r/16/12/20812 Health and Safety Management Plan

r/16/12/20812 Health and Safety Management Plan

Contents HEALTH AND SAFETY ARRANGEMENTS... 1 Health and Safety Policy Statement... 1 Roles and Responsibilities... 2 PCBU... 2 Officer... 2 Worker... 2 Other person at workplace... 3 Board of Directors... 3 Management... 4 Safety Officers at the Fire Ground... 4 Review Policy... 6 Policy... 6 Review Procedure... 6 Annual External Review... 6 Management Review... 7 Post Critical Event Review... 7 Hazard and Risk Review... 7 Governance Review... 8 Monthly Health and Safety Checklist... 8 HEALTH AND SAFETY FORMS... 9 Management Checklist for Governance No. 1... 9 Health and Safety Governance Agenda No. 2... 10 Monthly Health and Safety Checklist No. 3... 11 Incident and Injury Reporting and Recording... 12 Policy... 12 Definitions... 14 Near Miss (Incident) Report No. 4... 18 Accident Report No. 5... 19 Level 1 Investigation No. 6... 20 Level 2 Investigation No. 7... 21 Emergency Procedures (fixed building sites only)... 40 Policy... 40 Possible Emergencies... 40 Southern Rural Fire Authority Health and Safety Management Plan i r/16/12/2081212

1. Fire... 41 2. Earthquake... 42 3. Serious Injury... 43 4. Extreme Weather Conditions... 43 5. Tsunami... 44 EMERGENCY... 45 FIRE POLICE AMBULANCE... 45 Information and Training Policy... 46 New Employees... 46 Record of Employee Skills... 46 SRFA Fire Plan Standing Instructions... 47 SRFA Code of Safe Conduct... 47 Worker Participation, Engagement and Communication... 48 Other People at the Place of Work... 49 Definition... 49 Policy... 49 Contractor Engagement... 50 Contractor Agreement No. 10... 55 Engaging Clients/Customers... 57 Policy... 57 Procedure for Engaging Clients... 57 On Site Issues Procedure... 57 Contractor Engagement No. 11... 58 Hazardous Substances Management... 59 Policy... 59 Definitions... 59 Monitoring Employee Work Fitness... 61 Return to Work... 62 Working Alone and Remotely... 63 Smoke-free Working Environment... 64 Smoke-free buildings:... 64 Passive smoking:... 64 Complaints:... 64 Appendix... 65 Southern Rural Fire Authority Health and Safety Management Plan ii r/16/12/2081212

HEALTH AND SAFETY ARRANGEMENTS Health and Safety Policy Statement Southern Rural Fire Authority (SRFA) is committed to maintaining a safe and healthy working environment for all employees, managers, contractors, volunteers and people in the vicinity of where we are working. Health and safety is everyone s responsibility, and everyone is expected to share in our commitment to avoid all accidents and incidents, which may cause personal injury, property damage, illness or loss of any kind. Every worker is expected to act safely at all times to ensure their own welfare and that of their fellow workers and others in the workplace. We will ensure the safety of workers by: Providing and maintaining a safe working environment. Providing facilities for health and safety. Ensuring all plant and equipment is safe. Ensuring all workers and other people at (or in the vicinity) of the place of work are not exposed to unmanaged or uncontrolled hazards. Developing and implementing emergency and evacuation procedures. Setting health and safety objectives and performance criteria for management. Encouraging accurate and timely reporting and recording of all incidents and injuries. Investigating all reported incidents and injuries to identify all contributing factors and, where appropriate, formulating plans for corrective action. Actively encouraging the early reporting of any pain or discomfort. Ensuring that all workers are made aware of the hazards and associated risks in their work areas and are adequately trained so they can carry out their duties in a safe manner. Encouraging worker consultation and participation in all health and safety matters. Promoting a system of continuous improvement, including annual reviews of policies and procedures. To achieve this we will: 1. Systematically identify all hazards, and control the associated risks in our workplace. Where there are significant risks we will take all reasonably practicable steps to control the risks to prevent any injury, adverse health effects or damage. 2. Inform all workers of these hazards, the associated risks and the controls. 3. Ensure all employees are properly trained and supervised until they are assessed as being competent, including an induction process for new employees. 4. Inform all workers of emergency and evacuation procedures. 5. Record all incidents (near misses), illness and accidents in our workplace, and take all reasonably practicable steps to prevent these events from happening. 6. Carry out planned self-inspections to monitor health and safety issues. 7. Measure our improvements through setting measurable objectives and targets aimed at the reduction of risk and the elimination of work related injuries and illnesses. 8. Ensure all workers are given reasonable opportunities to participate effectively in ongoing processes for the improvement of health and safety in our workplace. Signed: 9/12/2016 9/12/2016 Chairperson Southern Rural Authority Date: Chief Executive/ Principal Rural Fire Officer Date: Southern Rural Fire Authority Health and Safety Management Plan 1 r/16/12/2081212

