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Home My WebLink AboutApplication APPLICANT 12/20/2021City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 SPRINGFIELD walk Drinking Water Protection Overlay District Development Required Project Information (Applicant: complete this section) A licant Name:ZackFalk Phone541-914-7801 Company: One Life Development Fax: Address:210 St Paul Street Unit 410 Denver, CO 80206 Applicant's Re.:PatrickBickler,AIA Phone 503-588-7046 Company: Architect- Patrick Bickler LLC Fax: Address: 1313 Mill Street Suite 201 Salem, OR 97301 Property Owner: Phone541-914-7801 Company: One Life Development Fax: Address: 210 St Paul Street Unit 410 Denver, CO 80206 ASSESSOR'S MAP NO: 17-03-15-40 TAX LOT2300-2500 Property Address: 3535 Game Farm Rd Size of Property: 2.77 net acres Acres ® Square Feet ❑ Zoning: High Density Residential (HDR) Existing Use: See'Site Information' attached Description of If you are filling in this form by hand, please attach your proposal description to this application. Proposal: See'Site Information' attached Si natures: Please si n and rint our name and date in the a ro riate box on the next a e. Associated Cases: Case No.: Date: Reviewed by: Application Fee: Technical Fee: $ 1 Postage Fee: 0 TOTAL FEES: PROJECT NUMBER: Revised 1/15/09 ddk 1 of 5 Signatures The undersigned a owledges that the information in this application is correct and accurate. Date: 12.20.2' Signature Zack Falk Print If the applicant is not the owner, the owner hereby grants permission for the applicant to act in his/her behalf. Owner: Same as above Date: Signature Print Revised 1/15/09 ddk 2 of 5 Drinking Water Protection Application Process 1. Applicant Submits a Drinking Water Protection Application to the Development & Public Works Department The application must conform to the Drinking Water Protection Submittal Requirements Checklist on pages 4-5 of this application packet. Planning Division staff screen the submittal at the front counter to determine whether all required items listed in the Drinking Water Protection Submittal Requirements Checklist have been submitted. Applications missing required items will not be accepted for submittal 2. City Staff Conduct Detailed Completeness Check Planning Division staff conducts a detailed completeness check within 30 days of submittal. • The assigned Planner notifies the applicant in writing regarding the completeness of the application. An application is not be deemed technically complete until all information necessary to evaluate the proposed development, its impacts, and its compliance with the provisions of the Springfield Development Code and other applicable codes and statutes have been provided. • Incomplete applications, as well as insufficient or unclear data, will delay the application review process and may result in denial. 3. City Staff Review the Application and Issue a Decision This is a Type I decision and thus is made without public notice and without a public hearing since there are clear and objective approval criteria and/or development standards that do not require the use of discretion. • Decisions address all the applicable approval criteria and/or development standards. • Applications may be approved, approved with conditions, or denied. • The City mails the applicant and any party of standing a copy of the decision, which is effective on the day it is mailed. • The decision issued is the final decision of the City but may be appealed within 15 calendar days to the Hearings Official. Revised 1/15/09 ddk 3 of 5 DWP Overlay District Development Submittal Requirements Checklist NOTE: If you feel an item does not apply, please state the reason why and attach the explanation to this form. Submitted Concurrently with Site Plan Review or Minimum Development Standards applications, where applicable. ❑ Application Fee - refer to the Development Code Fee Schedule for the appropriate fee calculation formula. A copy of the fee schedule is available at the Development & Public Works Department. The applicable application, technology, and postage fees are collected at the time of complete application submittal. DWP Overlay District Development Application Form Copy of the