WSR 98-06-061
PERMANENT RULES
DEPARTMENT OF
LABOR AND INDUSTRIES
[Filed March 2, 1998, 8:19 a.m., effective June 1, 1998]
Date of Adoption: March 2, 1998.
Purpose: First aid--General industry, chapter 296-24 WAC, General safety and health standards. In response to requests from the business and emergency health care community, a first-aid task force composed of emergency medical care representatives and business, labor, and Department of Labor and Industries representatives was formed. The task force met for over a year to draft and reach consensus on these new rules. The primary difference between the adopted rules vs. the former rules is that they allow a performance-based option for compliance rather than being exclusively specification rules. For employers who choose the performance-based option (developing first-aid response plans), non-mandatory appendices have been included to provide guidance. In addition, the new rules have been "clear rule written" to enable easier understanding for their intents and requirements. The adopted rules give the employer greater flexibility in ensuring that first-aid services are readily available to all employees. The significant changes include:
A new option for employers to prepare a first-aid response plan.
A second option for employers to maintain first-aid trained staff on the job site with specific requirements.
Changes in the information to be covered in first-aid training.
Less rigidity in the requirements for who must be trained.
Less rigidity in the requirements for the contents of first-aid kits.
Elimination of the requirement for a first-aid room for employers with more than two hundred employees.
Requiring successful completion of first-aid training (which includes CPR) every two years instead of one year for CPR and three years for first aid.
Existing WAC Sections Repealed: WAC 296-24-060 First-aid training and certification. This section is repealed and will be replaced by the four new sections indicated below:
WAC 296-24-06125 How many employees must be trained in first-aid?
WAC 296-24-06130 What must first-aid training cover?
WAC 296-24-06135 How often must employees complete first-aid training?
WAC 296-24-06140 How must an employer document first-aid training?
WAC 296-24-065 First-aid kit. This section is repealed and replaced by new section WAC 296-24-06145 What is the requirement for first-aid supplies?
WAC 296-24-067 First-aid station. This section is repealed and replaced by new section WAC 296-24-06150, What is the requirement to provide a first-aid station?
WAC 296-24-070 First-aid room. This section is repealed and will not be replaced by a new section. First-aid rooms will no longer be required in the general safety and health standards.
Adopted New Sections: WAC 296-24-061 First-aid requirements. This new section identifies that the requirements in the WAC 296-24-061 section series pertain to first aid.
WAC 296-24-06105 What work places does this rule apply to? This new section states that the rule applies to all work places except for the specific ones listed and identified by rule title and chapter number.
WAC 296-24-06110 What is the purpose of this rule? This new section describes the purpose of the standard and replaces similar language found at the beginning of current section WAC 296-24-060.
WAC 296-24-06115 What definitions apply to this section? This new section gives definitions of several words or terms used in the standard. The current standard has no word or phrase definitions.
WAC 296-24-06120 How must an employer ensure that first-aid assistance is available in the workplace? This new section describes an optional "first-aid response plan" that employers may prepare to address first-aid training, first-aid kits, emergency medical services availability and availability of first-aid trained employees. A second option employers may choose is to meet specific requirements for "maintaining first-aid trained staff on the job site." This first-aid response plan option is new, and not found in the former standard. The second option is a clear rule written version of what is found in the former standard.
WAC 296-24-06125 How many employees must be trained in first-aid? This new section requires employers:
Determine how many employees must be trained in first-aid,
To assess their workplace based on five listed factors, and
To use that assessment to determine how many employees must be first-aid trained.
WAC 296-24-06130 What must first-aid training cover? This new section identifies the eighteen core elements that must, at a minimum, be included in first-aid training. It includes some of the same elements of the existing standard and some new elements.
WAC 296-24-06135 How often must employees complete first-aid training? This new section requires that the first-aid training occur every two years and that employees demonstrate skill and knowledge in the core elements outlined in WAC 296-24-06130.