Roles and Responsibilities PCBU Definition Person Conducting a Business or Undertaking (PCBU). This is the legal entity or in the case of a sole trader, it could be a person. In our Organisation the PCBU is Southern Rural Fire Authority (SRFA) Responsibilities As a PCBU we must ensure, so far as is reasonably practicable, the health and safety of all of our workers and other persons in our workplace are not put at risk by our work. This is called the primary duty of care. Officer Definition An officer is a person who occupies a position that allows them to exercise significant influence over the management of the Organisation or undertaking. In our PCBU the officers are the Southern Rural Fire Committee and the Chief Executive Officer. Responsibilities Officers will exercise due diligence to: Worker Definition Acquire (and keep up-to-date) knowledge of work health and safety matters; Understand the nature of SRFA operations and the general hazards and risks associated with them; Provide appropriate resources and processes to eliminate or minimise the health and safety risks associated with the SRFA's operations; Make sure the SRFA has appropriate processes for receiving information on hazards, risks, and incidents, evaluate that information, and respond in a timely way; Make sure there are processes in place so that the SRFA complies with its legal obligations; and Verify that appropriate resources and processes have been provided and are being used. A worker is an individual who carries out work in any capacity for a PCBU. A worker may be a rural firefighter, volunteer, contractor, sub-contractor or a visitor. Volunteer Workers are individuals who carry out work in any capacity for a PCBU with the knowledge or consent of the PCBU and on an ongoing and regular basis and the work is an integral part of our business. Employees, Volunteers and Contractors Stand in the Gap If anyone sees an unsafe act / plant or equipment, do not just do nothing, it is your legal and moral responsibility to do something about - stand in the gap. If you can not immediately address the issue, then report the issue. Southern Rural Fire Authority Health and Safety Management Plan 2 r/16/12/2081212

All employees and contractors are inducted into SRFA and their role. They are provided with information on hazards, their controls and what to do in the event of an incident or emergency. They are responsible for taking reasonable care of their own health and safety and the health and safety of others who could be affected by their acts. To do this they are expected to: Practice safe working methods including wearing suitable protective clothing or using safety equipment and ensuring tasks are not carried out without the proper controls in place; Working in a safe manner to protect themselves, their fellow workers and all plant, property and equipment; Only operating equipment for which they have been trained and instructed in and hold appropriate certificates for or with their Manager or Supervisor s authorisation or specific supervision; Abiding by all displayed rules, safety regulations, policies and procedures; Keeping their work area or equipment clean and tidy and maintaining a high level of housekeeping; Protect themselves, their fellow workers and any other party, from unsafe situations by carrying out their duties in a safe and responsible manner; Actively encourage safe behaviour in the workplace; Participate in the risk identification, assessment and control program; Ensure they understand the risks that affect their jobs and the control measures in place; Report any new hazards / risks, accidents, incidents or work related illness; Being familiar with all emergency equipment in the work area and all emergency site procedures; and Not willingly interfering with or misusing items or facilities provided, in the interest of safety. Other person at workplace Examples of other persons at workplaces include workplace visitors, customers, suppliers, sales coordinators, delivery people. Responsibilities - Other persons i.e. media, landowners, have their own health and safety duty to take reasonable care to keep themselves and others safe at a workplace. Board of Directors SRFA is committed to providing a healthy and safe workplace. This requires wide commitment and the assignment of responsibilities at all levels of our organisation. The Board of Directors is ultimately accountable and has overall responsibility for ensuring that the organisation complies with the Health and Safety at Work Act 2015 and associated regulations and codes of practice. The Board also has responsibility for ensuring that our annual strategic planning, including resource allocation, encompasses and promotes workplace health, safety and wellbeing. The Board are aware of SRFA critical safety risks and will review our health and safety performance, ensuring that valid health and safety objectives are set, measured and achieved. We understand individual Directors are officers with specific due diligence obligations under the Act, as set out below. We will discuss health and safety matters at each board meeting and will monitor and review health and safety with a view to continuous improvement. Southern Rural Fire Authority Health and Safety Management Plan 3 r/16/12/2081212

As Directors we are responsible for providing quality advice and guidance on health and safety standards and assisting management to promote a positive health and safety culture. We will do this by: Management Keeping up to date knowledge of work health and safety matters; Assisting with development and implementation of policies; Auditing the implementation of policies and procedures within the Organisation; Setting health and safety Key Performance Indicators (KPI s); Monitoring health and safety performance; Overseeing accident reporting and investigations; and Verifying policies and procedures are being implemented and followed in the workplace. Management will ensure policies and procedures are adhered to and that people who don t adhere to polices or procedures are held to account. Management will be responsible for day-to-day health and safety management as outlined in our Health & Safety Management Plan, including: Ensuring employees and contractors are inducted and trained in our health and safety policies and procedures; Implementing policies and procedures; Ensuring effective mechanisms are in place for employees to raise health and safety issues and that these are addressed; Ensuring all accidents/incidents/near misses are accurately reported, recorded and investigated; Participating in the hazard identification, assessment and control program including regularly reviewing hazards and their controls and updating the risk register; Ensuring the proper hazard controls are provided and being used; Documenting all hazard identification, assessment and control; Completing the Hazardous Substances Register and procedure; Ensuring maintenance checks are completed in accordance with policy; Ensuring emergency procedures and practice evacuations are implemented; Monitoring performance and compliance; Assessing competency and ensuring necessary training is completed and recorded; and Ensuring Contractors are engaged and receive Contractor inductions. Safety Officers at the Fire Ground A Safety Officer will be appointed by the Incident Controller at a rural fire or emergency incident in the following circumstances: More than one Volunteer Rural Fire Force (VRFF) in attendance at the scene. More than 15 personnel involved in fire / emergency scene operations including other emergency service personnel. Where the incident controller deems there to be specific need to appoint a Safety Officer Southern Rural Fire Authority Health and Safety Management Plan 4 r/16/12/2081212

