(a) An employer who elects to participate in the safety incentive plan for purposes of obtaining a premium credit in accordance with subdivision (6) or a reduction in security deposit in accordance with subdivision (7) of section 134 of the Workers' Compensation Law shall, within 10 days after completing arrangements with a certified safety specialist to prepare and recommend a safety incentive plan, submit the following to the board:

1. (1) the name and address of the employer and the employer's insurer, if such employer is not a self-insured employer, and the employer's Federal tax identification number;

2. (2) evidence demonstrating that the employer satisfies the statutory eligibility requirements for safety incentive program participation, namely:

   1. (i) written documentation that the employer pays at least $5,000 in annual workers' compensation premiums;
   2. (ii) written documentation that the employer's experience rating for the year preceding and the years in which the credit is applied for is less than 1.30 or that the employer is/was self-insured under the Worker’s Compensation Law such year(s); and
   3. (iii) a statement, signed by an officer of the employer, that the employer is not subject to the compulsory workplace safety and loss prevention program established in subdivision (1) of section 134 of the Workers' Compensation Law;
3. (3) the name, address and certification number of the certified specialist(s) preparing and recommending the safety incentive plan;
4. (4) the date on which such plan preparation is scheduled to begin;
5. (5) the name(s) of the employee representative(s) who have continuing involvement in the development of the employer's safety incentive plan and a description of the nature of such involvement, including meetings and discussions with the certified safety and loss management specialist.

(b) Within 30 days of the receipt of the completed safety incentive plan recommended by the specialist, the specialist and employer shall jointly provide the employer's insurer and the board with a written copy of such safety incentive plan report which shall:

1. (1) set forth the means by which the safety incentive plan is to be implemented;
2. (2) provide the expected starting and completion dates for each element of safety incentive plan implementation;
3. (3) identify and describe the nature of the involvement of employee representatives and other individuals or organizations in the development and implementation of such safety incentive plan;
4. (4) set forth policies, procedures and practices needed to optimally control or reduce the hazards and exposures which would be detrimental to the safety and health of employees and other individuals;
5. (5) establish and communicate a clear goal for the safety incentive plan and the mechanisms which will be utilized in meeting this goal;
6. (6) provide for visible top management leadership in implementing the plan and ensure that all workers at the site are provided equally high quality safety protection, so that all will understand that management's commitment is serious;
7. (7) describe any sampling and testing protocols utilized, indicate whether such protocols conforms to any recognized Federal or State standards and identify the accreditation of any laboratory or laboratories which has performed or will perform sample analyses in the development or implementation of the safety incentive plan;
8. (8) provide for and encourage employee involvement in the implementation of such plan so that they will commit their insight and energy to achieving the goals and objectives of the safety incentive plan. Such involvement shall be accomplished through the employee representative(s) or the recognized employee organization(s), if any;
9. (9) assign and communicate responsibilities for all aspects of the safety incentive plan to managers, supervisors and employees so that such persons know and understand what is expected of them in the implementation of the plan and so that such parties may be held accountable for their responsibilities under such plan;

10. (10) ensure that the supervisors, managers and employees understand their responsibilities under the safety incentive plan and their importance to the safety of the workplace. In particular, appropriate training for managers, supervisors and employees shall enable them to:

    1. (i) recognize potential hazards;
    2. (ii) maintain safety protection in the work area; and
    3. (iii) reinforce employee training on the nature of the potential hazards and required protective measures;
11. (11) provide a reliable system for employees to notify management personnel of conditions that appear to be hazardous or to be in non-compliance with the terms of the safety incentive plan without fear of reprisal and provide a mechanism to ensure timely and appropriate responses;
12. (12) provide a mechanism to investigate accidents so that the root cause(s) and means for preventing recurrences are identified. For the purposes of this rule, the term accident shall mean any unexpected happening that interrupts the work sequence or process and that may result in injury, illness or property damage;
13. (13) provide a means to review injury and illness trends over time so that patterns with common causes can be identified and eliminated;
14. (14) establish a mechanism for the employer to conduct ongoing, periodic in-house safety inspections so that new or previously missed hazards or failures in controls are identified. Such inspections shall be conducted with a frequency necessary to be effective and this frequency shall be reviewed by the specialist preparing the safety incentive plan described in this Part;
15. (15) address the impact of emergency situations and develop written plans and procedures to insure employee safety during such emergencies. For the purposes of this rule, the term emergency situation shall mean an unforeseen single event or combination of events that calls for immediate action to prevent, control or contain injury or illness to person(s) or damage to property;
16. (16) establish procedures for transmitting and enforcing safe work practices in the workplace through training, positive reinforcement, correction of unsafe performance and, if necessary, reinforcement of such work practices through a clearly defined and communicated disciplinary system; and
17. (17) provide for a final closing conference to be conducted by the specialist upon completion of the specialist's safety evaluation to discuss the specialist's findings and recommendations with the employer and the employee representative(s) or recognized employee organization(s).