Deed d Copy of a Preliminary Title Report issued within the past 30 days documenting �f ownership and listing all encumbrances. vL� Narrative explaining the proposal and any additional information that may have a bearing in determining the action to be taken, including findings demonstrating compliance with the Standards for Hazardous Materials within Time of Travel Zones (TOTZ) listed in SDC 3.3-235. NOTE: Before the Director can approve a DWP Overlay District Development request, information submitted by the applicant must adequately support the request. All of the Standards for Hazardous Materials within TOTZ must be addressed. Incomplete applications, as well as insufficient or unclear data, will delay the application review process and may result in denial. In certain circumstances, it is advisable to hire a professional planner or land use attorney to prepare the required findings. Three (3) Copies of a Plot Plan reduced to 8'/z" by 11" outlining the applicable TOTZ boundaries in relationship to the property boundaries Three (3) Copies of the Following: ® Use of hazardous materials that pose a risk to groundwater that existed on the property prior to May 15, 2000, if applicable ® Hazardous Material Inventory Statement and Material Safety Data Sheet for all materials entered on the Statement. Hazardous material weights shall be converted to volume measurement for purposes of determining amounts (i.e. 10 pounds shall be considered equal to one gallon) ® List of chemicals to be monitored through the analysis of groundwater samples and a monitoring schedule if groundwater monitoring is anticipated to be required ® Detailed description of the activities conducted at the facility that involve the storage, handling, treatment, use, or production of hazardous materials in aggregate quantities greater than 500 gallons ® Description of the primary and any secondary containment devices proposed, and, if applicable, clearly identified as to whether the devices will drain to the sanitary sewer or stormwater system Revised 1/15/09 ddk 4 of 5 ® Proposed Hazardous Material Management Plan for the facility that indicates procedures to be followed to prevent, control, collect, and dispose of any unauthorized release of a hazardous material ® Description of the procedures for inspection and maintenance of containment devices and emergency equipment ® Description of the plan for disposition of unused hazardous materials or hazardous material waste products over the maximum allowable amounts, including the type of transportation and proposed routes Revised 1/15/09 ddk 5 of 5 ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Site Information: The subject site consists of three adjoining parcels that comprise approximately 2.77 acres. The proposed development area is located at the southeast corner of the intersection of Game Farm Road and Deadmond Ferry Road in the Gateway neighborhood of northwest Springfield. The property contains two single detached dwellings and a stand of mature fir trees (Assessor's Map 17-03-15-40, Tax Lots 2300-2500). The subject site is within the adopted Gateway Refinement Plan area; therefore, the applicable Comprehensive Plan is the adopted Gateway Refinement Plan diagram. The applicant previously amended the Metro Plan diagram, Gateway Refinement Plan diagram and Springfield Zoning Map to redesignate and rezone the subject site from Low Density Residential (LDR) to High Density Residential (HDR) pursuant to Planning Cases 811-18-000234-TYP4 & 811-18-000235-TYP3. Other properties in the vicinity of the subject site are zoned LDR Medium Density Residential (MDR), Mixed U se Commercial (MUC) and Campus Industrial (CI). The applicant is proposing to construct a three-story assisted living facility with 103 units. The facility is classified as a multi -unit residential dwelling under the provisions of the City's Development Code. Overall, the project achieves a dwelling unit density of 37 units per net acre. The Esther at Riverbend Assisted Living site is within the mapped 1-5 year Time of Travel Zone (TOTZ) for the Sports Way drinking water wellhead and, therefore, is subject to the provisions of the Drinking Water Protection Overlay District, SDC 