When selecting personnel to fulfil the role of Safety Officer, the Incident Controller must: Select personnel that have minimum qualifications / positions of Crew Leader/ Rural Fire Officer or a person that holds the required skills and experience to manage the principal hazard present. Provide appropriate briefing on the role required. A Safety Officer reports directly to the Incident Controller of the incident and will typically be a dedicated role depending on the type / size/ scale of the incident. Southern Rural Fire Authority Health and Safety Management Plan 5 r/16/12/2081212

Review Policy Policy SRFA will review and maintain this Health and Safety Management Plan (HSMP) as a quality living document. As an organisation, we are dedicated to continuous improvement in health and safety. The Health and Safety Management Plan (HSMP) will be systematically reviewed and evaluated in accordance with the following procedures. Review Procedure The review process will include: Annual external review; Monthly checklists; Review of internal practices; Review of employee meetings; Post critical event reviews; Hazard and risk management review. 1. The review processes will be carried out in consultation with employees, managers and the Directors. 2. The result of any reviews will to be discussed and reported to all employees, including management and the Directors. 3. At SRFA s request, a qualified provider will update and review the Health and Safety Management Plan in accordance with this procedure. 4. Officers, Management and any Health and Safety Co-ordinator will be required to attend regular training and keep up to date with both the legislative requirements and relevant industry guidelines. To do this we will attend health and safety training, discussions and forums. 5. Following any formal review and changes to the document, it will be re-signed and dated as appropriate. Annual External Review An external review will be undertaken on an annual basis by a qualified provider. The review will ensure the HSMP: Complies with current legislation including the relevant regulations; Complies with relevant codes of practice, industry guidelines and WorkSafe NZ guidance; Is understood and implemented effectively within the Organisation; Is practical and appropriate for the work environment; Adequately assists in progressing health and safety objectives and targets. Where practical, SRFA must attend to any identified deficiencies as soon as possible and within one month of receiving the report. Southern Rural Fire Authority Health and Safety Management Plan 6 r/16/12/2081212

Management Review On an annual basis or as documented in individual policies, all policies and procedures in the health and safety system, including this Review Policy, must be reviewed by the Management to ensure that they remain effective and suit the needs of our Organisation. The purpose of the review is to ensure its continuing suitability, adequacy and effectiveness. Suitability - fitness of the management system for its defined purpose - policy, processes, procedures, controls; Adequacy - is the integrated management system sufficient to meet requirements - legislative, regulatory, organisational, contractual; Effectiveness - extent to accomplishing planned activities and achieving planned results. We will ensure all relevant documentation and information has been circulated prior to any management review meeting. Any changes or amendments need to be discussed and communicated to all affected workers. Post Critical Event Review Health and safety management will be reviewed after any event which may have a bearing on Health and Safety practices. This will be initiated by SRFA, or their appointed coordinator(s). This includes, but is not limited to: A notifiable injury or illness; A major incident involving property damage; A notifiable incident; A potentially serious near miss incident; Any change in major work procedures; Any change in operations; and The introduction of new or altered machinery/equipment. The process of review will consider: The main contributing factors to any injury, incident or injury; Whether current policies and/or procedures are sufficient to prevent or minimise a recurrence of an injury, incident or injury; Any new hazards or risk; Whether employees have an adequate understanding of their responsibilities; and Whether additional employee training or information is required. Hazard and Risk Review SRFA will maintain a risk register. Hazards and risks identified must be updated on the risk register as soon as possible, adequate controls put in place and employees and other relevant persons, including contractors must be informed. Southern Rural Fire Authority Health and Safety Management Plan 7 r/16/12/2081212

Management must also review all currently identified hazards and their associated risks, listed in the risk register as well, any risks identified at the time (of the hazard). The review must confirm the status of current hazards and risks. In addition, management must inspect the workplace on a regular basis to identify any additional hazards that have not already been identified during the regular hazard review. As part of this review, accident, incident and near miss data will be analysed. Analysis will include the following: Number and cost of injuries, accidents, absences and near misses: Types of injuries that have occurred; Types of illness that have occurred; Hazards and risks involved in the injuries; Work areas or tasks that have a high number of injuries, accidents or incidents; and Pattern of injury in terms of time of day or weekends. Governance Review The Directors will meet on a regular basis. As part of this regular discussion, health and safety will form part of the agenda. Prior to the Directors meeting, the Senior Manager team must provide the completed Management Checklist (Form No. 1) and provide the required details to the Directors. The Health and Safety Governance Agenda (Form No. 2) will be used as a basis of health and safety matters to be discussed. Monthly Health and Safety Checklist The Senior Manager team must complete the Monthly Health and Safety Checklist (Form No. 3) on a monthly basis. Any actions that arise from the Checklist will be rectified as soon as possible and discussed in the monthly Safety Meeting where necessary. Southern Rural Fire Authority Health and Safety Management Plan 8 r/16/12/2081212

