6720

Page 1 of 19

FOREST SERVICE MANUAL

RUSSELLVILLE, AR

TITLE 6700 - SAFETY AND HEALTH PROGRAM

OZARK SUPPLEMENT NO. 6700-95-3

Effective October 31, 1995

POSTING NOTICE. Supplements to this title are numbered consecutively. Post by document name at the end of each chapter. Retain this transmittal as the first page of this document. The last Supplement to this title was Ozark Supplement No. 6700-95-2.

Superseded New

Document Name (Number of Pages)

6720 0 19

6720 Exhibit 01 0 12

6720 Exhibit 02 0 3

6720 Exhibit 03 0 7

Digest:

6725 - Adding the Ozark-St. Francis NFs Bloodborne Pathogens Exposure Plan to the directives system.

LYNN C. NEFF

Forest Supervisor

FSM 6700 - SAFETY AND HEALTH PROGRAM

OZARK SUPPLEMENT 6700-95-3

EFFECTIVE 10/31/95

CHAPTER 6720 - OCCUPATIONAL HEATH PROGRAM

6725 - EMERGENCY MEDICAL SERVICES. The Forest Bloodborne Pathogens Exposure Control Plan is an addendum to but separate from the Forest Safety and Health Plan. It will be reviewed and updated annually.

OZARK-ST. FRANCIS NATIONAL FORESTS

BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN

1. Purpose

This Bloodborne Pathogens Exposure Control Plan is to provide direction that will:

A. Assure that all employees, enrollees and volunteers are informed of the hazards of infection from bloodborne pathogens, the nature of the diseases, the meaning of "universal precautions" and ways to protect themselves from infection.

B. Ensure that employees, enrollees and volunteers who have an occupational exposure to bloodborne pathogens are provided work procedure training and the equipment and knowledge to minimize or eliminate any exposure.

C. Comply with the OSHA Bloodborne Pathogens Standard, 29 Code of Federal Regulations (CFR) 1910.1030.

Program Availability

It is the intent of this program to offer protection from bloodborne pathogens and their diseases to all employees, enrollees, and volunteers. The degree of protection will vary depending upon occupational exposure but all employees will receive awareness training and be entitled to post-exposure counseling, medical treatment and evaluation should they have an occupational exposure.

The procedures set forth in 29CFR 1910.1030, the Bloodborne Pathogens Standard and further detailed in FSM 6725 and the Regional Exposure Control Plan will be followed.

The word "employee" as used in this Exposure Control Plan refers to regular Forest Service Employees, SCSEP enrollees and volunteers covered by volunteer agreements who are performing jobs with an occupational exposure.

2. Scope and Definitions

2.1 Scope

The Bloodborne Pathogens Exposure Control Plan applies to all employees who have the potential for exposure to blood or other potentially infectious body fluids in the course of their assigned duties. Jobs identified as having occupational bloodborne pathogen exposure are listed in the Exposure Determinations forms in Appendix A.

All other groups of employees and enrollees (Job Corps Students, YCC, Youth Forest Camp, JTPA) will be offered medical treatment, medical evaluation and post-exposure counseling only upon exposure.

The OSHA Standard excludes "good samaritan acts" from coverage. This means they are not entitled to up-front Hepatitis B vaccinations but are entitled to all aspects of the program after an exposure has occurred, including Hepatitis B vaccinations. See definition for "occupational exposure".

"Bloodborne Pathogens" means: Pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

"Bloodborne or other body fluids" include: Human blood, human blood components, and products made from human blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.

"Contaminated sharps" means: Any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, etc.

"Exposure incident" is defined as: A specific eye, mouth, mucous membrane, non-intact skin, or parenteral contact (skin-piercing injury such as a needle-stick, glass, etc), with blood or other potentially infectious materials that results from the performance of an employee's duties. Non-intact skin includes dermatitis and breaks in cuticules. There is a distinction between getting blood or other suspected infectious material on intact skin or clothing versus an exposure incident. Blood on intact skin is not an exposure incident but should serve as a indicator that perhaps protective equipment is not being worn, is not available or work practices are not well understood. An investigation is warranted.