3.3-200. This means that chemicals that spill or leak onto the ground surface have the potential to contaminate the well in 1-5 years' time. The Esther at Riverbend Assisted Living is a committed partner in the effort to protect Springfield's drinking water supply. Our hazardous materials management program emphasizes the importance of preventing chemicals leaks and spills and responding promptly and effectively should a release occur. We strive to increases awareness that the property lies within a sensitive drinking water protection area among both our employees and the public who visit our business. This hazardous materials management plan outlines The Esther at Riverbend Assisted Living's protocol for preventing, controlling, collecting, and disposing of any unauthorized releases of hazardous materials. The plan also identifies the greatest areas of risk within our facility and outlines the steps we take to reduce the risk. Any questions about this plan or how The Esther at Riverbend Assisted Living manages its hazardous materials should be directed to Terry Rose, The Esther at Riverbend Assisted Living Environmental Health & Safety Manager, Terry Rose at 503-484-8879. ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN HAZARDOUS MATERIALS MANAGEMENT PLAN (TO BE UPDATED ANNUALLY) The Esther at Riverbend Assisted Living site is within the mapped 1-5 year Time of Travel Zone (TOTZ) for the Sports Way drinking water wellhead and, therefore, is subject to the provisions of the Drinking Water Protection Overlay District, SDC 3.3-200. This means that chemicals that spill or leak onto the ground surface have the potential to contaminate the well in 1-5 years' time. The Esther at Riverbend Assisted Living is a committed partner in the effort to protect Springfield's drinking water supply. Our hazardous materials management program emphasizes the importance of preventing chemicals leaks and spills and responding promptly and effectively should a release occur. We strive to increases awareness that the property lies within a sensitive drinking water protection area among both our employees and the public who visit our business. This hazardous materials management plan outlines The Esther at Riverbend Assisted Living's protocol for preventing, controlling, collecting, and disposing of any unauthorized releases of hazardous materials. The plan also identifies the greatest areas of risk within our facility and outlines the steps we take to reduce the risk. Any questions about this plan or how The Esther at Riverbend Assisted Living manages its hazardous materials should be directed to Terry Rose, The Esther at Riverbend Assisted Living Environmental Health & Safety Manager, Terry Rose at 503-484-8879. ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section I: Facility Description Part A—General Information 1. Business Name: The Esther at Riverbend Assisted Living Phone: 503-484-8879 Address: 3535 Game Farm Rd Home Phone Springfield, OR 97477 2. Person Responsible for the Business Name Title Phone Zack Falk Chief Executive Officer 541-914-7801 TerryRose Chief Operating Officer 503-484-8879 3. Emergency Contacts: Name Title Home Phone Work Phone Natalie Nelson Regional Director of Operations 503-560-0536 503-560-0536 TerryRose Chief Operating Officer 503-484-8879 503-484-8879 Edward Zimmerman Proiect Manager ZF Construction 509-675-2973 509-675-2973 4. Person Responsible for the HMMP Name Title Phone Terry Rose Chief Operating Officer 503-484-8879 5. Property Owner: Name Address Phone One Life Development 210 St. Paul Street, Unit 410 541-914-7801 Denver CO 80206 6. Principle Business Activity: Assisted Living Facility 7. Number of Employees (maximum number expected): 75 8. Number of Shifts: 3 9. Hours of Operation: 24hrs/day, 7days/week, 365days/year 10. Declaration: I certify that the information above and on the following parts is true and correct to the best of my knowledge. Signature: % A"a Date: 12/8/2021 Print Name: Terry Rose Title: coo f 1k ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Part B -- General Facility Description/Site Plan GENQULNOTES: DEVELOPMENT INFORMATION: O E R D M O N O_l E P II XDAD 0 LEGEND_ ID_YNOTES_ 1ie y.....�. onmvnvvm. � mm.