WAC 296-24-06140 How must employers document first-aid training? This new section requires employers to document first-aid training with training rosters, first-aid cards, or certificates.
WAC 296-24-06145 What is the requirement for first-aid supplies? This new section requires that first-aid supplies:
Be readily available,
Be stored in protective containers,
Are appropriate to the workplace setting, and
Can be moved to injured employees.
This section allows the employer to determine the contents of the kit depending on the occupational setting rather than specifying in detail the contents as required in the current standard.
WAC 296-24-06150 What is the requirement to provide a first-aid station? This new section requires that:
A first-aid station be established if there are fifty or more employees at a work site.
The station is well marked.
The station be available to employees during all working hours.
The station be equipped with first-aid supplies (according to number of employees, occupational setting and conditions).
The station has at least one portable first-aid kit.
At least one first-aid trained employee be available.
This section removes the requirement for wool blankets and stretcher, a roster of doctors, hospitals and ambulances and at least two first-aid kits, as required in the former standard.
WAC 296-24-06155, APPENDIX 1 Evaluation worksheet for the first-aid response plan. This is a nonmandatory appendix to provide guidance to employers, particularly those who choose Option 1 of the first-aid standard (WAC 296-24-061). This new section contains a questionnaire that is designed to be used by employers to assess the need for first-aid trained employees. The questionnaire can be used to assess multiple locations or types of work. The questionnaire was distributed to members of the first-aid task force representing small, medium and large companies. They assigned their safety committee members, or other persons, the task of developing a first-aid response plan by using the evaluation worksheet with little or no coaching. The results were very positive. The advisory committee reviewed and analyzed the results and found them fairly complete. Those that completed the first-aid response plan commented that the process was straightforward. They felt the result was a much better analysis of their worksite needs with regard to first-aid support.
WAC 296-24-06160 APPENDIX 2 - First-aid kit guidance. This is a nonmandatory appendix to provide guidance to employers. This new section lists sample first-aid kit contents and optional first-aid kit contents for workplaces. An added note indicates that "ASTM, ANSI or other consensus national standard kits will meet these requirements."
Citation of Existing Rules Affected by this Order: WAC 296-24-060 First-aid training and certification, 296-24-065 First-aid kit, 296-24-067 First-aid station, and 296-24-070 First-aid room.
Statutory Authority for Adoption: Chapter 49.17 RCW.
Adopted under notice filed as WSR 97-17-079 on August 19, 1997.
Changes Other than Editing from Proposed to Adopted Version: As a result of written and oral comments received, the following sections are changed as indicated below:
New section WAC 296-24-06115 What definitions apply to this section? The prefix "tele" was added to the word phone in the definition of "First-aid station." The words "hospitals or clinics and" were removed from the same definition.
New section WAC 296-24-06120 What are the requirements for a first-aid response plan?
The mandatory "first-aid response plan" was made optional, and reorganized.
A second option for employer compliance "Maintaining first-aid trained staff on the job site," with specific requirements, was added.
A new title "How must an employer ensure that first-aid assistance is available in the workplace?" reflects the new contents of the section.
New section WAC 296-24-06125 How many employees must be trained in first-aid?
The note was edited and the reference to voluntary provisions of first-aid in RCW 4.24.300 was removed.
The list of factors by which to determine how many employees to train in first-aid was numbered.
"Complexity of the work force" was clarified by adding the words "including, but not limited to, design, size, etc."
"Degree of occupational hazards" was rephrased to read "Nature, potential and degree of occupational hazards."
New section WAC 296-24-06130 What must first-aid training cover?
"Scene safety" and "body substance isolation" were split into separate elements numbered (4) and (5), respectively.
In the adopted rule, first-aid training must now include eighteen core elements.
New section WAC 296-24-06140 How must an employer document first-aid training?
The second sentence was rewritten with the words "first-aid" substituted for "successful completion." The effect is to specifically identify "first-aid cards" as a form of documentation.
New section WAC 296-24-06145 How must an employer store first-aid supplies? The section title was changed to "What is the requirement for first-aid supplies?"
