Section Adm 703.04 - Contents of the Risk Management Health and Safety Summary FormThe risk management health and safety summary form, upon its completion by the agency, shall disclose the following information:
(a) The name of the agency;(b) The years to which the summary applies;(c) The name and job title of the person responsible for filling out the form;(d) The name and job title of the agency risk management coordinator, if any;(e) The name and job title of the members of the joint loss management committee, indicating the chairperson and which members represent employees and which members represent the agency;(f) The name and job title of the person(s) responsible for health and safety training for employees, if any;(g) The name and job title of a person knowledgeable about site-specific health and safety, if any;(h) The agency's written health and safety program introductory policy statement called for by Adm 704.01(a)(1);(i) A description of the agency's plan to complete, at least annually, health and safety inspections for hazard identification;(j) A description of the agency's written plan for:(4) Accident reporting and investigation; and(k) A description of any significant health and safety hazards that the agency has identified and the specific written health and safety plans for those hazards.N.H. Admin. Code § Adm 703.04