Sample Exposure Control Plan Exposure Control Plan (Paragraph(c)(2))
Policies and Program Administration
(company name) maintains, reviews and updates the
Exposure Control Plan (ECP) at least annually, and whenever necessary to reflect new or
modified tasks, procedures and engineering controls * that affect occupational exposure.
The ECP is also updated to reflect new or revised employee positions with occupational
exposure.
This facility has had ________ cases of confirmed TB in
the last 12 months. (Paragraph (c)(2)(vi))
(b) This facility is located in __________ county which
has reported cases of TB in the last twelve month reporting period.
Employee Exposure Determination (Paragraph (c)(2)(i)(A))
ALL employees in the following job classifications have
or may have occupational exposure to TB (Paragraph(c)(1)(i)(A)): JOB TITLE
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Employees in the following job classifications have or
may have exposure to TB when they are performing the listed tasks and procedures
(Paragraph (c)(1)(B)):
|
JOB TITLE |
TASKS/PROCEDURES |
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Employee Notification of TB Hazard (Paragraph
(c)(2)(i)(B))
(organization's name ) uses the following procedures to
assure that all employees with job tasks that offer potential for occupational exposure
are informed of the hazard and take proper precautions against exposure to TB.
(procedures described)
______________________________________________________________________
(*) ________ (responsible person(s)/department) ________
maintains contact with all outside contractors who provide temporary or contract employees
who may incur occupational exposure. This allows the contractor to institute precautions
to protect his or her employees. Theses contractors are informed of the TB hazard and the
facility's procedures for protecting themselves from exposure.
(*) Signs are posted at the entrance to:
(*) 1) Rooms or areas used to isolate an individual with
suspected or confirmed infectious TB,
(*) 2) Areas where procedures or services are being
performed on an individual with suspected/confirmed infectious TB, and
(*) 3) clinical land research laboratories where M.
tuberculosis is present.
(*) All signs are red with white text stating "No
Admittance Without a Type N95 of More Protective Respirator" and have a picture of a
stop sign.
(*) ________ (organization's name) ________ ensures that
warning labels are placed on AFB isolation room exhaust ducts and areas where occupational
exposure to TB is expected.
(*) All systems carrying air that may be contain
aerosolized M. Tuberculosis are labeled at all points where ducts are accessed prior to
HEPA filter, at fans and at the discharge outlets of non-HEPA filtered direct discharge
systems. The label says: "Contaminated AirRespiratory Protection
Required".
(*) ____ (organization's name) ____ notifies employees
entering the laboratory and the autopsy room of the occupational hazards by using signs at
the entrance to both these locations. These signs indicate the name and telephone number
of the director of the laboratory, infectious agent M. tuberculosis, and the special
requirements for entering the laboratory or autopsy room. The sign displays the Biohazard
symbol.
Exposure Incident Reporting (Paragraph (c)(2)(i)(C))
All employees must report exposure incidents immediately
to (responsible person(s)/department). ____ (Organization's name) is responsible for
investigating, evaluating, and documenting the circumstances surrounding the exposure
incident for instituting changes to prevent similar occurrences.
The following procedures are used to investigate/evaluate
exposure incidents at (organization's name):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Prompt Identification of Individuals With Suspected or
Confirmed Infectious TB (Paragraph (c)(2)(ii) and (iii)(A))
(Organization's name) considers an individual to be
suspected of having Infectious TB (unless the individual's condition has been medically
determined to result from a cause other than TB) if either the company or any of its
employees determine(s)/learn(s)that the individual:
- has a persistent cough lasting 3 or more weeks with 2 or
more signs and symptoms of active infectious TB (e.g., bloody sputum, night sweats, weight
loss, fever, anorexia),
- has a positive AFB smear,
Based on the criteria listed above, (Organization's name)
utilizes the following procedures for early detection of individuals with
suspected/confirmed infectious TB.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Employers Who Transfer (Paragraph(c)(2)(ii))
Procedures for Transfer of Individuals With Suspected or
Confirmed Infectious TB:
If/when an isolation room is not available at our
facility, the individual is transferred within 5 hours of identifying the infectivity to a
facility (name of facility) where isolation rooms are available. The following procedures
for transfer of an individual with suspected/ confirmed infectious tuberculosis are
utilized:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
While awaiting transfer, the individual is masked or
segregated to protect employees who are without respiratory protection. (organization's
name) uses the following procedures/equipment when masking and segregating an individual
with suspected/confirmed infectious TB:
______________________________________________________________________
______________________________________________________________________
If a situation arises and the individual is not able to
be transferred within 5 hours of identifying the suspected or confirmed infectious TB, the
following procedures, including AFB isolation, are instituted: (list procedures used)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Employers Who Admit and Provide Medical Services
(Paragraph (c)(2)(iii))
Procedures to Isolate and Manage Care
(Paragraph(c)(2)(iii)(B))
(*) The following procedures are used to isolate
individuals with suspected or confirmed infectious TB.