New section WAC 296-24-06150 Which employers must have first-aid stations?
The section was changed in the adopted rule to reflect RCW requirements regarding having at least one first-aid trained employee available on a job site.
Bulleted points were numbered in accord with WAC rules and are now citable in the adopted rule.
The title was changed in the adopted rule to "What is the requirement to provide a first-aid station?" It now reflects the section contents.
New section WAC 296-24-06155 APPENDIX 1 Evaluation worksheet for the first-aid response plan.
No changes were made due to public comment on this section.
The words "Option 1" were added to the second sentence to reflect changes in the proposed standard that resulted from changes to WAC 296-24-06120.
New section WAC 296-24-06160 APPENDIX 2, recommended contents of first-aid kits. This is a nonmandatory appendix.
The words "Recommended contents of first-aid kits. This is a nonmandatory appendix." were deleted from the proposed rule. The words "First-aid kit guidance" were substituted for clarity.
The heading "Basic First-aid kit - Minimum contents" was changed to read "Sample First-aid Kit Contents." This was done for clarity.
The list under "Sample First-aid Kit Contents" was renumbered for clarity.
The list under "Optional First-aid Kit Contents" was renumbered for clarity.
Mouth-to-mouth barrier for CPR was added to the list of Optional First-aid Kit Contents.
A note was added to clarify that ASTM, ANSI or other consensus national standard kits will meet the requirements listed in Appendix 2. The note also states that "employers may consider factors in Appendix 1 (item #15) to determine additional locations or quantities of first-aid supplies.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 13, amended 0, repealed 4.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 13, amended 0, repealed 4.
Effective Date of Rule: June 1, 1998.
March 2, 1998
Gary Moore
Director
NEW SECTION
WAC 296-24-061 First-aid requirements.
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NEW SECTION
WAC 296-24-06105 What workplaces does this rule apply to? This
rule applies to all workplaces, except for the ones listed below. They
are, instead covered by separate individual rules (vertical standards):
Rule Title Chapter
Agriculture 296-307 WAC
Compressed Air Work 296-36 WAC
Construction 296-155 WAC
Fire Fighters 296-305 WAC
Logging 296-54 WAC
Longshoring/Stevedoring 296-56 WAC
Sawmills 296-78 WAC
Shipbuilding and Repairing 296-304 WAC
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NEW SECTION
WAC 296-24-06110 What is the purpose of this rule? This rule
ensures quick and effective first aid for all employees of the state, in
case an injury or acute illness occurs on the job.
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NEW SECTION
WAC 296-24-06115 What definitions apply to this section? "Emergency medical service" means medical treatment and care given at the scene of any medical emergency or while transporting any victim to a medical facility.
"First aid" is immediate emergency care for injuries or acute illness before emergency medical treatment is available.
"First-aid station" is a well marked location where first-aid kits and supplies are stored and telephone numbers of emergency medical services are posted.
"First-aid kit" is an unlocked container holding first-aid supplies.
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NEW SECTION
WAC 296-24-06120 How must an employer ensure that first-aid assistance is available in the workplace? The employer must ensure that first-aid trained personnel are available to help employees who are injured or who become acutely ill on the job. The employer must meet this requirement by one of the two options listed below.
(1) Option 1: Developing and maintaining a written first-aid response plan. The first-aid response plan must:
(a) Fit the work location, type of work and environmental conditions;
(b) Identify available emergency medical services and access numbers;
(c) Tell where the emergency medical services access numbers are posted;
(d) Tell how employees are trained in first aid, if applicable;
(e) Tell how injured or ill employees will have access to first-aid-trained employees;
(f) Give the location(s) of first-aid supplies and/or first-aid stations;
(g) Identify the contents of first-aid kits; and
(h) Tell how first-aid supplies or kits will be inspected and
maintained.
Note: The first-aid response plan can be part of the written accident prevention program. See Appendix 1 for further guidance on a first-aid response plan.