HEALTH AND SAFETY FORMS Management Checklist for Governance No. 1 CHECKLIST Y/N ATTACH Monthly meeting carried out? Monthly checklist completed? Any incidents/near miss? Any Accidents? Any reports of discomfort or occupation illness? Anybody off sick or Injured? Any new hazards identified? Risk assessment carried out for new hazards? Any controls changed? Any new employees? Any training undertaken? Vehicle maintenance up to date? Any contractors engaged? Assess Objectives/Targets and KPI s Any qualified assessors been onsite? Any audits carried out? Any other relevant matter? Meeting Minutes Monthly Checklist Incident Register Investigation Form Accident Form Investigation Form Notification Form (if applicable) Early Reporting Form Investigation Form Absentee Data Updated Risk Register Updated Risk Register Updated Risk Register Acknowledgement Form Capabilities Analysis Assessment Forms Training Records Maintenance Records Contractor Agreement Contractor Induction Form Monitoring Documentation Assessment Documentation Assessment Reports Audit Documentation Relevant documentation MANAGER S SIGNATURE: DATE: Southern Rural Fire Authority Health and Safety Management Plan 9 r/16/12/2081212

Health and Safety Governance Agenda No. 2 Health and Safety topics for discussion during the Bi-Monthly Governance Meeting. Discuss and review Directors Health and Safety Charter. Review monthly safety meeting minutes. Discuss monthly health and safety checklist. Ensure all notifiable events have been reported by Management and the Director/s Discuss any incidents that occurred. Discuss all accident reports. Discuss any work related illness. Review and discuss all accident investigations. Review and discuss data on absence rates due to sickness. Review new hazards, risk assessments and discuss the controls. Discuss and review any Health and Safety Management Plan amendments. Discuss one relevant Industry Guideline. Report and discuss any Director/Trustee health and safety training recently completed. Discuss any recent policy reviews or audits. Discuss management health and safety KPI results. Discuss health and safety targets and objectives. Any other matters arising. Southern Rural Fire Authority Health and Safety Management Plan 10 r/16/12/2081212

Monthly Health and Safety Checklist No. 3 Checklist Completed Actions Required Person(s) Responsible Action closed (date) Any new hazards identified? Updated risk and HSNO register Risks assessed Updated controls Communicated new hazards and risks to relevant employees JSA s completed as required Any new accidents, incidents, illnesses, discomfort All relevant forms completed and filed All incidents, injuries, illness investigated If notifiable event occurred - correct procedure followed and WorkSafe NZ notified. New Employees Health and Safety training completed Induction checklist completed and filed Employee training and capability Employee training record updated Capability analysis updated New JSA completed and appropriate employees trained Contractors and Clients Acknowledgements and Agreements up to date for any new contractors and clients JSA completed as required Contractors checklist completed Vehicles and Machinery Pre-operational checklists completed Maintenance up to date Other Health and safety meeting held Emergency response information current PPE in safe condition and issued where required First Aid Kit checked and stocked Fire Extinguishers current Checklist completed by Date completed Site: Signed by: Southern Rural Fire Authority Health And Safety Management Plan 11 r/16/12/2081212

Incident and Injury Reporting and Recording Policy Southern Rural Fire Authority is committed to reporting and investigating accidents, incidents and events in the workplace. Our policies and procedures aim to ensure: All incidents, injuries, illness, and discomfort are be notified to the Manager immediately or as soon as practical. All employees with an injury, illness and/or signs of discomfort accurately complete the accident/early reporting form and return this to the Manager immediately. All incidents and injuries are investigated by the Manager; not to place blame or fault, but to identify new hazards and controls and therefore avoid future injuries. All employees are informed of the injury, illness, incident, discomfort investigation, i.e. new hazard identified and the hazard controls. All notifiable events, involving any person (employee, contractor and other person/s, are reported to WorkSafe NZ as soon as possible. All accident, incident, illness, discomfort data is maintained, collated and reviewed regularly to identify patterns or particularly dangerous work. Southern Rural Fire Authority Health and Safety Management Plan 12 r/16/12/2081212