�m�mmm f 1k ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Part C -- Facility Map/Hazardous Material Storage Locations (1� Floor) ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Part C -- Facility Map/Hazardous Material Storage Locations (2-d Floor) vi ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Part C -- Facility Map/Hazardous Material Storage Locations (3'd Floor) vi ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section II: Hazardous Materials Inventory •N smnn[ almsaq -W M�rdero1Rmx1 • eau eeoecemmuYeceesul mm,i • ssieva ssiev a gt wm • n m Yvmv ¢ea/.am. m¢Igsvl �n a gwe p pin anu OSW smi.nMwdni¢Nxl ea.0 gogs:-p g .. g ..m xg. xwd xa eaeu sm•mxµaaalvfsl .-1 g .4 g nm x -g4 casae nm pfvmv- mm l ea.0 d�i•u"wsea•.ddlm-mxl a ng xxsbg ...am g . xg< xwe omA,0a i•am, •mai.nMbl unpecelgosoul ea.0 q® n -s%1 " pmygga g.+a g.+xm xgt xwe I— Am gxmms•res rc.m•iu/-.w�vrewcanreaelb. gal mreRgaq w�gMeMM[o oemaeunmmmeeaavxSW umsgs eaeu mxMaag,vecexsal u.x.g 54ex xw caws x•eyM0rt /eam, evmomnemanmcexsxl eavng—.1.iwege ,i - me mNero1xsal my ea•u xwNemMygennnummimdsMxNl[u m% 7— u4es ' 54ex xg� cawe xey • res/eam, aaq[mgaglgmW n gm m�+mcelg-s%1 ¢local mevm ea• u i.n ^Igsal pe¢xsnl "xw 1 v. cnm v a a mid x N p v� gum gm m ns gnmpmeeed.l�MmneMxdmWv-,�mvamvex na•e,me�lmidxdl eaeu vm m•JvmmlgSW M^v amv.i aim au mid Mp gxmmsmnF baNuenargmmcelagul w�NmvgSedeNiMAaipie.lgm-mne.Mmn-. e en eNvs>oei.nssinrymW eaeu moo RmW giuv.i sim aw sale x•eyM0gxmmsmnF bae+lgsxl �" '� paymmeµ-sxl •a,enemMmw�•vrevaugm �arelmmxl eaeu um N:aq v uiuva mm x•M0p,mmimnF o AdmWm �gMl[w[gfsxiul d�are,MmMim�M eaeu local iim au mm xpN gxmmsmnF ayNpa�usatagsxo,i .cal x•�"g a eureuniwnNemrm•mmio�imlmsdxl uvg �Mbmeelso[mim eau • • m N -a • fm v xgt mm x N p �•m@ m�rv�emlm-soul eceRw% Immo me eaeu wemem•msnimmimeiMmcel�:l sgsnxa 4im.2 aim xgt mid Mp a Vj ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section II: Hazardous Materials Inventory "®""h a:mm.m.meha«. 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Yq.e mwws Vj ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section II: Hazardous Materials Inventory Statement Jpsk e a� i uowe4etlanmaveb r«k¢,s aOooOeMvamwtlsmry akena 0 . d- -A.. p n1k1 .-s5w% baamwalelso% .k tsmts zm a os u�sn —de okk% x.emmwaw,naele(s x�mxx®eedetltltliluNmNNg mrdnn«ceaaeQ waxc®-mrex ade(5o7m I.oi0+%) sem -ks ocen :I«5 / Fan.awnx:Maa .1l1--. ad resnwnsb Yvvr::mkseeZN� bb iomrwttM. cs nsba%p % szak rl«s «/aniw mmpdNmyslrlsdamsN euaxdnpno.arl easasa.� am marl seas -5 2--"--- p itl is-wp - mlps atlab tlkNamitlewegd.hi0-sp oppys spromLno ;oromL xs+ bgntl ops cepan a®.cegnsm¢dipare:¢aeM mN ®v<mian 0-s%1 xmeuNgo swag uMpdvgycas nls-s%1 ncelasap mpim vmpMis mlpz a .axwmmrxNmmumnsmaaqul>•s-ap any°° uaz-e —.a sva xs-a b ma 0 ce/- s345-4 mlps xWweala awwMmetlrrd m¢glN eNellas-zp mm es -a aeaxd ops reo nce/un ells -s%1 ovpysseaeuz mNNgo wNs anes.InpinsmWnplsw%1 74w19 a1. re 31. es -a wwe ops rqt Jsw nce/uaw .alleumxs mra e 4aswp sWi meamnarelsse%1 lail 51 .mbW.m aelofox1A 03%1 sse ik. s eGnebsimal i d.bO"pbs%1 otewvze ncenz zsm eu wwe oce� l dalntsancepsivr sss80E60 �detlNryb spnp mm zalkN tle SMmm eefaseuz umdcemnia. o®.xa ON E LI FE HAZARDOUS MATERIALS MANAGEMENT PLAN Section III: Separation, Secondary Containment, and Monitoring Part A—Above Ground Storage Areas Storage Area Identification (as shown on Site plan and Floor Plan): Laundry. Maintenance / Janitor Closets 1. Storage Type: X_Original Containers Inside Machinery SS -Gallon Drums Pressurized Vessel 2. Storage Location: X_ Inside Building 3. Separation: All Materials Compatible Separated by 20 feet 4. Secondary Containment*: Safety Cans Bulk Tank Outside Barrels Other: Outside Building Secured One -Hour Separation Wall X Approved Cabinets Other: X Approved Cabinet Secondary Drums X Tray _ Bermed, Coated Floor Vaulted Tank Double -Wall Tank _ Other: _ Secondary containment will be achieved by use of approved cabinets or trays in each laundry, and Janitor closet on each floor. Monitoring: X Visual 6. Monitoring Frequency: X Dafly(VISUAL) X Other: MONTHLYAUDITS Continuous X Other: MONTHLY AUDITS [SEE FORMI Weekly *All hazardous materials and wastes, regardless of container size, must be kept in secondary