(2) Option 2: Maintaining first-aid trained staff on the job site. The employer must ensure that:
(a) Each person in charge of employees has first-aid training; or another person with first-aid training is present or available to the employees;
(b) Documentation of first-aid training is kept as required in WAC 296-24-06140;
(c) Emergency telephone numbers are adequately posted.
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NEW SECTION
WAC 296-24-06125 How many employees must be trained in first aid? If the employer chooses Option 1 of WAC 296-24-06120, the employer must determine how many employees to train in first aid based on the following factors:
(1) Nature, potential and degree of occupational hazards;
(2) Remoteness of the workplace;
(3) Complexity of the workplace (including, but not limited to, design, size, etc.);
(4) History of past medical emergencies; and
(5) Time and distance to emergency medical services.
Note: If the employer requires an employee to give first aid, the bloodborne pathogen standard, WAC 296-62-080 applies and requires additional training.
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NEW SECTION
WAC 296-24-06130 What must first-aid training cover? First-aid training must include these core elements:
(1) Role and responsibilities of the first-aid provider;
(2) Assessing a scene;
(3) Performing an initial and ongoing assessment of an injured or ill person;
(4) Scene safety;
(5) Body substance isolation;
(6) Performing an emergency move;
(7) Placing an ill person in the recovery position;
(8) Opening and maintaining an airway;
(9) Providing rescue breathing;
(10) Managing an obstructed airway;
(11) Performing adult one rescuer CPR;
(12) Recognizing the warning signs and symptoms of medical problems;
(13) Recognizing and caring for an injured or ill person with decreased levels of responsiveness;
(14) Controlling external bleeding and recognizing internal bleeding;
(15) Recognizing and caring for victims of shock;
(16) Recognizing and stabilizing spinal injury;
(17) Recognizing and manually stabilizing suspected skeletal injuries; and
(18) Knowledge of voluntary provisions of first aid, consent and
confidentiality.
Note: Occupational risk or extended time and distance from emergency medical services may indicate a need for training beyond the items listed above. Each work environment
should be surveyed to determine the appropriate level of training that employees should receive.
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NEW SECTION
WAC 296-24-06135 How often must employees complete first-aid
training? Every two years, employees must successfully complete first-aid training by demonstrating skill and knowledge in the core elements
outlined in WAC 296-24-06130.
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NEW SECTION
WAC 296-24-06140 How must an employer document first-aid training?
Documentation of first-aid training must be maintained by the employer.
Training rosters, first-aid cards or certificates are considered
documentation.
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NEW SECTION
WAC 296-24-06145 What is the requirement for first-aid supplies? (1) First-aid supplies must be readily available to all employees.
(2) First-aid supplies must be stored in containers adequate to protect the contents from damage, deterioration, or contamination. The containers must be clearly marked and not locked, but may be sealed.
(3) First-aid supplies must be able to be moved to the location of the injured or acutely ill worker.
(4) The first-aid supplies must be appropriate to the occupational
setting and the response time of emergency medical services.
Note: See Appendix 2 for recommended contents of first-aid kits.
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NEW SECTION
WAC 296-24-06150 What is the requirement to provide a first-aid station? (1) Employers with 50 or more employees per shift at one location must establish a first-aid station.
(2) The first-aid station must:
(a) Be well marked;
(b) Be available to employees during all working hours;
(c) Be equipped with first-aid supplies (type and amount depends on the number of employees, occupational setting and conditions);
(d) Have at least one portable first-aid kit.
(3) At least one first-aid trained employee must be available.
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NEW SECTION
WAC 296-24-06155 APPENDIX 1 Evaluation worksheet for the first-aid
response plan. This is a nonmandatory appendix. Option 1 of the first-aid standard (WAC 296-24-061) requires employers to prepare a first-aid
response plan. The plan must address the availability of first-aid
trained personnel at each place of employment. Since work sites are
highly variable, the first-aid needs will also vary, depending on the
number of employees, the type of work, the job hazards, and the
availability of emergency medical services.
