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Division of Labor Standards
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Managing Worker Safety and Health

APPENDIX 5-1

WORKSHEET

SAFETY AND HEALTH PROGRAM RESPONSIBILITIES

All employees will be fully responsible for carrying out the provisions of our safety and health policy that pertain to operations under their jurisdiction.  The responsibilities listed below are out minimum expectations.  We encourage individual initiatives to curb losses.

JOB TITLE:
GENERAL STATEMENT:
.
LIMITS OF AUTHORITY AND RESOURCES (Expenditures, reporting, authority to shut down equipment):
.
.
THE EMPLOYEE WILL BE RESPONSIBLE FOR AND HELD ACCOUNTABLE FOR:
.
.
.
.
.
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