containment. **All hazardous materials shall be properly labeled. ON E LI FE HAZARDOUS MATERIALS MANAGEMENT PLAN Section III: Separation, Secondary Containment, and Monitoring Part A—Above Ground Storage Areas Storage Area Identification (as shown on Site plan and Floor Plan): Commercial Kitchen Storage 1. Storage Type: X_Original Containers Inside Machinery SS -Gallon Drums Pressurized Vessel 2. Storage Location: X Inside Building 3. Separation: All Materials Compatible Separated by 20 feet S. Secondary Containment* Safety Cans Bulk Tank Outside Barrels Other: Outside Building Secured One -Hour Separation Wall X_ Approved Cabinets Other: X Approved Cabinet Secondary Drums X_ Tray _ Bermed, Coated Floor Vaulted Tank Double -Wall Tank _ Other: _ Secondary containment will be achieved by use of approved cabinets or trays in the kitchen storage area. 6. Monitoring: X Visual 7. Monitoring Frequency: X Daffy(VISUAL) X Other: MONTHLYAUDITS Continuous X Other: MONTHLY AUDITS (SEE FORM) Weekly *All hazardous materials and wastes, regardless of container size, must be kept in secondary containment. **All hazardous materials shall be properly labeled. WAR ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section IV: Waste Disposal X Discharge to Sanitary Sewer Pretreatment Wastes: Waste Water X Licensed Waste Hauler Wastes: SANIPAC }{ Other Wastes: X Recycle Wastes: SANIPAC Describe Method: VARIOUS MEDICATIONS DISPOSED VIA CONTRACTED PHARMACY (CONSONUS PHARMACY) OR THROUGH FDA -APPROVED LIOU ID PHARMACEUTICAL WASTE DISPOSAL METHODS (see policy attached) Wastes: VARIOUS DISCONTINUED OR EXPIRED MEDICATIONS No Waste ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section V: Record Keeping (Inspection and Maintenance) Description of our Inspection Program: • Storage area inspections will be conducted monthly. • Inspections to be performed by Maintenance Director. • Executive Director will sign off on completed inspections. • Inspection forms to be kept on file for 3 years. • In the event that a problem is identified: o Executive Director will be informed immediately. o Executive Director will inform Corporate immediately. o Means of resolution will be identified and implemented. • Sample inspection form attached. Section VI: Spill Prevention • All staff will be trained on spill prevention plan • Store containers at eye -level or below • Segregate incompatible materials • Maintain all containers in good condition • Conduct regular employee training • Regular inspections conducted by Maintenance Director in higher -risk areas (outdoor equipment, hazardous chemical storage areas, trash enclosures, etc.) 0 14 Vvi ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section VII: Emergency Response Plan 1. In the event of an emergency, the following shall be notified: A. On -Site Responders: Name Title Home Phone Work Phone Terry Rose 9r Chief Operating Officer 503-484-8879 503-484-8879 Natalie Nelson Regional Director of Operations 503-560-0536 503-560-0536 Edward Zimmerman Project Manager ZF Construction 509-675-2973 509-675-2973 B. Method of Notification to Responders Automatic Alarm X Telephone Manual Alarm Verbal X Other: TEXT MESSAGE C. A enc Phone Number Fire Departmen 911* Oregon Emergency Response System 1-800-452-0311 Services THD OtherM& Dial 91 me event of an emergency or hazardous material * The standard procedure for notification of a hazardous material release in Springfield is to call 911. The first responder will dispatch information to Springfield Utility Board, which must be notified as soon as possible if a chemical release has the potential to contaminate municipal wells. 2. Designated Local Emergency Medical Facility: Name Address Phone Peacetlealth 3333 Riverbend Drive 541-222-7300 Medical Center Springfield, OR 97477 0 14 Vvi ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN 3. Mitigation Equipment: A Monitoring Devices: Toxic or flammable gas detection Fluid detection Other: Spill Containment X Absorbents Other: A. Spill Control and Treatment: Vapor Scrubber Mechanical Ventilation Pumps/Vacuums Secondary Containment Neutralizer Other: S. Evacuation: X Immediate area evacuation routes posted Entire building evacuation procedures developed Assembly areas pre -planned X Evacuation maps posted Other: 6. Supplemental Hazardous Materials Emergency Response Plan on Site: Location: LOCATED IN MAINTENANCE DIRECTOR'S OFFICE AND RECEPTION DESK Responsible Person: COO OR DESIGNEE Phone: (Description offacility's spill response procedures and protocol enclosed.) ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Spill Response & Clean Up Plan Spill Response & Containment Plan • Assess the area for safety. If it is unsafe to access the spill area or for fires and other dangerous situations call 911. Evacuate the area and cordon off the site to prevent others from entering the spill zone. • Contain the spilled material. o Stop the source of the spill. o Contain all spilled material with items in your spill kit (absorbent pads, socks, and kitty litter). Spill kits are found at the following locations (as noted in the site map): o Locations include, Janitors closet, kitchen, soiled linen • Soak up spilled materials and collect used spill kit items for proper disposal. • If necessary, call for help. If the spill is too large to contain yourself call 911. If spills have entered any drains to the storm or sanitary sewer system, call City of Springfield Operations at (541)726-3761 and the Environmental Services Division at (541)726-3694 for assistance. Emergency Contact Numbers To be called when the spill area is unsafe to access and/or employees are unable to contain the spill onsite • Emergency Services (Police, Fire Department, Ambulance services): 911 • Poison Control Center: (800) 222-1222 • Oregon Emergency Response System: (800) 452-0311 • National Response Center: (800) 424-8802 Spill Product Disposal After clean-up and containment • Dispose of soaked materials in spill clean-up barrels. • Consult with Lane County Hazmat (541-682-4120) to determine proper disposal of cleanup materials. • Restock spill kits. • Review why the spill occurred and make necessary changes to avoid future spills. ONELIFE Spill Clean -Up Plan HAZARDOUS MATERIALS MANAGEMENT PLAN All Team Members need to be aware of the hazardous materials in their work area and be familiar with the health hazards, required protective equipment, and procedures for the safe handling of those hazardous materials. If a hazardous material is spilled, Team Members with the training, knowledge, and experience to clean up the material need to follow these steps: 1. When you encounter a spill [Figure 1], cordon off the area immediately to prevent others from coming into contact with the spill [Figure 2], and look for additional hazards such as chemical reactions, corroding shelves, etc. Ask anyone not involved in cleaning up the hazardous material to evacuate the area and not return until the area is reported as safe. It is important that a Team Member always remain at the site to direct others away from the spill. 2. Alert a supervisor that a spill has occurred [Figure 3]. 3. Respond to medical emergencies. 4. With the assistance of a supervisor, determine whether emergency personnel are needed for clean-up; if not, determine what Personal Protective Equipment [PPE] you need to wear when cleaning up the spill by reading the label [Figure 4] or checking the MSDS. The PPE includes the following: • Rubbergloves • Disposable gown • Rubber shoe covers • Goggles • Respirator Note: PPE for biohazard clean-up is located at the remption desk, Soiled Linen rooms, and all Janitor closets; includes gloves, a facemask, an apron, and bags labeled as a biohazard. S. After putting on your PPE, start cleaning up the spill [Figure 4] • Put an absorbent sock around the spill so it doesn't spread any farther. • Use a soaker pad to soak up the spill. 6. After the spill is soaked up, dispose of the clean-up materials Ir sealing everything used (i.e. product container, PPE, absorbent sock soaker pads, etc.) in a spill clean-up bag [Figure S]. With a blackmarker, label the bag with the product name, and the names of any hazardous materials that the product contains [Figure 6]. 