Safety (SHEM) Committee webpage

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

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

Click here to view the Pandemic Plan (login required)

Click here to view the Biosecurity Plan.

Milwaukee, WI IACUC Executive Summary

USDFRC, Madison, WI IACUC Executive Summary

Click here to view the annual Environmental Management System Policy.

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

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

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

• Slides (.pdf): http://usda.wisc.edu/safety/training/SupervisorSafety4.pdf
• Video (.mp4):

*** 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/

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

• Slides (.pdf): http://usda.wisc.edu/safety/training/MWA-ATV-SafetyTraining.pdf
• Video (.mp4):

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

• 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