Welcome to the APPapp

Ready to begin? Use the form below to create your Accident Prevention Program document:

For best results, use the TAB key to move from one field to the next. Review the checklist before you begin, but don't worry if you are missing information. You'll review and complete the document in Word after you download it.

When you are done, click Submit my Entries & Get my Document.

Organization(Required)

Enter the legal or official name or your organization:

Address(Required)

Your Accident Prevention Program will apply to this location. If you have more than one location, you may need different documents for each one.

Email(Required)

Safety Orientation Contact

Who is responsible for conducting safety orientations?

Safety Orientation Phone

Enter their phone number.

Safety Orientation Email

Enter their email address.

Number of Employees(Required)

1-10 employees

11 or more employees

Safety Committee

Organizations with 11 or more employees must have a safety committee that holds regular meetings and keeps minutes. What is your safety committee policy?

Safety Meetings

Organizations with 10 or fewer employees are not required to have a safety committee, but must hold regular safety meetings and keep minutes. What is your safety meeting policy?

Reporting an Injury

If an employee gets injured or becomes ill on the job, who should they report it to?

First Aid Location

Where is the first aid kit located?

First Aid/CPR Help

In the event of an emergency, who is trained in first aid and/or CPR?

Emergency Phone Location

Where is the list of emergency phone numbers located?

Evacuation Map Location

If you have an evacuation map for your facility, where is it located?

Fire Emergencies

What should employees do in the event of a fire?

Fire Extinguisher Locations

Where are fire extinguishers located?

Fire Extinguisher Use

Who is knowledgeable about fire procedures and fire extinguisher use and can provide training?

Earthquake Response

What should employees do in the event of an earthquake?

Earthquake Shutoff Valves

Are there emergency shutoff valves on the premises? Where are they located?

Earthquake Gathering Place

Is there a designated gathering place in the event of an earthquake? Where is it?

Earthquake Contact

Person who knows about earthquake procedures and can provide training.

Violence/Active Shooter Incident

What should employees do in the event of an incident?

Violence/Active Shooter Contact

Person who conducts drills and/or briefs employees about what to do.

Reporting Hazards and Unsafe Practices

If an employee sees a hazard or unsafe practice, who should they report it to?

Areas of Safety Concern

Check the box for any items that apply to your location.

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PPE Details

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Food Safety Details

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Driving Details

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Burn Details

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Medications Details

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Safe Lifting Details

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Slips and Falls Details

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Electrical Details

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Cut Details

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Heavy Equipment Details