Event Incident / Accident / Illness Is This A Worksafe NZ Notifiable Event (definition of notifiable event found on next page] Accident / Illness / Incident YES NO Minor accident incident (near miss) Immediate medical assistance provided Fill in accident report level 1 Form # 6 YES Under different circumstances could this have a more serious outcome Phone Emergency Services CEO Notifies Board NO YES Fill in accident form Form # 5 Ensure that no others can be hurt by the event Secure the scene Notify the CEO YES CEO Notifies Worksafe NZ Worksafe NZ Investigator attending scene Fill in Event Form (near miss) Form # 4 Fill in accident form Form # 5 PRFO notifies Insurance Company YES NO Worksafe NZ request Duty Holder review Give completed form to H & S Co-ordinator Scene can only be released by Worksafe NZ or the PRFO NO Management Team to review risk register to ensure controls are still relevant Internal Investigation - Investigation Form # 7 Worksafe NZ advise that no further actin will be taken Report goes to Management Team to review risk register to ensure controls are still relevant or need updated Report goes to Board. Board reviews and signs off on any recommendations Control measures implemented to prevent future occurrence Board advises employees/other affected PCBU of outcome from investigation Summary of event goes to Board Report and changes goes to the Board Southern Rural Fire Authority Health And Safety Management Plan 13 r/16/12/2081212

Definitions Accident An event that causes any person to be harmed. Incident In different circumstances, might have caused any person to be harmed. Injury/Harm An illness, injury, or both and includes physical or mental harm caused by work-related stress. Notifiable Event A notifiable event means any of the following events that arise from work: (a) (b) (c) the death of a person; or a notifiable injury or illness; or a notifiable incident. Notifiable Incident An unplanned or uncontrolled incident in relation to a workplace that exposes a worker or any other person to a serious risk to that person s health or safety arising from an immediate or imminent exposure to: an escape, a spillage, or a leakage of a substance; or an implosion, explosion, or fire; or an escape of gas or steam; or an escape of a pressurised substance; or an electric shock; or the fall or release from a height of any plant, substance, or thing; or the collapse, overturning, failure, or malfunction of, or damage to, any plant that is required to be authorised for use in accordance with regulations; or the collapse or partial collapse of a structure; or the collapse or failure of an excavation or any shoring supporting an excavation; or the inrush of water, mud, or gas in workings in an underground excavation or tunnel; or the interruption of the main system of ventilation in an underground excavation or tunnel; or a collision between 2 vessels, a vessel capsize, or the inrush of water into a vessel; or any other incident declared by regulations to be a notifiable incident for the purposes of this section. Southern Rural Fire Authority Health And Safety Management Plan 14 r/16/12/208121

Notifiable Injury or Illness 1. Any of the following injury or illnesses that requires the person to have immediate treatment (other than first aid): The amputation of any body part A serious head injury A serious eye injury A serious burn The separation of skin from underlying tissue (such as degloving or scalping) A spinal injury Loss of bodily function Serious lacerations. 2. An injury or illness that requires, or would usually require, the person to be admitted to a hospital for immediate treatment. 3. An injury or illness that requires, or would usually require, the person to be have medical treatment within 48 hours of exposure to a substance. 4. Any serious infection (including occupational zoonoses) to which the carrying out of work is a significant contributing factor, including any infection that is attributable to caring out work: With micro-organisms; or That involves providing treatment or care to a person; or That involves contact with human blood or bodily substances; or That involves handling or contact with animals, animal hides, animal skins, animal wool or hair, animal carcasses, or animal waste products; or That involves handling or contact with fish or marine mammals. 5. Any other injury or illness declared by regulations to be a notifiable injury of illness for the purposes of this section. Southern Rural Fire Authority Health And Safety Management Plan 15 r/16/12/208121

Incident Procedure 1. In the event of an incident the Manager must be notified as soon as possible. Note: If the incident amounts to a notifiable event, follow the Notifiable Event Procedure. This requirement applies to all employees, working family members, visitors, and contractors. 2. The incident must be investigated. The Level 1 Investigation Form (Form No. 6) should be used in the event of any minor incident that is not regularly occurring and does not have the potential to result in a notifiable event. The Level 2 Investigation Form (Form No. 7) should be used in the event of an incident that is occurring regularly or has the potential to result in a notifiable event. 3. The result of the investigation must be communicated to all affected workers including any action taken to control or prevent the incident from reoccurring. Accident Procedure 1. In the event of an accident resulting in an injury the Manager must be notified immediately. Note: If the accident amounts to a notifiable event, follow the Notifiable Event Procedure. This requirement applies to all employees, working family members, visitors, and contractors. 2. The employee must complete the Accident Report (Form No. 4) and give this to the Manager. 3. The accident must be investigated and appropriate Investigation Form completed: A Level 1 Investigation Form No. 6 should be used in the event of any minor accident that is not regularly occurring and does not have the potential to result in a notifiable event. A Level 2 Investigation Form No. 7 should be used in the event of an accident that is occurring regularly or has the potential to result in a notifiable event. 4. The result of the Investigation must be communicated to all affected workers including any actions taken to control or prevent the accident from reoccurring. Work Related Early Discomfort Procedure 1. In the event of an employee experiencing signs of early discomfort potentially caused by a factor in the workplace the Manager must be notified as soon as possible. 2. The workplace discomfort must be investigated to determine the root cause. This investigation may include sending the employee to a specialist to seek their professional medical opinion. 3. The result of the investigation must be communicated to all affected workers including any action taken to control or prevent the risk of harm reoccurring. Two incident reporting forms are required to be filled in, these are: 1. SRFA Fire Ground Incident - Crew Leaders HSWA Incident Report Card; 2. WorkSafe NZ Notifiable Events for either Incidents or Notifiable Accidents /Illness. Southern Rural Fire Authority Health And Safety Management Plan 16 r/16/12/208121

