B Name: Social Sex: Witness(s}:, _ _ __ _ _ _ _ _ _ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ _ _ __ Department and location where occurred ;( be specific) @:d s ,'#-e!~ ~) ~7 Did you report the incident? ~ Yes __ No If yes, to whom? _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ If no, explain: _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ Employee's shift on day of injury (from) _ _-LILf. . !J. .(..L--__ a.m.@) (to) _~....I.gL'....:....J...l...C_'_ _~. Ip.m. Yes _ _ _-"Is.........., th""' is'-"'a...... n......aggravation of a pre' ><. No If yes, when were you last treated for the condition? _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ __ Have you ever had a similar injury? __ Yes ----:I-- No If yes, describe _ _ _ _ _ _ _ _ __ _ Shade in body parts affected on diagram Was treatment provided in the clinic? ~Yes No If yes, describe: (~:rs+-- th·~ . Employee Incident Report Page 2 of 5 Further Medical treatment soughUrequired: _ _ none _ _ First aid/Urgent care , / Doctor/hospital . . . . !.;l ~~ ~~a1iooJ.aclllty-.aodl Latte dlnQ..ooy:slc'iaOb.:".J..~~ ' ~~~~=~==loo:I',,~j,~m-~'C"TJ= == ..... = = = = = = ==----=- If medical treatment was not sought immediately, explain why _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Were you hospitalized at all? _ _ Yes ~ No b' !nsed I1ea!h care jlIlIresslooal. You must aIsc I1lCOfCf work-related injuriils and !loesses Ibatmeel anyoflhe spec:ifoc~cri!erla ~tEd in 29 CFR 1904.8 through 1904.12. Feel free III use two &nes fdraslogle case W)'Ou need 10. You must ooml!lele IIIl inju'Yand iijes.s inaide~t report (OSHA Form 301) or equiva~t ~rm [or each iniu'Y or iIness recorded on lhIS form. ")'DU're no! sUre wheihe1 acase is recordable, can )'Our local OSHA office fofhelp. Establishment name City ~~~~ case (A) Case No. (8) Employee's Name (C) Job Tille (e.g., Welder) (D) (E) Date of IWhele the event occumed (e.g. injury or loadlng dock north end) onset of iHness (moJday) + u.s. DepanunentofLabor CALLAGHAN & CALLAGHAN, INC - FEIN 34-1704943 ALL ALL State .~ (F) ICHECK ONLY ONE box for each case based on Idaysthe injured or ~I Desaibe injury or illness, parts of body aflected, the most serious outcome for that case: WOIlter was: object/substance that direcUy injured or made ::=-= =-=- ::a: ill (e.g. Second degree bums on right from acetylene torch) Dealh I I!la)t$ awiIy ~alWOIk transrer or II'OI'n vIOt1! restriction ~lness: --- I (M) Ii; 'E0 ;.. is ~ .91: .. 0 '5.~ ~ '2 2 . " ..'" 0 :¥ '"I: '1: :5 -' ~ " 0 7d (days) I Check the "injury"column or choose one type of Be sure to transfer these totals to the Summary page (Fonn 300A) before you post it. Publ'iC rejIorti1g burden roc lIIis coIIed»n of infQrmaIi)n Is estinated to average 14 miruJl!s per response, Inc*>dirog !me 10 reW!w the Ins~ seOIdl and ga\her t!iedata