"Occupational Exposure" is defined as: Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. This definition excludes incidental exposures that may take place on the job, and that are neither reasonably nor routinely expected. The example cited in the Standard for illustration is that of an employee coming to the aid of another employee, i.e., "good samaritan act". The exposure must be reasonably anticipated. For example, an employee performing wastewater treatment plant duties would be reasonably expected to contact bloodborne pathogens while a computer operator would not be. In addition to being reasonably anticipated, the contact must result from the performance of an employees duties. The computer operator is not expected to provide first aid to a fellow worker that may fall even tho that person may be more then willing to provide aid and may even have been provided first aid and CPR training. Their job is to run a computer. Record exposures on forms

FS 6700-12A and FS 6700-12B.

"Parenteral" means: Piercing mucous membranes or the skin barrier though such events as needle sticks, human bites, cuts and/or abrasions.

"Regulated waste" means: Liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials. All infectious wastes destined for disposal shall be placed in closable, leak-proof containers or bags that are color-coded or properly labeled.

"Source Individual" is any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to employees.

"Universal precautions" is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

2.3 Responsibilities of Supervisors and Managers

- Review and update the Exposure Control Plan annually or as necessary.

- Ensure implementation of the Exposure Control Plan.

- Investigate all exposure incidents.

- Advise employees on the protective equipment required for each task and ensure it is readily available.

- Audit program annually.

- Maintain file of Exposure Incident forms, and training records.

- Ensure the Exposure Control Plan is readily available to all affected employees.

- Advise affected employees on the appropriate work practices, engineering controls and protective equipment necessary to minimize exposure and ensure they are in use.

- Ensure the work areas are kept in a clean and sanitary condition.

- Assist with proper labeling practices.

- Report all exposure incidents to the Program Administrator.

- Coordinate employee training.

- Coordinates pick up and disposal of regulated waste.

- Arrange for medical evaluation after an exposure incident.

- Coordinate offering and implementation of the hepatitis B vaccination program.

2.4 Responsibilities of Employees (definition includes volunteers, and SCSEP enrollees)

- Know where the Exposure Control Plan is located.

- Know and practice universal precautions in all situations where potential contact with bloodborne pathogens exists.

- Use the work practices, engineering controls and protective equipment outlined in the Exposure Control Plan.

- Report all exposure incidents to your supervisor immediately after they occur.

- Report any inconsistencies, alterations, errors and non-compliance with the Exposure Control Plan to your supervisor.

3. Occupational Exposure Determination

3.1 Job Classifications in which all employees have occupational exposure to bloodborne pathogens appear on the appropriate form in Appendix A, FS 6700-95-2.

3.2 Job Classifications in which some employees have occupational exposure to bloodborne pathogens appears in Appendix A, FS 6700-95-3. The specific tasks, and procedures which may involve occupational exposure are shown.

Job Hazard Analysis forms, FS-6700-7, have been prepared for the tasks normally done by employees with occupational exposure to bloodborne pathogens. These also appear in Appendix A.

4. Implementation Time

See figure B-1 of Appendix B for the Program Implementation Timeline. Local programs must adhere to this schedule if the program is to be considered to be in compliance. Prepare form FS-6700-XX-4, Exposure Control Plan Schedule and Method of Implementation to record dates of compliance.

5. Methods of Control

Bloodborne pathogen sources will never be eliminated from the work environments of our employees. Therefore, employees must be provided the tools necessary to allow them to avoid contamination. There are five major avoidance methods, which if appropriately used, will eliminate or minimize employee exposure.

- Universal Precautions

- Engineering Controls

- Work Practice Controls

- Personal Protective Equipment (PPE)

- Housekeeping

5.1 "Universal Precautions"

Refers to a concept of infection control, which was developed by the Center of Disease Control for health-care workers but logically applied to all workers. Universal Precautions is the practice of treating all blood and certain body fluids as if known to be infectious for HIV, HBV and other bloodborne pathogens. Blood and other body fluids can contaminate clothing, tool handles, bedding, walls, floors and surfaces in toilet buildings, vehicle seats and all the numerous locations where humans could be found.

Discarded needles and other sharps must be assumed to be "Other Potentially Infectious Material" (OPIM) and carefully handled.

Universal Precautions will be taught in all bloodborne pathogen training. Universal precautions will be practiced by all employees when responding to the needs of injured employees, and all other persons contacted.

Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials.

