Injury & Illness Prevention Program (IIPP)
IIPP Template
The Injury and Illness Prevention Program (IIPP) template has been prepared by the Office of Environmental Health & Safety in accordance with University Policy and California Code of Regulations Title 8, Section 3203.
Download the IIPP template
(To edit, open template in Word)
The purpose of an Injury & Illness Prevention Program is to establish a management framework for reducing the risks associated with workplace injuries and illnesses, and identifying what is required to promote the safety and health, and create an outline of policies and procedures to achieve safety and health goals.
Effective July 1, 1991, Cal-OSHA regulations require every employer to establish, implement and maintain an effective Injury and Illness Prevention Program. The program must be in writing and include the following elements:
- Management commitment/assignment of responsibilities
- Safety communications system with employees
- System for assuring employee compliance with safe work practices
- Scheduled inspections/evaluation system
- Accident Investigation
- Procedures for correcting unsafe/unhealthy conditions
- Safety and health training and instruction; and
- Recordkeeping and documentation
Download the IIPP Template
To complete this template, enter requested data in each text box. Upon completion, print the document, obtain the necessary signatures, review with departmental employees, and document the training in writing. Annual IIPP review/revision and training with employees is required.
Download the Appendices
- A - Hazard Alert/Correction Form
- B1 - Example EH&S Job Safety Analysis
- B2 - Example Business Office Job Safety Analysis
- C1 - Example Office Worksite Inspection Form
- C2 - Self-Inspection Checklist
- D - Injury and Illness Investigation Form
- E - Safety Training Attendance Form
Job Safety Analysis (JSA)
The JSA identifies and evaluates employee work functions, potential health or injury hazards, and specifies appropriate safe practices, personal protective equipment, and tools/equipment. JSA’s can be completed for worksites, an individual employee’s job description, or a class of employees’ job description.
The following resources are available for assistance in completing JSA’s:
- Laboratory personnel - please refer to the Assessment Tool
- Non-Laboratory personnel - please refer to the following JSA/PPE Certification Forms