Work Related Illness Procedure 1. In the event of an employee suffering an illness which has the potential to relate to factors in the workplace, the Manager must be notified immediately. Note: If the incident amounts to a notifiable event, follow the Notifiable Event Procedure. 2. The cause of any workplace illnesses must be investigated to determine the root cause. This investigation phase may include sending the employee to a specialist to seek their professional medical opinion. 3. The result of the Investigation must be communicated to all affected workers including any action taken to control or prevent the risk of harm reoccurring. Notifiable Event Procedure 1. In the event of a notifiable event (death or notifiable injury, illness or incident WorkSafe NZ needs to be notified immediately. If unsure whether the event amounts to a notifiable event, contact them anyway. Notification must be given by the fastest possible means in the circumstances: Phone: 0800 030 040 Email: healthsafety.notification@worksafe.govt.nz Electronic Notification: www.forms.worksafe.govt.nz/notifiable-event-notification Post: The Registrar, WorkSafe New Zealand, PO Box 105-146, Auckland 1143. 2. Take all reasonable steps to ensure the site is not disturbed until authorised by an inspector. Except: To assist an injured person; or To remove a deceased person; or That is essential to make the site safe; or To minimise the rise of a further notifiable event; or If under the direction of the Police. 3. An investigation into the event must occur, sometimes in consultation with the WorkSafe NZ Inspector. 4. WorkSafe NZ may require us to give written notice. Written notice will be in the Notifiable Event Form (Forms No. 8 and No. 9). WorkSafe NZ provides 48 hours notice for this form to be submitted following the PCBU being informed of the requirement to do so. 5. The event and any outcome of the investigation must be reported to employees. 6. Records of all notifiable events must be maintained for a minimum of five years. Southern Rural Fire Authority Health And Safety Management Plan 17 r/16/12/208121

Near Miss (Incident) Report No. 4 Location Time Date Tick appropriate box RED Stop Work And Report YELLOW Use Caution and Report GREEN Continue and Report Unsafe Act Unsafe Condition Unsafe Equipment Unsafe use of Equipment Description of Near Miss / incident Reported by Name: Signature: Southern Rural Fire Authority Health And Safety Management Plan 18 r/16/12/208121

Accident Report No. 5 Personal Details Name: Phone Number: Address: Date of Birth: Sex: Male Female SRFA: Job Title: Permanent Casual Contractor Visitor Accident Details Date: Time: Date Reported: Hours at Work: Notifiable Event: Yes No Notification to WorkSafe NZ: Yes No Treatment Near Miss No Treatment First Aid Doctor Hospital Injury Type Strain/Sprain Cut Head Injury Fracture/Break Burns Gradual Process Bruising Poison/Chemical Multiple Injuries No injury Where did the accident happen? Location of Injury (circle location) How did the accident happen? What type of vehicle was involved (if at all)? Was the person trained for the task? Yes No Was a significant hazard involved? Yes No If yes, what was the hazard? Is the hazard on the Risk Register? Yes No How serious could the accident have been? Action Taken to Prevent Recurrence Action? By Whom? When? Initial needs Assessment (Only Complete If a Doctors Visit Was Required) Able to continue full duties Able to do light duties Unable to work Help available from home Assistance required at home Transport assistance needed Form Completed by: Position: Southern Rural Fire Authority Health And Safety Management Plan 19 r/16/12/208121

PARTICULARS OF EVENT Date of event M T W T F S S THE PERSON Level 1 Investigation No. 6 Time Location Date reported Name Address Age Phone number Date of event Length of employment at plant on job DAMAGED PROPERTY Property/material damaged Nature of any damage Object/substance inflicting damage THE INCIDENT Description Describe what happened (space overleaf for diagram - essential for all vehicle event) Analysis What were the causes of the event? HOW BAD COULD IT HAVE BEEN? WHAT IS THE CHANCE OF IT HAPPENING AGAIN? Critical Serious Minor Minor Occasional Often Prevention What action has or will be taken to prevent a recurrence? Tick items already By whom When actioned Use space overleaf if required INVESTIGATION OF INCIDENT Investigated by Signed Date Southern Rural Fire Authority Health And Safety Management Plan 20 r/16/12/208121

Level 2 Investigation No. 7 Section 1: The Organisation Your Organisation: Registered business name (include trading name) and postal address: Number of employees: Number of sites: Directors: Phone: Email: Are you employed by a Principal or have you engaged a Contractor? Principal (company who engaged your services) if relevant: Registered business name (include trading name) and postal address: Principal Contractor N/A Number of employees: Number of sites: Directors: Contact name: Their role/title: Phone: Email: Contractors (people you have engaged) - those on site at the time of the incident: Registered business name (include trading name) and postal address: Number of employees: Number of sites: Directors: Contact name: Their role/title: Phone: Email: Southern Rural Fire Authority Health And Safety Management Plan 21 r/16/12/208121