5.2 Engineering Controls

Engineering controls isolate or remove bloodborne pathogen hazards from the workplace or prevent contact with them. Such controls include the one-way mouth barrier used to perform CPR, the use of sealed sharps containers, or tongs or other mechanical devices to pick up sharps, etc., from the ground. Vehicle barrier screens and handcuffs could be considered engineering controls for law enforcement work. Engineering controls shall be examined and maintained or replaced on a regular schedule to ensure their effectiveness.

5.3 Work Practice Controls

These are the key to prevent exposure to bloodborne pathogens. They must be combined with engineering controls and personal protective equipment to be successful. Below are tasks and descriptions of work practices in combination with PPE and engineering controls.

5.31 Recreation Clean-up Crews

Extra-length nitrile, heavy latex or rubber gloves should be worn while washing down interiors of rest rooms, bath houses and other facilities where pathogens could be anticipated. Extra-length indicates at least a 12 inch glove. Disinfect reusable gloves daily by dunking in clean antiseptic compound used for cleaning, or in a 10% solution of household bleach. Rinse thoroughly, turn inside out, and allow to dry. Use a clean and dry pair of gloves each day. Discard gloves that become punctured or torn. Soap or antiseptic waterless hand cleaner and paper towels will be provided on the job site. Employees will wash hands immediately after removing gloves or other PPE and before smoking or eating.

Do not use hands to pick up discarded sharps or suspected contaminated materials. Use a shovel, tongs or other devices. Each crew will have with their vehicle an approved sharps container and bags marked with the biohazard symbol for use in containing contaminated material other than sharps. The sharps container must be closable, puncture resistant, leak proof on sides and bottom and labeled with the standard biohazard symbol. Do not overfill sharps containers.

The sharps container shall not be reused nor emptied and shall be shipped along with its contents to an approved medical waste disposal site. Contact your local hospital authority to determine if they will accept your wastes; even if you must contract and pay for this service. Maintain files documenting proper disposal of all material.

Rubber or plasticized aprons will be worn while cleaning interiors to minimize contact with contaminated surfaces and contamination of personal clothings.

Use leather work gloves to lift garbage bag containers. Grasp garbage bags only by the top. Avoid contacting the bag with the body or forearms. Treat the bag as if it does contain sharps. There are no gloves that will guarantee protection

5.32 Job Corps Operations - Nurses & Health Technicians, HOT students & Other Staff

These are the jobs with greater potential occupational exposure. The D.O.L. April 13, 1993, Directive Notice 92-34, Prototype Exposure Control Plan for Occupational Exposure to Bloodborne Pathogens, coupled with 29CFR1910.1030 offer up-to-date recommendations. Equip every health care office with these publications. Adherence to the guidelines is required.

Prevent fighting and assaults among students by education in social skills, discipline, peer pressure and by early intervention into situations, which appear, headed to a confrontation. Training such as Anger Control and Social Skills is recommended.

Immediately after use, sharps shall be disposed of in closable, leak proof, puncture resistant, disposable container that is properly labeled and/or color-coded. Medical waste disposal regulations must be followed. Maintain manifests and records documenting proper disposal.

Employees who are bitten by a person should:

Allow the wound to bleed, but do not massage wound to encourage bleeding. Wash the area thoroughly with soap and water. Get medical attention quickly. This is an occupational exposure if it occurred while the employee was on duty. It is also an occupational injury and OWCP reports should be filed. Begin post-exposure and follow-up protocol immediately.

5.33 Laundry Workers :

- Minimize handling of soiled laundry with bare arms and hands. Maximize use of mechanical handling.

- Require each enrollee to sort or bag their own laundry.

- Soiled or bloodied laundry will be segregated and labeled before washing as other laundry. Have enrollees or the user of the laundry place it in specially marked bags or containers that prevent soak-through or leakage.

- Rubber gloves and rubber or plasticized aprons will be worn when handling soiled laundry. Wash gloves and aprons frequently.

5.34 Law Enforcement Activities :

These activities may involve considerable risk to employees because of the uncontrolled nature of arrest situations or the nature of the persons they come in contact with. The use of universal precautions and PPE is critical.

- Law enforcement personnel must follow accepted procedures to avoid reaching into clothing pockets, under car seats, and other dark and inaccessible places that may conceal needles, etc.

