Health and Safety Policies and Procedures Template

• Company name:

• Site/Building/Facility name:

• Site/Building/Facility location:
  Address

• Official document title:

• Document prepared on:

  Date

• Document prepared by:

• List the health and safety policies included:

Health and Safety Policy

• Policy title:

• Policy number:

• Policy title:

• Policy number:

• Policy issued on:

  Date

• Policy issued by:

• Policy approved by:

  Sign

• Select "Add note" option under the "Policy approved by:" item above and indicate the Title of the person approving the policy and the Department they belong to.

• Policy effective on:

  Date

Definition of terms used in this policy:

• Slip, trip, and fall hazards

• Electrical hazards

• Ergonomic hazards

• Purpose of this policy:

• Official policy statement:

• Procedures related to this policy:

• Scope of this policy:

• Responsibilities of persons with regards to this policy and related procedures:

• References:

• Help contact:

For policy review:

• Policy reviewed on:

  Date

• Policy reviewed by:

For policy revision:

• Policy version number:

• Policy revised on:

  Date

• Policy revised version approved by:

  Sign

• Policy revised version effective on:

  Date

• Policy title:

• Policy number:

• Policy issued on:

  Date

• Policy issued by:

• Policy approved by:

  Sign

• Select "Add note" option under the "Policy approved by:" item above and indicate the Title of the person approving the policy and the Department they belong to.

• Policy effective on:

  Date

Definition of terms used in this policy:

• Verbal harassment

• Verbal assault

• Verbal abuse

• Physical harassment

• Physical assault

• Physical abuse

• Sexual harassment

• Sexual assault

• Sexual abuse

• Harassment in the form of behavior, actions, or decisions (non-verbal and no physical contact)

• Verbal discrimination based on gender

• Discrimination based on gender through behavior, actions, or decisions

• Verbal discrimination based on race

• Discrimination based on race through behavior, actions, or decisions

• Verbal discrimination based on sexuality

• Discrimination based on sexuality through behavior, actions, or decisions

• Verbal discrimination based on religion

• Discrimination based on religion through behavior, actions, or decisions

• Purpose of this policy:

• Official policy statement:

• Procedures related to this policy:

• Scope of this policy:

• Responsibilities of persons with regards to this policy and related procedures:

• References:

• Help contact:

For policy review:

• Policy reviewed on:

  Date

• Policy reviewed by:

For policy revision:

• Policy version number:

• Policy revised on:

  Date

• Policy revised version approved by:

  Sign

• Policy revised version effective on:

  Date

• Policy title:

• Policy number:

• Policy issued on:

  Date

• Policy issued by:

• Policy approved by:

  Sign

• Select "Add note" option under the "Policy approved by:" item above and indicate the Title of the person approving the policy and the Department they belong to.

• Policy effective on:

  Date

Definition of terms used in this policy:

• COVID-19

• COVID-19 symptom

• Asymptomatic

• Handwashing

• Cleaning

• Disinfection

• Ventilation

• Social distancing

• Face mask

• COVID-19 vaccine

• Vaccinated

• Unvaccinated

• Contact tracing

• Close contact

• COVID-19 test

• Confirmed COVID-19 case

• Unconfirmed COVID-19 case

• Isolation

• Purpose of this policy:

• Official policy statement:

• Procedures related to this policy:

Handwashing procedure:

Step

Social distancing procedure:

Step

Cleaning procedure:

Step

Disinfection procedure:

Step

Symptom checking and monitoring procedure:

Step

Contact tracing procedure:

Step

Isolation procedure:

Step

• Scope of this policy:

• Responsibilities of persons with regards to this policy and related procedures:

• References:

• Help contact:

For policy review:

• Policy reviewed on:

  Date

• Policy reviewed by:

For policy revision:

• Policy version number:

• Policy revised on:

  Date

• Policy revised version approved by:

  Sign

• Policy revised version effective on:

  Date

• Policy title:

• Policy number:

• Policy issued on:

  Date

• Policy issued by:

• Policy approved by:

  Sign

• Select "Add note" option under the "Policy approved by:" item above and indicate the Title of the person approving the policy and the Department they belong to.

• Policy effective on:

  Date

Policy

• Definition of terms used in this policy:

• Industry/site-specific hazard:

• Risks posed by the hazard:

Risk

• Risk description:

• Likelihood of risk occurring:

  Highly Likely

  Likely

  Unlikely

  Highly Unlikely

• Possible consequence of risk:

  Long-term illness

  Short-term illness

  Fatal injury

  Major injury

  Minor injury

• Purpose of this policy:

• Official policy statement:

• *FOR EXAMPLE:
  Measures in place to protect [affected group] from [industry/site-specific hazard] and its risks:
  
  Duties of [affected group] involving hazard identification, risk assessment, control, and mitigation:

• Related procedures:

Procedure

• Title:

• Steps:

• Scope of this policy:

• Responsibilities of persons with regards to this policy and related procedures:

• References:

• Help contact:

For policy review:

• Policy reviewed on:

  Date

• Policy reviewed by:

For policy revision:

• Policy version number:

• Policy revised on:

  Date

• Policy revised version approved by:

  Sign

• Policy revised version effective on:

  Date