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Safety (SHEM) Committee webpage

1 What To Do When Injured on the Job 1

Click here to view What To Do When Injured on the Job


1 Incident/Accident forms 1

Madison Location Accident/Illness Reporting Instructions

Listed below are the documents that need to be completed and returned to Terri Gureno (terri.gureno@ars.usda.gov) within 24 hours of the Incident/Accident.


Form CA-16 Authorization for Examination And/Or Treatment - authorizes an injured employee to obtain immediate examination and/or treatment from a physician chosen by the employee for an on-the-job injury. Forms are available from Terri Gureno, Julie Grogan, or from SHEM stations within each building.

Form CA-20 Attending Physician’s Report – If you decide to see a medical professional 48 hours or more after the incident, you will need to take the CA-20 form and give to the attending physician to complete. This form along with the appointment bill is then sent to the Worker’s Compensation Specialist in Beltsville.

Form CA-1 Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation – Please complete all boxes 1-15. Do not complete shaded areas. Witness (If there is a witness) Complete bottom section 16. Supervisor completes all of the 2nd page. I will complete OWCP Agency Code and OSHA Site Code.  If a question is not applicable to you or the situation enter N/A in the boxes.  All boxes must be filled in or the form will be rejected at Headquarter’s.

Form CA-2 Notice of Occupational Disease and Claim for Compensation

Form CA-2A Notice of Recurrence


Accident Report Form 


OSHA Forms 300, 300A, 301 Instructions

OSHA Forms 300, 300A, 301 - Log of Work-Related Injuries and Illness


160.0M - Safety, Health, and Environmental Management Program P&P


Basic Program Elements for Federal Employees OSHA

Executive Order 12196 – Occupational Safety and Health Programs for Federal Employees


1 Pandemic Plan 1

Click here to view the Pandemic Plan (login required)


1 Biosecurity Plan 1

Click here to view the Biosecurity Plan.


1 IACUC Executive Summaries 1

Milwaukee, WI IACUC Executive Summary

USDFRC, Madison, WI IACUC Executive Summary


1 Annual EMS Policy 1

Click here to view the annual Environmental Management System Policy.


1 Current SHEM Committee Members 1

Click here to see the current SHEM Committee members: http://usda.wisc.edu/safety/forms/SHEMCommitteeRosterFY21.pdf


1 Location Emergency Plans 1

To download the Occupant Emergency Plan for the Madison location, click here: http://usda.wisc.edu/safety/forms/OccupantEmergencyPlan-Madison.pdf


To download the Emergency and Waste Incidence Reporting plan, click here: http://usda.wisc.edu/safety/forms/MadisonEmergencyandIncidentReportingPlan-2016.pdf


1 Supervisor Safety Training 1

Supervisor's Roles and Responsibilities for Safety, Health and Environmental Management


*** If you are having trouble viewing this video, click here to download: http://usda.wisc.edu/safety/training/SupervisorsTraining.mp4


Safety and health posters: http://www.afm.ars.usda.gov/shem/safetyhealth/



1 Midwest Area ATV Safety Training 1

Midwest Area ATV Safety Training - Ralph Jesse, MWA Environmental Protection Specialist


*** If you are having trouble viewing this video, click here to download: http://usda.wisc.edu/safety/training/ATVTraining.mp4

1 2019-2020 Meeting Schedule 1

  • November 20th, 2019
  • December 18th, 2019
  • January 15, 2020
  • February 19th, 2020 - Location Safety Day
  • March 18th, 2020
  • March 23rd-27th, 2020 - Location Inspections
  • April 15th, 2020
  • May 20th, 2020





Page last updated on: October 21, 2020

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