- Ask suspects to empty their own pockets.

- Use a flashlight before reaching into dark areas.

- Do not touch blood contaminated clothing or other objects.

- Wash thoroughly after each contact with body substances.

- Contaminated vehicles should be decontaminated using 1 part household bleach and 9 parts water. Thoroughly wash all surfaces.

- Keep hands and fingers away from eyes and mouth until washed.

- Ask arrested suspects if HIV positive or hepatitis B carrier and protect yourself and downline law enforcement officers. If in doubt, assume the person is a source.

- Confiscated and suspect contaminated items will be segregated and labeled "Contagious Disease Contamination" or appropriate other wording. Bag separate from other items.

- Protect your own skin breaks, rashes, etc., from serving as routes of entry by bandaging, wearing gloves, etc., prior to contact/exposure. Take the time to protect yourself.

- Each vehicle used in law enforcement must have soap and water or waterless antiseptic hand cleanser, paper towels; two HIV kits and extra Latex gloves, an approved sharps container, appropriately labeled contaminated waste disposal bags.

- Immediately report an occupational exposure to your supervisor.

- Puncture proof and properly labeled containers must be used to transport and store contaminated evidence.

- Use a stick, tongs, etc., to sort thru garbage/refuse when searching for evidence. Do not use hands, even with gloves.

5.35 General Work Practices for all Employees.

- Universal precautions shall be the standard operating procedures for all employees.

- Employees are responsible for the use of discretion and recognition of situations, which could expose them to bloodborne pathogens.

- First-aid and CPR providers shall take the time to first protect themselves by wearing gloves/face shields/masks/goggles before beginning medical care of any victim.

- CPR providers should be aware that risk of transmission of HIV or hepatitis B from saliva is extremely low. However, use the one-way valve protective mask in all cases. Do not use the same mask on different victims. Dispose of the mask after use.

- If injuries are minor, hand the person the necessary bandage, Band-Aid, gauze pad, etc., and have the person apply pressure and clean and dress their own wound.

- Each vehicle used on official business shall be equipped with 2 of the standard HIV kits. It is recommended that work centers and other offices be equipped as well.

- The appropriate PPE is to be provided to workers with occupational exposure to bloodborne pathogens. It must be used.

- Hands must be washed with soap and water after removing gloves or protective clothing. Skin surfaces shall be washed immediately if contaminated by blood or body fluids. Hand washing facilities must be readily accessible where feasible. When the provision of hand washing facilities is not feasible, an appropriate antiseptic hand cleaner in conjunction with clean cloth/paper towels or antiseptic towelettes shall be used. When antiseptic hand cleaners or towelettes are used, hands shall be washed with soap and water as soon as feasible.

- Do not use bleach solution on hands or other skin. Frequent use dries the skin and removes natural oils weakening the skin as a barrier to pathogens.

- Mucous membranes must be flushed with water immediately or as soon as possible following contact with potentially infectious materials.

- Eating, drinking, smoking, chewing tobacco, applying cosmetics or lip balm and handling contact lens are prohibited in work areas where there is a reasonable likelihood of occupational exposure.

- For spills, accident sites, and other situations involving a concentration of blood or suspected infectious materials, appropriate protective clothing must be worn during clean-up. The spill shall be contained, absorbed and properly disposed of.

- All materials collected should be deposited in an infectious waste container and the area must be decontaminated with a 10% bleach solution. Spills should be cleaned up immediately so that dried residue will not be spread as a dust.

- Safety face-shields should be used for any procedure, which could produce blood splashes, splatters or aerosols.

- Equipment that has been potentially contaminated with bodily fluids, and is to be sent outside the facility for disposal or repair shall be decontaminated prior to shipping. This equipment shall be properly labeled and shall state which portions of the equipment remain contaminated. A sewerage pump sent for repairs could be a common example of this. Tool handles from fire fighting may be bloodied by broken blisters, cuts, scratches, etc. They should be dipped in a bleach solution before being reconditioned.

5.4 Personal Protective Equipment

Appropriate PPE will be provided at no cost to all employees with an occupational exposure and to all employees that may be called upon to render first-aid or CPR as a "good samaritan."

The equipment will include but is not limited to:

- Gloves (many types - rubber, latex, hypo-allergenic, utility, leather, disposable, frisker, etc.)