This questionnaire is designed to be used as a tool to assess the need
for first-aid trained employees. Since some employers may have more than
one location or type of work, this questionnaire can be used to assess
each site. The plan should be reviewed annually or whenever conditions
change at the work site.
1. What site or location does this plan cover?
2. Who is responsible for managing this plan?
3. How is this plan communicated to employees?
4. When was the plan written or last reviewed?
5. How many employees at the work site? (If work is seasonal, consider
how many per season and shifts worked.)
6. How many work shifts at the work site? (Indicate shifts and employees
per shift.)
Number of Employees Shifts
Day Swing Graveyard
less than 10 ___ ___ ___
11-49 ___ ___ ___
50-99 ___ ___ ___
100 or more ___ ___ ___
7. What are the sources of potential injuries or illnesses at the work
site?
8. What types of injuries or illnesses have occurred in the past at the
work site? (This information may be found in such sources as OSHA 200
forms, worker compensation claims, or safety committee minutes.)
9. What is the response time of the available emergency medical services
to the work site (estimated time in minutes)?
10. How accessible are the first-aid trained personnel in the case of an
accident?
11. What factors did I consider in deciding how many employees to train
in first aid (specify)?
> Injury/illness history.
> Possible hazardous exposures (chemicals, flammable liquids,
temperature extremes, moving machinery or machinery parts, powered tools,
work at elevations, high voltage electricity, confined spaces. If
seasonal work, list for each season).
> Number of separate work sites (can be either separate locations,
buildings, or types of work such as offices, warehouses, production
areas, etc.).
> Number of employees at this work site? (If seasonal work, list
for each season.)
> Number of employees in each shift?
> Emergency medical service response time?
> First-aid response time?
12. Does the first-aid training provided to my employees include all the
core elements required in the standard?
13. Based on my assessment of work site hazards, is additional training
required beyond the core elements? (Examples include burns, eye
injuries, poisoning, heat stress, frostbite.)
14. What factors did I consider in determining the contents of my first-aid supplies/kits (specify)?
> Injury/illness history.
> Type of hazards at work site (physical, chemical, biological).
> Number of employees and shifts.
> Recommendations of first-aid training providers, local emergency
response providers, physicians or clinics, trade organizations,
knowledgeable employees or first-aid kit vendors.
15. What factors did I consider in determining the number and location
of my first-aid supplies/kit(s) (specify)?
> Location of employees.
> Areas of greatest hazards.
> Ease of accessibility of kit.
16. Who is responsible for maintaining first-aid supplies/kit(s)?
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NEW SECTION
WAC 296-24-06160 APPENDIX 2--First-aid kit guidance.
Sample First-aid Kit Contents
a) 1 absorbent compress, 4x8 inches
b) 16 adhesive bandages, 1x3 inches
c) 1 adhesive tape, 5 yards long
d) 10 antiseptic single-use packages, 0.5 g. application
e) 6 burn treatment single-use packages, 0.5 g. application
f) 1 eye covering (for two eyes)
g) 1 eye wash, 1 fluid ounce
h) 4 sterile pads, 3x3 inches
i) 2 pair of medical exam gloves
j) 1 triangular bandage, 39x39x55 inches
Optional First-aid Kit Contents
ao) Bandage compresses, 2x2 inches, 3x3 inches and 5x5 inches
bo) Self-activating cold packs, 4x5 inches
co) Roller bandages, 6 yards long
do) Mouth-to-mouth barrier for CPR
Note: ASTM, ANSI, or other consensus national standard kits will meet these requirements.
Employers may consider factors in Appendix 1 (item #15) to determine additional locations or quantities of first-aid supplies.
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REPEALER
The following sections of the Washington Administrative Code are
repealed:
WAC 296-24-060 First-aid training and certification.
WAC 296-24-065 First-aid kit.
WAC 296-24-067 First-aid station.
WAC 296-24-070 First-aid room.