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Model Policies / Forms

ANTIMICROBIALS
Model Policy
Notice to Institutions Using Antimicrobials
Pesticide Safety Information No. 8

BLOODBORNE PATHOGENS
Model Policy
Sharps Injury Log
Post Exposure Evaluation Flow Chart
Post Exposure Evaluation Form
Exposed Individual Consent Form
Source Individual Consent Form

FORKLIFTS
Forklift Stability Triangle
Pre-shift Fork Lift Inspection Form

HEALTHY SCHOOLS ACT – IPM
Model Policy
IPM Model Policy Statement
Form A – Annual Pesticide Use Notification-To Staff & Parents
Form B – Pesticide Application Notification
FORM C – Notice to Employees & Parents
Form D – Pesticide Application Notification Registration
Form E – Marking Fields-Grounds Crew Memo
Form F – Pesticide Application Notice to Site Administrator

HEARING CONSERVATION
Model Policy

INJURY AND ILLNESS PREVENTION
Model Policy
Confidential School Incident Investigation Report
Supvisor’s Report of Work Related Injury and Illness Report

JOB TASK ANALYSIS
Analysis Form

RESPIRATORY PROTECTION
Model Program

RETURN TO WORK
Model Board Policy
Alternative Work Assignments
Brochure for District Use
Flow Chart
Employee Ability To Return To Work – Physician Work Status Report

VOLUNTEERS
Volunteers Manual

WORKSTATION EVALUATIONS
Computer Workstation Design Guidelines
Workstation Evaluation Form



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