- Eye Protection (face shields, goggles, safety glasses)

- Aprons (plastic, rubber)

- CPR mouth barriers with one-way valves as part of HIV/HBV prevention kits required by the NFFE Master Agreement, Section 27.

Personal protective equipment will be considered "appropriate" if it does not permit blood or other potentially infectious materials to pass through to reach the employee's work clothes, street clothes, undergarment, skin, eyes, mouth or other mucous membranes.

- The Government will provide for cleaning, laundering or disposal of protective clothing or equipment, at no cost to the employee.

If an employee does not use PPE in an emergency because it would cause a safety hazard or prevent or hinder the proper emergency response or first aid procedures, it must be documented and investigated to determine if changes can be made to prevent such occurrence in the future.

- If a garment is penetrated by blood or other potentially infectious material, it shall be removed, contained in a properly labeled container and washed or disposed of.

Gloves

Gloves shall be worn when there is potential for direct skin contact with potential bloodborne pathogen containing materials, items or surfaces.

See the various write-ups under Section 5.3, Working Practice Controls, for required uses of gloves, their cleaning, reuse, and disposal.

Other PPE:

Pocket masks, resuscitation bags, or other ventilation devices shall be provided at each work site and used when performing CPR or other life support activities.

NOTE: Employees shall not take contaminated laundry or PPE home to wash.

5.5 Housekeeping

- Worksites where bloodborne pathogens could potentially be found (small labs of wastewater treatment plants, JCC healthcare clinics, accident sites within a building, etc) shall be properly cleaned and disinfected after contact with blood or other potentially infectious material. Prepare FS 6700-XX-7, Housekeeping Schedule and Method of Decontamination form for these sites.

- JCC Healthcare clinics will comply fully with Department of Labor direction.

- If a blood spill occurs, the following procedure defines cleanup activities:

Work surfaces shall be decontaminated with an appropriate disinfectant immediately after any spill of blood or other potentially infectious materials. Should contamination or a spill occur, alert all nearby workers and deny access until the area has been decontaminated.

The appropriate disinfectant solution is a 10% sodium hypochlorite (household bleach such as Clorox) mixed at a ratio of 1:10, 1 part of clorox to 10 parts of water.

- All reusable bins, pails, cans, and similar receptacles that have been used for cleaning, etc., which have a potential for contamination with infectious materials shall be inspected, cleaned, and disinfected weekly and cleaned and disinfected immediately or as soon as possible upon visible contamination.

IMPORTANT:

To assure the effectiveness of any disinfections process, equipment and instruments must be thoroughly cleaned of all visible contamination before being disinfected.

- Mops, rags, sponges, paper towels and other cleaning equipment which is used to clean up blood or other potentially infectious material will be disposed of and it's cleaning for reuse will not be attempted. Use the appropriate labeled red bag and treat as regulated waste.

Regulated wastes.

See section 2 for definition. The objective of special treatment of these wastes is to prevent accidental contacts and exposures due to needlesticks, spills, or leaks during storage, handling and disposal. It's disposal is regulated and under strict control. The wastes need to be taken to a disposal facility approved to handle medical wastes. Job Corps Centers will have a disposal contract already established and it may be possible to use the Centers contracts for regulated wastes from Ranger Districts. Local hospital authorities may be willing to take small quantities of medical wastes or a contract may have to be developed for this purpose.

- All containers used to store, transport or ship bloodborne pathogens or potentially infectious materials will be orange/red or labeled with the standard biohazard symbol. Sharps containers must be puncture proof and leak-proof.

- The containers shall be easily accessible to crews, which may discover or generate the wastes.

- Do not over-fill the containers, and replace them often.

- Keep the lid on sharps containers closed if moving it or if it is subject to jostling, as with a crew in a pickup.

- Turn in contaminated items at least weekly or more often if necessary. Select a designated area for storage until taken to a medical waste facility.

NOTE: Sanitary napkins collected as part of trash are not regulated wastes and may be routinely disposed of. A separate container with a plastic bag liner is required in restrooms.

6. Medical Management

Program items under this heading include the Hepatitis B vaccination, post-exposure evaluation and follow-up and necessary medical records. All medical procedures and evaluations will only be done by or under the supervision of a licensed physician and at reasonable times and places. The Public Health Service recommendations will be used and all tests shall be done by an accredited laboratory.

