7.2 Description and Retention of Forms

The following chart lists the forms alphabetically and indicates who is responsible for completing each form, the purpose of each form, where each form is kept or sent, and how long each form should be retained according to the established record retention policies for the organization.

Form Title	Responsible Person	Purpose	Minimum Retention
Chemical Inventory List	Manager or supervisor	Show all chemical products at a Church facility and whether or not there is an SDS for a particular chemical. Keep the form at the facility, and update it as changes occur.	Keep lists and supporting SDS documents for 30 years.
Conditions of Reinstatement Agreement	Manager or supervisor	Provide for random drug screening tests after reinstatement of employees after initial testing.	Keep as long as the employee is active.
Confined Space Entry Permit	Manager or supervisor	Permit employees or contract workers to enter a confined space. Post the permit at the job site.	Keep for 1 year after the current year ends.
Consent or Refusal to Consent to Physical Examination and Tests	Manager or supervisor	Allow employees to grant or refuse permission to undergo medical evaluation after an accident or observed impairment when substance abuse is suspected.	Keep as long as the employee is active.
Driver Qualification Record	Manager or supervisor of driver	Collect information needed for individuals driving a vehicle for Church business.	Information may be kept online or on a hard copy of the form as long as the individual is actively driving a vehicle on Church business.
Emergency Telephone Numbers	Manager or supervisor	Provide every employee access to emergency telephone numbers. Post near each telephone and at other critical areas.	Always keep an updated copy posted.
Energized Electrical Work Permit	Manager or supervisor	Allow workers to work within the restricted-approach boundary.	Keep for 1 year after the current year ends.
Fall Hazard Assessment	Manager or supervisor	Survey each facility or physical location for fall hazards and determine best controls to protect employees.	Keep for as long as the fall hazards remain the same.
First-Aid Log	Manager or supervisor	Document minor first-aid injuries that don’t require professional medical attention.	Keep for 3 years after the current year ends.
Hazard Report	Employee	Report the nature and location of any potential hazard. Give completed form to the manager or supervisor.	Keep 1 year after the current year ends.
Hepatitis B Vaccine Declination Form	Manager or supervisor	Allow employees to waive access to a hepatitis B vaccine after an occupational exposure.	Keep as long as the employee is active.
Hot Work Permit	Manager or supervisor	Allow employees or contract workers with a permit to use tools and equipment that produce sparks, flames, or heat at a Church facility. Post the permit at the job site.	Keep for 3 years after the current year ends.
Incident Report	Person involved in incident and his or her manager or supervisor	Collect initial information about and report the nature and causes of an incident. File the Incident Report online unless the incident is serious. If the incident is considered serious (death, lost time, or hospitalization), contact the Risk Management Division or your local area office as soon as possible. Keep the original report on file.	Keep for 3 years after the current year ends.
Incident Report Addendum— Statement	Person involved in incident and his or her manager or supervisor	Report information gathered from witnesses or others regarding the incident.	Keep for 3 years after the current year ends.
Indoor Air Quality Questionnaire	Manager, supervisor, or investigator	Report information gathered from individuals who may have been affected by their indoor environment.	Keep until the indoor air quality investigation is completed and the final report is distributed.
Job Safety Observation	Manager or supervisor	Assist supervisors and safety committee members in evaluating a worker’s actual knowledge and application of working safely.	Keep for 3 years after the current year ends.
Lockout/Tagout Procedure Inspection	Manager or supervisor	Provide an independent review and inspection of the lockout/tagout procedures implemented for equipment.	Keep for 2 years after the current year ends.
Powered Industrial Truck (PIT) Training Record	Instructor of PIT training or supervisor	Provide a record of employees attending required PIT training. Keep a copy on file.	Keep for 3 years after the current year ends.
PPE Hazard Assessment	Manager or supervisor	Help supervisors identify hazards that may require personal protective equipment.	Keep for as long as the process or hazards remain the same.
Respirator Fit Test Record	Person testing the fit of the respirator	Determine if the respirator properly fits the employee. Keep the completed form in the employee’s file.	Keep as long as the employee is active.
Respirator Medical Determination	Employee and his or her physician	Give a physician the necessary health information to determine if an employee is medically qualified to use a specific type of respirator. Keep the completed form in the employee’s file.	Keep as long as the employee is active.
Respirator Selection	Manager or supervisor	Determine the type of respirator required for an employee at a Church facility. Keep a copy in the employee’s file.	Keep as long as this type of respirator is required.
Safety and Health Committee Meeting Record	Chairperson of safety and health committee	Record proceedings of the safety and health committee. Use as an administrative tool in making plans and following up on action items. Chairperson keeps a copy on file.	Keep 1 year after the current year ends.
Safety and Health Inspection Checklist (Sample)	Manager or supervisor	Use this sample to help develop a Safety and Heath Inspection Checklist form for each unique Church facility.	Keep 1 year after the current year ends.
Safety Orientation Checklist	Manager or supervisor	Provide an additional resource for the safety orientation of employees new to Church employment and for employees recently transferred into the department. Keep the completed form in the employee’s file.	Keep as long as employee is active.
Safety Preplanning Worksheet	Manager or supervisor	Identify potential safety concerns for nonroutine hazardous tasks.	Keep 1 year after the current year ends.
Safety Training Meeting Record	Manager, supervisor, or assigned training coordinator	Record safety training meeting attendance.	Keep for 3 years after the current year ends.
Safety Training Record—Annual	Manager, supervisor, or assigned training coordinator	Track and verify that all employees receive required and other safety training. This applies only to training that is not completed online through Learning Center.	Keep for 3 years after the current year ends.
Traffic Accident Report and Exchange Form—Outside the United States	Driver involved in a traffic accident or who has vehicle damage	Use this report to obtain information from the other parties involved in the incident and for an information exchange at the scene.	Use the information in this report to complete an incident report online at incidents.churchofjesuschrist.org.
Traffic Accident Report and Exchange Form—United States	Driver involved in a traffic accident or who has vehicle damage	Use this report to obtain information from the other parties involved in the incident and for an information exchange at the scene.	Use the information in this report to complete an incident report online at incidents.churchofjesuschrist.org.
Vehicle Use Agreement	Manager or supervisor	Establish the conditions of use for drivers who are assigned Church-owned vehicles and collect information needed for individuals driving a vehicle for Church business.	Information may be kept online or on a hard copy of the form as long as the individual is actively driving a vehicle on Church business.
What to Do If You Have an Accident	Driver involved in a traffic accident or who has vehicle damage	Provide the driver of the vehicle step-by-step information about what to do when involved in an accident, including how to report the accident.	Always have a copy in vehicles being used for Church business.
Written Hazard Communication Program	Manager or supervisor	Provide a template to create the written documents required to establish a hazard communication program.	Keep the most current version on file, and review annually.