Section 2: The People Who is investigating: Lead investigator: Name: Role/title: Phone: Email: Others involved in investigation ie, H&S Committee, HSR, Department manager etc. Was injured person involved in the investigation? Yes No People at the scene: Injured party: Name: Role/title: Address: Start time: Statement obtained: Yes No (please provide copy) Witnesses (those present at scene; the first aider; first on scene etc.) Were there any witnesses: Yes No Statement/s obtained: Yes No (please provide copy) Type of injury: Mark location of injuries: Bruising Dislocation Strain/sprain Scratch/abrasion Internal Fracture Amputation Foreign body Laceration/cut Burn/scald Chemical reaction Other (specify) Comments: ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- Southern Rural Fire Authority Health And Safety Management Plan 22 r/16/12/208121

Section 3: Describe The Incident Scene Provide detailed relevant information Date of incident: Time of incident: am pm Address and exact location of incident (i.e. 123 First St, Auckland. South east corner of warehouse 2): Working conditions at the location and time of the incident (e.g. poor lighting, extreme temperature, time pressures, confined working space etc.): Weather conditions at the time of the incident (if applicable): Create a timeline. Describe the details in the order of what happened immediately before, during, and after the incident: Before (i.e. Worker started at 0700 and attended a toolbox meeting at ): During (i.e. The incident description): After (i.e. John was first on scene and provided first aid to the injured party while Peter called an ambulance ): Southern Rural Fire Authority Health And Safety Management Plan 23 r/16/12/208121

Section 3 continued - complete if appropriate: DIAGRAM OF LOCATION OF INCIDENT Southern Rural Fire Authority Health And Safety Management Plan 24 r/16/12/208121

Section 3 continued complete if appropriate: PHOTO(S) TAKEN Provide photo taken immediately after incident and/or items directly related to the incident. Southern Rural Fire Authority Health And Safety Management Plan 25 r/16/12/208121

Section 4: Identify Direct Cause(s): Immediate factors that influence human decisions A direct cause is anything that is at the location that has had an immediate influence on actions or decisions made by workers leading to the incident occurring (the actions or inactions of people, obstacles, poorly maintained equipment etc). People: List all those who were present in the area and describe the actions or inactions of: the injured party; supervisors (who was in charge?); others (witnesses etc.). Have these actions or inactions contributed or failed to stop the incident? Plant (building, machinery etc.) and Equipment (bench saw, gas bottles, pallets etc.): What plant and/or equipment was at the location that had an influence on the incident? What was this influence? Substances: What substances were at the location that had an influence on the incident? What was this influence? Environment: Describe the environment and how it influenced the incident (confined working space etc.). Southern Rural Fire Authority Health And Safety Management Plan 26 r/16/12/208121

Section 5: Your Health and Safety Management System IDENTIFY CAUSATIVE FACTOR(S) Given that people make mistakes and/or take short-cuts, what could have been in place to mitigate the consequences of their actions? Training: What training or instruction have the parties been provided (induction, task specific, hazard identification etc.)? Please provide supporting documents (company records, certificates etc.). Competence: What qualifications and/or experience do the parties have to undertake the task being performed? How do you know workers are performing as per training provided and remain competent? Procedures: What procedures do you have that cover the task being performed at the time of the incident? Consider the following: standard operating procedures (SOPs), job safety analysis (JSA), emergency plans, contractor management etc. Please provide a copy of these where applicable. Have the procedures been followed? Supervision: Who was the supervisor? What level of supervision was required for the task? Has the supervisor or other workers noticed any actions that are out of line with procedures, and if so what actions were taken? Hazard Identification: When was the hazard identified? Please provide a copy of your hazard identification. Hazard Control: If the hazard was previously identified, what controls were put in place? How has the incident come to occur with these controls in place? Hazard Management: What other controls were considered? How do you assess hazards and consider controls? Southern Rural Fire Authority Health And Safety Management Plan 27 r/16/12/208121

Monitor and Review: What do you have in place to: Assess effectiveness of hazard/risk controls that are in place? Ensure workers and visitors are doing what they should in relation to the procedures and SOPs? Compare existing controls with new control opportunities? Governance: How are senior management made aware of hazards and risks within the workplace? When were senior management first aware of the hazards and risks associated with this incident? What factors were assessed when deciding on the existing controls? Health and Safety Standards: What standards, codes of practice, guidelines do you refer to in relation to the task being performed (you may reference manufacturers manuals or similar)? Other Causes: If applicable, advise what other causes contributed to the incident (fatigue, complacency etc.) Section 6: Immediate Factors That Influence Human Decisions DIRECT CAUSE(S) Direct causes: Summary of identified key points from Section 4 Southern Rural Fire Authority Health And Safety Management Plan 28 r/16/12/208121

