10.1. New. EHS PROCEDURE WRITING

10.1.1. New. PURPOSE

To describe the requirements for writing and reviewing environment, health and safety procedures, standard operating procedures (SOP) and EHS work instructions.

10.1.2. New. SCOPE

This procedure applies to:

• EHS procedures contained in the EHS manual; and

• local EHS procedures, SOP and EHS work instructions developed for use in Faculties (Budget Divisions) and Departments.

This procedure does not apply to EHS policies.

10.1.3. New. DEFINITIONS

Definition (Section):

Defines any terms applying to the document that have a technical or special meaning

EHS Document Control:

Method of regulating EHS procedures and documents to ensure that current and redundant versions are readily identifiable

EHS Document Control (Section):

The University EHS Procedure template includes the following minimum document control requirements:

• Date

• Version number

• Authorised by

• Next review date

• Note for electronic versions only: Uncontrolled when printed

EHS Work Instructions:

Established written instructions for safely completing a work, research or teaching activity whilst minimising environmental impact

Minor Amendments:

Alterations to a procedure that do not substantially affect the operation of the procedure. Examples include:

• departmental or name changes;

• reference changes, such as legislation or Standards; and

• correction of typographical errors.

OHSC:

Occupational Health and Safety Committee

Procedure (Section):

Describes the responsibilities and actions required in order to fulfill the requirements of an EHS procedure

Responsibilities:

Identifies the staff member position(s) responsible for the implementation of one or more elements of the procedure

RMC:

Risk Management Committee

SOP:

Standard Operating Procedure

Urgent Amendments:

Substantial changes to a procedure that are required to ensure legislative compliance or certification and where it is not reasonably practicable for the OHSC or the RMC to review the procedure prior to implementation

10.1.4. New. PROCEDURE

10.1.4.1. New. Procedure Development and Review

The General Manager EHS shall develop and review EHS procedures in accordance with the requirements of Safety MAP and ISO14001.

The General Manager EHS shall develop EHS procedures that are consistent with the University EHS procedure template.

The University EHS procedure template shall include the following sections:

• Procedure title

• Purpose

• Scope

• Definitions

• Procedure

• Responsibilities

• References

• Document Control

University EHS Procedure Template

The General Manager EHS shall develop and/or review EHS procedures:

• upon request by OHSC or RMC;

• at scheduled review dates for each procedure (maximum three yearly intervals);

• upon changes to relevant Standards;

• upon relevant legislative changes;

• upon significant changes to organisational structure(s);

• upon significant operational changes;

• as a result of an EHS management system review; and

• as a result of corrective actions or improvements.

10.1.4.2. New. Consultation Process and Endorsement

The General Manager EHS shall provide a draft version of new or altered procedures to EHS management representatives, HSRs and OHSC members for consultation for a period of at least 14 days.

The General Manager EHS shall take into account feedback provided by those consulted.

Following the consultation and feedback process the General Manager EHS shall submit draft procedures to OHSC for formal review.

Following formal review by the OHSC the General Manager EHS shall submit draft procedures to RMC for endorsement by the University.

The General Manager EHS shall publish new or altered procedures on the EHS website only after review by the OHSC and endorsement by RMC.

10.1.4.3. New. Minor Amendments to EHS Procedures

The General Manager EHS may make minor procedural amendments.

Following any minor procedural amendments the General Manager EHS shall report the details of the minor procedural change at the next scheduled:

• OHSC meeting; and

• RMC meeting.

10.1.4.4. New. Urgent Amendments to EHS Procedures

The General Manager EHS in consultation with the Chairs of the OHSC and the RMC may make urgent procedural amendments.

Following any urgent procedural amendments the General Manager EHS shall immediately initiate a formal review of the new or revised procedure in accordance with section 10-1.4.2. Consultation Process and Endorsement.

This section is not applicable to:

• agreed health and safety consultation procedures; or

• agreed health and safety issue resolution procedures.

10.1.4.5. New. Faculty (Budget Division) EHS procedures

The Dean (Vice Principal) or delegate may develop Faculty (Budget Division) specific EHS procedures in consultation with Faculty (Budget Division) EHS Committee and shall ensure that Faculty (Budget Division) EHS procedures are:

• consistent with University EHS procedures;

• consistent with the University EHS procedure template, including document control; and

• reviewed in accordance with the scheduled review date (maximum three yearly intervals).