(*) All individuals with suspected or confirmed
infectious TB are placed in AFB isolation rooms or areas.
(*) ______ (organization's name) ______ uses the
following procedures to minimize the time an individual with suspected or confirmed
infectious TB remains outside of an AFB isolation room or area: ______ (detail
responsibilities and steps)
______________________________________________________________________
______________________________________________________________________
(Paragraph(C)(2)(iii)(B)(1))
(*) Employee exposure in AFB isolation rooms is minimized
by combining tasks the amount of time an employee spends in an AFB isolation room is
minimized by ______ (list procedures used)
______________________________________________________________________
___________ Paragraph (c)(2)(iii)(B)(2))
(*) ____ (organization's name) ______ uses the following
procedures, minimizing the number of workers entering AFB isolation rooms:
______________________________________________________________________
______________________________________________________________________
(*) ____ (organization's name) ______ utilizes the
following procedures to delay transport or relocation within the facility until the
individual is considered non-infectious:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(Paragraph (c)(2)(iii)(B)(3))
(*) Services are provided in the patient's room whenever
feasible such as portable x-ray and ______ (list other services provided in the patient's
room to minimize exposure)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(*) This facility uses ________ (list the type of
engineering controls in useproperly fitted masks or valveless respirators for the
for the patient to be masked or portable containment devices)
______________________________________________________________________
on individuals with suspected or confirmed infectious TB
when it is necessary to transport or relocate the individual.
(Paragraph (c)(2)(iii)(B)(4))
(*) The following procedures assure that the individual
is returned to the AFB isolation room as soon as practical after completion of the
procedure ______ (list of procedures)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(*) Services that cannot be rendered in the patient's
room are provided in and area that meets the requirements for an AFB isolation room.
(*) Elective high-hazard procedures and surgery are
delayed until the patient is non-infectious.(Paragraph(c)(2)(iii)(B)(5))
(*) HIGH-HAZARD PROCEDURES (Paragraph(c)(2)(iii)(C))
(*) High-hazard procedures (where TB may be aerosolized)
require precautions to prevent/minimize occupational exposure to infectious TB. The
following high-hazard procedures are performed at this facility: ______ (list procedures)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(*) Engineering Controls Maintenance Schedules and
Records (Paragraph (c)(2)(iii)(D))
(*) The maintenance schedule for engineering controls is
as follows:
(*) DailyNegative pressure areas are qualitatively
demonstrated by using smoke trails.
(*) Whenever HEPA filters are changed, the system is
inspected and its performance monitored in accordance with current USPHS guidelines. HEPA
filters are changed every ______ in this facility or whenever
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(*) Every six monthsHEPA filters in contained air
exhaust systems are inspected, maintained and performance monitored in accordance with
current USPHS guidelines.
Clinical and/or Research Laboratories (Paragraph
(c)(2)(iv))
The ________ (type of laboratoryclinical or
research) ________ operates at biosafety level ________ as determined by ________ (name of
laboratory director) ________ for ________ (organization's name) ________. This is in
accordance with CDC/NIOSH Biosafety in Microbiological and Biomedical Laboratories).
The following controls are in operation in the laboratory
at this facility ________ (list controlled access, anterooms, sealed windows and other
controls required in the standard and determined necessary by the laboratory director)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(c)(2)(v) HOME HEALTH CARE OR HOME-BASED HOSPICE
See the following sections of this sample ECP for
information regarding the ECP requirements:
(1) (c)(2)(ii) & (iii)(A) for sample statements
regarding the Prompt identification of individuals with suspected or confirmed infectious
TB.
(2) (c)(2)(iii) for sample statements re: procedures for
minimizing employee exposure.
(3) (c)(2)(iii)(C) for a sample statement regarding high
hazard procedures.
The procedures in this Exposure Control Plan minimize the
occupational exposure to TB. The procedures for isolating and managing care are used until
the individual with suspected or confirmed infectious TB is determined to be
non-infectious or until the diagnosis for TB is ruled out.
|