SAFETY COMMITTEE ANNUAL PLAN TEMPLATE

The safety committee and the unit administration work together in promoting the unit’s safety and
health efforts. The Safety Committee Annual Plan provides a blueprint for the committee and the
unit administration to establish and maintain an effective committee. Committee’s are encouraged
to modify the Annual Plan to fit their needs.

The completion of the Annual Plan is not mandatory; however, it will assist your committee in
tracking goals and accomplishments, and improve communication among the committee,
administrator and constituency. Section I - Annual Plan Components, provides a brief description
of each component and Section II is the template.

Section I - Annual Plan Components

The following recommended components are provided to assist in developing your Annual Plan.

1. Mission statement - Use example in the template or customize

2. Distribution of Annual Plan – Include how the committee will share the plan. It is
suggested that each director and supervisor be given an updated copy annually. Consider
distributing the plan via e-mail, or posting on the departmental homepage for the
constituency. Supervisors can review the plan with new employees during their safety
orientation.

3. Safety committee organizational chart - Include name, phone, and e-mail of

supervisors, chairman, recorder, and safety committee representatives and area they
represent.

4. Annual goals – It is suggested that committees meet at least annually with unit
management to develop goals to be included in their Annual Plan.

5. Accomplishments - Provide the previous year’s accomplishments.

6. Meeting schedule – Hold a minimum of 6 meetings per calendar year. Provide the
dates, times and locations.

7. Agenda items - Topics from the official agenda that should be covered at each meeting
when applicable.

8. Encourage sharing safety concerns – Members are to regularly encourage constituents

to share concerns with committee. Consider providing a “suggestion box” to allow for
concerns to be raised anonymously. Include information on how constituents address
safety concerns.

9. Distribution of meeting minutes - It is recommended that each director and supervisor

be given a copy of meetings minutes. The minutes must be posted on the safety bulletin
board. When possible distribute minutes by posting on departmental homepage, or via e-
mail.

10. Signature - of department Chair, Dean, Director

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Section II - Template
1. Mission statement
At Washington State University maintaining and enhancing a safe work environment is a
responsibility that is shared by the administration, supervisors, employees, safety and
health and risk management offices, and safety committees.

The (director/dean) of XYZ (department, college etc.) is committed to protecting the safety
and health of faculty, staff, students, and visitors. In order to fulfill this commitment the
(director/dean) of XYZ (department, college etc.) has established the XYZ Safety
Committee which is an ______ area (academic or nonacademic), building or
departmental safety committee (select one) to advise and assist unit management in
evaluating and resolving health and safety issues. Area or building committees should list
all the departments or areas represented by the committee. The committee will meet at
least annually with unit management to develop goals.

Employee involvement in the unit’s safety and health efforts including safety committee
activities is necessary to ensure a safe and healthful workplace. The XYZ Safety
Committee provides a forum where every employee or student represented by the
committee can communicate safety related concerns. Hazards that are identified and
shared with the safety committee will be addressed in a timely manner. The ultimate goal
is to prevent injury or illness.

2. Distribution of the Annual Plan

Each year during the month of January a copy of the XYZ Safety Committee Annual Plan
will be distributed via e-mail to all employees (Executive and Principal Administrative
Officers, Department Chairs and Directors, Supervisors, Employees) represented by the
committee. In addition a copy will be posted on the Safety bulletin board located on floor
X next to room 123 in XYZ Hall.

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3. Safety Committee 2009 Organizational Chart

XYZ Unit Administrator

Presidential Safety
XYZ Safety chair -name, Comm. Rep. -name,
phone, e-mail phone, e-mail

Dept. X Safety Rep. - Dept. Y Safety Rep. - Dept. Z Safety Rep. -

name, phone, e-mail name, phone, e-mail name, phone, e-mail

Dept. X Dept. Y Dept. Z

AP’s, Faculty, Staff AP’s, Faculty, Staff AP’s, Faculty, Staff

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 4. Safety Committee 2009 Goals
Consider developing goals annually with your unit supervisor or administrator. Goals
provide direction and purpose for committee members and promote the importance and
value of the safety to committee to the constituency.
Goal Date Project Coordinator(s) Date
Started Completed

Perform Annual Workplace January 2 Name, phone January 31

Inspections number, e-mail

Resolve Annual Workplace March 2 Name, phone March 31

Inspections deficiencies number, e-mail

Review two job procedures May 4 Name, phone September 4

number, e-mail

Defensive driving on snow and December 1 Name, phone December 1

ice training (video and fact number, e-mail
sheet)

5. Safety Committee 2008 Accomplishments

Consider including last years accomplishments in the Annual Plan. A list of
accomplishments provides committee members with a sense of satisfaction related to
their achievements. The list also promotes the importance and value of the safety
committee to the constituency.
Accomplishment Date Project Coordinator(s) Date
Started Completed
Evaluated unit’s Accident January Name, phone March 15
Prevention Program number, e-mail

Coordinated building evacuation March 1 Name, phone May 10

training number, e-mail

Assisted in addressing July 7 Name, phone August 4

constituent concern about indoor number, e-mail
air quality

Annual Workplace Inspections November 1 Name, phone November

Performed number, e-mail 31

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 6. 2009 Meeting Schedule
In 2009 the committee will meet six times in room 142 French Ad, 10:00-11:00 a.m.:
 January 3 (Monday)
 March 1 (Tuesday)
 May 2 (Monday)
 July 11 (Monday)
 September 12 (Monday)
 November 1 (Tuesday)

7. Basic Agenda Items

• Promote and publicize health and safety topics and solutions
• Accept, evaluate and respond to employee concerns
• Review job procedures and recommend improvements
• Review Incident Reports and recommend solutions
• Review University Health & Safety Committee minutes
• Refer unresolved issues to higher level
• Recommend improvements to Accident Prevention Program
• Assist in conducting safety Self-Inspections
• Projects and goals – discuss progress on each topic

8. Encourage sharing safety concerns

Committee members will ask for safety concerns from their constituents on a regular basis (i.e.
prior to each safety committee meeting). A “safety suggestion box” is located in XYZ Hall on the
2nd floor outside room 222.

Teach constituents how to address:

Minor safety concerns:
• Inform supervisor
• Repair or replace immediately
• Share problem and resolution with safety committee representative

Safety concerns that could cause a serious injury or illness:

• Stop the activity or leave the area
• Immediately notify your supervisor or unit administrator
• Contact appropriate safety and health units
• Inform safety committee chairman

When unsure about the severity of any safety hazard contact the appropriate safety and health
unit such as Environmental Health & Safety, Police, Radiation Safety Office, or Fire Marshall for
assistance.

9. Distribution of safety committee meeting minutes

The XYZ Safety Committee minutes will be posted on the Safety bulletin board located on floor X
next to room 123 in XYZ Hall and distributed to all employees via e-mail. Please call the recorder
if you do not receive your copy within two weeks following the scheduled meeting.

10. Signature of department Chair, Dean, Director