6.1 Hepatitis B Vaccinations

These will be made available to all employees with the job classifications shown on the "ALL" and "SOME" Exposure Determination forms of appendix A.

In addition, any employee that is not covered by the Standard because they do not have a job with occupational exposure and that has an occupational exposure during a good samaritian act or under other occupationally connected circumstances, will be immediately enrolled in the program and be entitled, at no cost, to all post-exposure benefits. Vaccines are to be offered within 24 hours.

- The required bloodborne pathogen training will be given before offering the HB vaccine to employees to allow them to make a better informed decision as to accept or decline the vaccination.

- Both the training and the vaccine will be offered within 10 working days to all employees who have occupational exposure unless the employee has previously received the vaccine, and antibody testing shows immunity or vaccination is not allowed for medical reasons.

- Recombinox or Engerix are the recommended vaccines and the route of injection will be intramuscular.

- Revaccination screening (to determine an employees antibody protection before offering the vaccine) is not recommended and cannot be used as a prerequisite for obtaining the vaccination.

- Titers (antibody level testing) will be done 4-12 weeks after the last vaccination. This test measures the immunity protection.

- Boosters, at Government expense, are authorized until titers test indicate full immunity levels. Follow the advice of your medical provider.

- An employee may decline the HBV vaccination but must sign the declination form, FS 6700-14.

- If the employee initially declines HBV vaccination but at a later date, while still covered under the program, decides to accept the HBV vaccine, it shall be provided.

- Accurate records of vaccinations given or declined are mandatory. A unit log of vaccinations is recommended as well as individual records in each employee's medical section of their OPF. Basic information, which should be kept, includes name, dates of shots and titer tests and dates of any required booster shots.

6.2 Post-Exposure and Follow-up

An employee who receives an occupational exposure shall immediately notify their supervisor. The supervisor shall immediately begin an investigation and begin completing the Bloodborne Exposure Incident Report, FS 6700-12A,B & C. The employee is entitled to a confidential medical evaluation, which includes appropriate testing, an investigation of the incident, knowledge of the source individual if known, and counseling.

Guidelines in the event of an occupational exposure:

1. Wash affected areas with soap and water and disinfectant as soon as possible.

2. Notify supervisor immediately of the incident and begin investigation.

3. Notify your Forest Safety Coordinator.

4. Complete and sign the Exposure Incident Form, FS 6700-12A, B & C.

5. Provide the attending physician with FS 6700-15, Post-exposure Evaluation and Follow-up report.

IF EMPLOYEE HAS NOT BEEN VACCINATED FOR HEPATITIS B:

1. Do pretest counseling for affected employee(s).

2. Offer HBV per Infection Control Protocol within 24 hours at no charge to the employee(s) or have the employee complete the declination form, FS 6700-14.

3. Offer HIV screening to employee(s)

4. Enroll employee in post-exposure and follow-up protocol.

5. Establish medical records.

IF EMPLOYEE HAS BEEN VACCINATED FOR HEPATITIS B:

1. Coordinate pretest counseling to affected employees(s).

2. Test employee for Hepatitis-B Antibodies and offer boosters if needed.

3. Begin post-exposure and follow-up.

SPECIAL NOTE: Complete a CA-1, Notice of Traumatic Injury, should an occupational exposure occur. File with the Office of Workers' Compensation as for any other injury if the investigation indicates an occupational exposure did occur and the case:

1. Is work-related and involves loss of consciousness, transfer to another job, or restriction of work or motion.

2. Results in the recommendation of medical treatment beyond first aid. If shots of gamma globulin, Hepatitis B immune globulin or Hepatitis B vaccine are given the case is reportable.

3. Results in a diagnosis of seroconversion.

Cases meeting the above criteria are also to be recorded on the OSHA 200 Log. Complete a precautionary CA-1 when an exposure occurs but does not meet the above criteria. File in the employees medical section of their OPF.

7. Information and Training

A. All employees who are designated as being within the scope of this plan (they have an occupational exposure) shall participate in a training program within 10 days of initial assignment and at least annually thereafter. Training shall also be done when new or modified tasks or procedures affect the employee's potential for occupational exposure.