7. Take the sealed spill clean-up bag to the yellow Hazardous Material cabinets. E. Fill out an Incident Report. Submit it to your supervisor for review. Figure 4 Figure 5 Figure 6 ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section XIII: Emergency -Response Training Plan 1. Person Responsible for the Emergency -Response Training Plan: Name Title Phone Terry Rose Chief Operating Officer 503-484-8879 Natalie Nelson Regional Director of Operations 503-560-0536 TBD Maintenance Director TBD Training Requirements: A. All employees trained in the following as indicated: X Procedures for internal alarm/notification X Procedures for notification of external emergency -response organizations X Location and content of the emergency -response plan X Awareness of the facility's proximity to sensitive drinking water protection area Drinking water protection presentation (contact SUB Water Quality Protection Coordinator, Amy Chinitz, at 541-744-3745) B. Chemical handlers are trained in the following as indicated: X Safe methods for handling and storage of hazardous materials X Proper use of personal protective equipment X Locations and proper use of fire -and spill -control equipment X Specific hazards of each chemical to which they may be exposed C. Emergency -response team members are trained in the following: X Procedures for shutdown of operations X Procedures for using, maintaining and replacing facility emergency and monitoring equipment 3. The Following Records are Maintained for All Employees: X Verification that training was completed by the employee X Description of the type and amount of introductory and continuing training X Documentation on and description of emergency -response drills conducted at the facility 4. Amore comprehensive and detailed emergency -response training plan is maintained on site. Location: Emereencv response trainine elan to be kept in Maintenance Director's office Responsible Person: Maintenance Director Phone: ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN Section IX: Process for Updating HMMP 1. Person Responsible for updating the Emergency -Response Training Plan: TBD Maintenance Director TBD 2. Emergency -Response Training Plan to be reviewed and updated with any necessary changes annually. Section X: Notes ON E LI FE HAZARDOUS MATERIALS MANAGEMENT PLAN HAZARDOUS MATERIAL STORAGE MONTHLY INSPECTION FORM Completed inspection sheets are to he maintained in the inspection 1Qq for at least three ears Storage Area Date & Time Inspector Name Reviewedby bistruc dons: *Note, some items may not be present in storage area. If not applicable, note in the comments section. INSPECTION TOPIC OK COMMENTS PROBLEMS DETECTED RESOLUTION (Include dates and times corrective actions taken) Area is free of leaks and/or spills Secondary containment devices dpresent) intact and secured Original containers not leaking, rusted bWginF or damaged Hazardous material containers are properly labeled Containers closed and sealed Spill kit accessible with signage andinstructions Incompatible materials are stored separately Floor free of cracks and other damage NOTES: ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN PRODUCT REVIEW LOG All prospective new chemical products must be reviewed prior to purchase to determine whether they contain DNAPL chemicals. Use this log to ensure that no DNAPL-containing products are reintroduced into the inventory. Manufacturer Product Name DNAPL? DNAPL chemical component(s)/ Date Suspected DNAPL reviewed ONELIFE HAZARDOUS MATERIALS MANAGEMENT PLAN 0 ON ELI FE witness the destruction of medication. b) At no time will a corporate representative, auditing nurse or pharmacist remove or destroy controlled substances without the Director of Health Services or Executive Director present. All usual protocols for destruction will be followed. 2. The Director of Health Services or Med Tech will document destruction of the medication on the Medication Disposition Record. The destruction is documented by completing all items listed the form, including the amount of medication destroyed and a signature from both witnesses. 3. Staff members will be trained to identify drug diversion and will report suspected drug diversion to the Executive Director for proper investigation. a) Any drug diversion will be reported to the state licensing agency, law enforcement, and any other agencies as required. CLINICAL POLICY & PROCEDURE MANUAL—OREGON