University EHS Procedure Template

10.1.4.6. New. SOPs and EHS Work Instructions

Local supervisors, in consultation with staff/students, may develop SOPs or EHS work instructions for specific tasks or operations.

The local supervisor may use the University SOP template for SOPs or EHS work instructions.

University SOP Template

10.1.5. New. RESPONSIBILITIES

• GM EHS

• Dean (Vice Principal) or Delegate

• Supervisors

• Chair OHSC

• Chair RMC

10.1.6. New. REFERENCES

Occupational Health and Safety Act 2004 (Vic)

SafetyMAP - Version 4

ISO 14001:2004 Environmental management systems - Requirements with guidance for use

10.1.7. New. DOCUMENT CONTROL

 Table 19: Document Control: 10.1.New. EHS Procedure Writing

Date: 21 November 2006  Version: 1  Authorised by: OHSC on 31 October 2006 and RMC on 21 November 2006  Next Review: 21 November 2009  © The University of Melbourne - Uncontrolled when printed

10.2. New. Not in Use

10.3. New. DOCUMENT AND DATA CONTROL

10.3.1. New. Purpose

To guide the management of system procedures and associated documents required for the Environment Health and Safety (EHS) Manual.

10.3.2. New. Application

Document control includes publication, review, security and version-control, and is the management of procedures and associated documentation that require formal authorization and/or version control. The aim of document control is to ensure that staff who need to use these documents have access to up-to-date versions, and to guard against inadvertent use of obsolete documents.

10.3.3. New. Legislation

Not applicable.

10.3.4. New. References

ISO 14001 Environmental Management System Standard

SafetyMAP 4th Edition

University Records Management Manual

10.3.5. New. Responsibilities

10.3.5.1. New. Occupational Health & Safety Committee and Risk Management Committee

Has responsibility for approving or amending procedures brought to the committee.

10.3.5.2. New. General Manager, Environment Health and Safety

The General Manager, Environment Health and Safety, is responsible for drafting proposed changes to the EHSM in line with current legislation and practices. Following appropriate authorisation from the responsible committee the General Manager EHS is required to retain records of the changes.

The General Manager EHS has responsibility for issuing electronic circulars alerting the University community of revisions to the EHS manual, following notification by responsible officer.

10.3.6. New. Procedure and Guidelines

10.3.6.1. New. Review of Procedures

see Section 10.1.New. EHS Procedure Writing for the requirements of the review of procedures.

10.3.6.2. New. Issue of Documents

All procedures within the EHS manual are published on the Web in SGML format, this format specifies the layout. Only the General Manager EHS will be able to make changes to the controlled documents on this system, and records of authorization of all changes to documents will be kept by the GM EHS.

10.3.6.3. New. Availability of Documents

Documentation will be available to every staff member who needs to use them via the Web, hard copies will be made available on request to staff who do not have access to a computer. A list of the recipients of hard copies will be kept by the General Manager EHS. Hard copies will be made by printing the PDF version of the manual which is published online. Every second month the responsible officer will check with the recipients of hard copies to see if they still want to receive updates.

10.3.6.4. New. Security of Documents

All current and retained documents will be secured against unauthorised tampering and accidental loss. The University conducts a nightly data backup of all information on computer file servers.

10.3.6.5. New. Retention of Documents

All obsolete procedures and associated documents are to be retained according to the appropriate disposal schedule.

Obsolete procedures within the EHS manual shall be archived in http://www.unimelb.edu.au/ehsm/archive.

This archive will be kept permanently.

10.3.6.6. New. Receipt and Control of External Documents

All authorised externally-sourced documents (e.g. licences, permits, agreements, contracts) received by the University of Melbourne will be directed to the appropriate section.

10.3.7. New. Document Control

 Table 20: Document control: 10.3.New. Document and Data Control

Established: 18 August 1993. Reviewed 15 September 2008.  Authorised: Administrative Committee  Next Review: 15 September 2011  © The University of Melbourne - uncontrolled when printed.

Created: January 2000
Last Modified: 24 September 2008
Authorised by: General Manager, Environment Health and Safety Unit.