B. All other employees will receive awareness training that will improve their knowledge of universal precautions, and the modes of transmission and symptoms of bloodborne pathogen diseases. Offer reviews of any exposure incidents which may have occurred, and provide training in the use of the HIV kit equipment. Cover reporting of exposure incidents and record keeping. This training and the annual training can be done in a safety meeting format. Maintain records of attendance.

C. Training for employees with an occupational exposure must include the 14 items of 29 CFR 1910.1030, (g) (2) (vii) (A-N). Training will also include the following:

1. An explanation of the facility's hand washing policy;

2. Methods of prevention of HBV and HIV exposure;

3. Workplace practices for responding to incidents that might involve body fluids, laundry and work around/in the wastewater treatment plant(s);

4. Handling and clean-up of blood spills;

5. Precautionary measures outlined in the CDC guidelines;

6. Locations of hand washing facilities, detergents and disinfectants;

7. Handling sharp instruments;

8. Routine examinations;

9. Re-usable equipment;

10. Review of Job Hazard Analysis prepared for jobs with occupational exposure;

11. Explanation of how "Good Samaritian" acts are covered by the program and the long term protection offered.

D. Instructors must be knowledgeable in all phases of bloodborne pathogen hazards, control methods and be able to respond toquestions.

It is recommended Forests contact local sources of training rather than trying to do it themselves. Hospitals, EMT units, ambulance attendants, police training academies, Job corps medical teams, public health departments and fire departments have been involved with similiar programs and should be able to provide training that covers the 14 OSHA required items.

It is important that potential sources of training be provided with a description of typical Forest Service work with occupational exposures, otherwise, training will be geared heavy to medical occupations and will miss the majority of our exposures.

Provide potential trainers with copies of job hazard analysis and the exposure determinations for "all" and "some" employees and any other information necessary to assure vendors understand our exposures.

E. Use FS 6700-16 A & B to document training accomplishment.

8. Record keeping

A. Medical Records: Accurate medical records are extremely important for employees with occupational exposure jobs and for employees that have an occupationally related exposure. Personnel Management will develop and maintain a record-keeping system for the duration of employment plus 30 years.

B. Training Records

Training records shall include the following information and will be maintained by the Safety Coordinator.

A. The dates of the training sessions;

B. The contents or a summary of the training sessions;

C. The names and qualifications of persons conducting the training;

D. The names and job titles of all persons attending the training sessions.

These records shall be maintained for at least three years.

Use the required Bloodborne Pathogens Program Training Record to document

training, FS 6700-16 A & B.

Appendix A

This appendix contains FS Forms 6700-XX-2 and 6700-XX-3, Exposure Determinations for All Employees Exposed and Some Employees Exposed for the job classifications identified in Region 8 and Job Hazard Analysis, 6700-7 for jobs performed by the employees with occupational exposure. The Job Hazard Analysis are basic and need to be expanded to reflect local conditions/procedures.

EXHIBIT 01 IS A SEPARATE DOCUMENT

(IN HARDCOPY ONLY)

Appendix B

This Appendix identifies the timeframes required to effectively implement the Forest Service Bloodborne Pathogen Program (Figure B-1), contains Form

6700-XX-4, Exposure Control Plan Schedule and Method of Implementation (Figure B-2), and contains Form 6700-XX-7, Housekeeping Schedule and Methods of Decomtamination (Figure B-3).

EXHIBIT 02 IS A SEPARATE DOCUMENT

(IN HARDCOPY ONLY)

Appendix C

Other forms required in managing the Bloodborne Pathogen program

- FS 6700-16A Bloodborne Pathogens Program Training Record - Part I.

- FS 6700-16B Bloodborne Pathogens Program Training Record - Part II.

- FS 6700-14 Hepatitis B Vaccine Declination Statement (Mandatory)

- FS 6700-12A Bloodborne Pathogens Exposure Incident Report - Part I.

- FS 6700-12B Bloodborne Pathogens Exposure Incident Report - Part II.

- FS 6700-12C Bloodborne Pathogens Exposure Incident Report - Part III.

- FS 6700-15 Post-Exposure Evaluation and Follow-up Report.

EXHIBIT 03 IS A SEPARATE DOCUMENT

(IN HARDCOPY ONLY)