Section 7: Your Broader Health And Safety System ROOT CAUSE Root Cause: Reviewing key points identified in Section 5, can you now identify what, if added or removed from the situation, would have prevented the incident from occurring? Southern Rural Fire Authority Health And Safety Management Plan 29 r/16/12/208121

Section 8: Corrective Actions Taken Corrective Actions Taken: Corrective actions taken to address the direct and root causes as listed above (Section 6 and 7) Action: Control Type: Eliminate, Minimise Expected completion date: By whom: Guidance on the Hierarchy of Controls:. Elimination: Completely remove the hazard or hazardous work practice. Minimisation: Substitution: Isolation: Engineering: Administrative: PPE: Incorporates the following categories. Change a work practice, substance or piece of equipment to provide a safer environment Separate the substance or piece of equipment from people, either by distance or physical barrier Modify the design of the workplace of plant and/or environmental conditions Develop procedures and systems to control the interaction between people and hazards Implement PPE to prevent physical contact between a person and a hazard Note : Whenever introducing these controls, you MUST always re-assess to ensure you haven t introduced a new hazard/risk. Southern Rural Fire Authority Health And Safety Management Plan 30 r/16/12/208121

Section 9: Supporting Documentation (add others as necessary) Statements (injured party, witnesses etc.) Standard operating procedures Toolbox minutes Skills assessment documentation Procedures Hazard identification and control docs Training records Certification (forklifts, cranes etc.) Section 10: Sign-Off Person responsible for report Name: Title: Signature: Date: Health and Safety Representative (if applicable) Name: Title: Signature: Date: Chief Executive or Senior Decision Maker Declaration: I confirm that improvements identified in this report have been implemented or are planned to be implemented by the dates specified. Name: Title: Signature: Date: Southern Rural Fire Authority Health And Safety Management Plan 31 r/16/12/208121

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Emergency Procedures (fixed building sites only) Policy Emergencies are any unplanned events that can have a significant effect on your Organisation. They may involve physical or environmental damage, or injury, harm or death to employees, visitors, contractors, or members of the public. All employees are to be familiar with the emergency procedures included in this health and safety management plan. Employees have emergency responsibilities assigned to them and are trained how to carry them out in the case of an emergency: Emergency contact details will be displayed at every emergency exit and in the main office area: An emergency drill for all employees is to be conducted every six months. These drills are recorded and a note made of any further improvements or training needed. All emergency equipment including first aid kits and fire extinguishers are checked and replenished as necessary by the Manager. Possible Emergencies Natural: Man-made: Earthquake, earth movement/slip, flood, heavy snowfall, tsunami, volcanic eruption. Injury, chemical spill, fire, gas leak, missing person, power failure, and vehicle accident. Whilst every event is unique, there are some basic steps to follow when responding to any emergency, which are outlined below: Southern Rural Fire Authority Health And Safety Management Plan 40 r/16/12/208121

1. Fire Response actions (as appropriate) Discovery of a fire Activate the fire alarm Call 111 Warn anyone in immediate danger If no personal danger and safe to do so extinguish the fire On hearing the fire alarm Evacuate the building using the nearest fire exit If indoors, time permits, and there is no danger, close all doors and windows If outdoors ensure that you and any others are removed from the scene and are at no risk Fire Wardens should direct colleagues, clients and visitors in their area to the designated assembly point(s) Ensure workers and clients with disabilities are assisted by a responsible person Walk calmly and quickly and avoid panic Fire Wardens to check rest areas, bathrooms and common rooms en route to the designated exit point Returning to the building Ensure all employees remain at the evacuation point until clearance to leave is given. Do not return to the building(s) until given the all clear by the Fire Service. The continuing operation of work will be determined by the nature of the fire and the availability of resources such as building, employees and other resources. The responsibility of whether or not to continue work rests with the manager. In the event that a designated Fire Warden is not available, the most senior person present will act as Fire Warden. Southern Rural Fire Authority Health And Safety Management Plan 41 r/16/12/208121

2. Earthquake During an earthquake Response actions (as appropriate) If indoors: Drop to the floor, take cover under a desk or table and hold onto the legs until the shaking stops. Keep away from shelves containing heavy objects and other large items of furniture. Keep away from windows. Stay indoors until the shaking stops and it is safe to go outside. If outside: Move away from buildings, trees, streetlights and power lines, then. Drop, cover and hold. When the shaking stops Keep calm and ensure your personal safety first Check on those around you and offer assistance if necessary If anyone requires medical assistance, call 111 and/or administer first aid If the area is unsafe evacuate to the site disaster assembly areas: Keep staff and clients away from dangerous areas Ensure electrical sources and gas taps are turned off If the office is located near the coast be aware of the possible risk of tsunami Listen to the radio for instructions from Civil Defense. Ongoing operations following an earthquake The continuing operation of the organisation will be determined by the severity of the earthquake and the availability of resources such as buildings, services, equipment, staff and other resources. The responsibility of whether or not to continue work rests with the Chief Executive Officer. Southern Rural Fire Authority Health And Safety Management Plan 42 r/16/12/208121