7.2 Description and Retention of Forms
    Footnotes

    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.