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INDIANOLA COMMUNITY SCHOOLS EXPOSURE CONTROL PLAN The Model Exposure Control Plan is provided by the Occupational Safety and Health Administration, U.S. Department of Labor, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, Directive Number CPL2‐2.44D. Appendix D. November 5, 1999. April2016 The Indianola Community School District is committed to providing a safe and healthy work environment for our entire staff. In pursuit of this endeavor, the following Exposure Control Plan (ECP) is provided to eliminate or minimize occupational exposure to bloodborne pathogens in accordance with OSHA standard 29 CFR 1910.1030, "Occupational Exposure to Bloodborne Pathogens." The ECP is a key document to assist our district in implementing and ensuring compliance with the standard, thereby protecting our employees. This ECP includes: Definitions Program Administration Determination of employee exposure Communication of hazards to employees and training Implementation of various methods of exposure control, including: o Universal precautions o Engineering and work practice controls o Personal protective equipment o Custodial Hepatitis B vaccination Procedures for evaluating circumstances surrounding an exposure incident Post-exposure evaluation and follow-up Recordkeeping Latex Reaction Information The methods of implementation of these elements of the standard are discussed in the subsequent pages of this ECP. DEFINITIONS Body Fluids and/or Materials Containing Body Fluids: Blood, sputum, vomitus, urine, fecal material, semen, vaginal secretions, facial tissues, gauze, sanitary napkins, diapers, temp-a-dot's or thermometer sleeves must all be treated as containing bloodborne pathogens. Occupational exposure is defined as "reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or Other Potentially Infectious Materials (OPIM) that may result from the performance of the employee's duties." Blood is defined as human blood, human blood components, and products made from human blood. Other Potentially Infectious Materials (OPIM) is defined as the following human body fluids: saliva in dental procedures, semen, vaginal secretions, cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids; body fluids visibly contaminated with blood; along with all body fluids in situations where it is difficult or impossible to differentiate between body fluids; unfixed human tissues or organs (other than intact skin); HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture media or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. Regulated Waste refers to the following categories of waste which require special handling at a minimum; (1) liquid or semi-liquid blood or OPIM; (2) items contaminated ICSD/Personnel Revised April 2016 2 with blood or OPIM and which would release these substances in a liquid or semi-liquid state if compressed; (3) items that are caked with dried blood or OPIM and are capable of releasing these materials during handling; (4) contaminated sharps; and (5) pathological and microbiological wastes containing blood or OPIM. Viral Hepatitis/Hepatitis B is a liver infection caused by the Hepatitis B virus (HBV). Hepatitis B is transmitted when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth. For some people, hepatitis B is an acute, or short-term, illness but for others, it can become a long-term, chronic infection. Risk for chronic infection is related to age at infection: approximately 90% of infected infants become chronically infected, compared with 2%–6% of adults. Chronic Hepatitis B can lead to serious health issues, like cirrhosis or liver cancer. The best way to prevent Hepatitis B is by getting vaccinated. (Centers for Disease Control and Prevention. http://www.cdc.gov/hepatitis/HBV/index.htm. Retrieved April 12, 2016.) COPIES OF THE PLAN An electronic copy of the plan will be available to all district employees and others on the district website. PLAN REVIEW AND UPDATE The plan shall be reviewed and updated annually and whenever necessary to reflect new or modified tasks and procedures which effect occupational exposure and to reflect new or revised employee positions with occupational exposure. PROGRAM ADMINISTRATION The Superintendent is responsible for the implementation of the ECP. The Superintendent will maintain, review, and update the ECP at least annually, and whenever necessary to include new or modified tasks and procedures. Questions or concerns can be referred to the Superintendent’s Office at 515-961-9500. Those employees who are determined to have occupational exposure to blood or OPIM must comply with the procedures and work practices outlined in this ECP. The Directors of Facilities, Child Care, Transportation, Food Service, Activities, school nurses and/or health associates, will maintain and provide all necessary personal protective equipment (PPE, like gloves), engineering controls (e.g., proper waste disposal containers), labels, and red bags as required by the standard. Each Director will ensure that adequate supplies of the aforementioned equipment are available in the appropriate sizes. See contact location and phone number below. Each Director will be responsible for ensuring that all medical actions required are performed and that appropriate employee health and OSHA records are maintained. See contact location and phone number below. ICSD/Personnel Revised April 2016 3 Each Director will be responsible for training, documentation of training, and making the written ECP available to employees, OSHA, and NIOSH representatives. See contact location and phone number below. Nurses/Health Associates: High School Middle School Emerson Elementary Irving Elementary Whittier Elementary Wilder Elementary Facilities: Child Care: Transportation: Food Service: Activities: 961-9510 961-9530 961-9550 961-9560 961-9570 961-9540 ext. 2177 ext. 3124 ext. 5131 ext. 6132 ext. 7128 ext. 4102 961-9590 961-9565 961-9592 961-9591 961-9520 *ext. 1601 *ext. 5135 *ext. 1605 *ext. 1608 *ext. 2180 *Extension numbers may be dialed from building to building only. EMPLOYEE EXPOSURE DETERMINATION Following is a list of employee groups which may be at risk for occupational exposure: School nurses & nurse associates Special education teachers & associates Facilities mechanic I Facilities mechanic II Environmental Systems Mechanic Child Care Site Supervisors METHODS OF IMPLEMENTATION AND CONTROL Universal Precautions All employees will utilize universal precautions. Exposure Control Plan Employees covered by the bloodborne pathogens standard receive an explanation of this ECP during their initial training session. It will also be reviewed in their annual refresher training. All employees have an opportunity to review this plan at any time during their work shifts by contacting the Director of their Department. If requested, we will provide an employee with a copy of the ECP free of charge and within 15 days of the request. The Superintendent is responsible for reviewing and updating the ECP annually or more frequently if necessary to reflect any new or modified tasks and procedures that affect occupational exposure and to reflect new or revised employee positions with occupational exposure. Personal Protective Equipment (PPE) PPE is provided to our employees at no cost to them. Training is provided by each department in the use of the appropriate PPE for the tasks or procedures employees will perform. PPE is located in each department and may be obtained through the Program Director. The types of PPE available to employees are as follows: ICSD/Personnel Revised April 2016 4 Gloves Breathing Barriers (CPR) Eye Protection All employees using PPE must observe the following precautions: Wash hands immediately or as soon as feasible after removal of gloves or other PPE. Remove PPE and dispose properly before leaving the work area. Used PPE may be disposed of in appropriate containers for storage, decontamination, or disposal. Wear appropriate gloves when it can be reasonably anticipated that there may be hand contact with blood or OPIM, and when handling or touching contaminated items or surfaces; replace gloves if torn, punctured, contaminated, or if their ability to function as a barrier is compromised. Utility gloves may be decontaminated for reuse if their integrity is not compromised; discard utility gloves if they show signs of cracking, peeling, tearing, puncturing, or deterioration. Never wash or decontaminate disposable gloves for reuse. Wear appropriate face and eye protection when splashes, sprays, spatters, or droplets of blood or OPIM pose a hazard to the eye, nose, or mouth. Remove immediately or as soon as feasible any garment contaminated by blood or OPIM, in such a way as to avoid contact with the outer surface. Custodial Regulated waste is placed in containers which are closable, constructed to contain all contents and prevent leakage, appropriately labeled or color-coded (see Labels), and closed prior to removal to prevent spillage or protrusion of contents during handling. This includes the procedures for handling sharps disposal containers and other regulated waste. Contaminated sharps are discarded immediately or as soon as possible in containers that are closable, puncture-resistant, leak-proof on sides and bottoms, and labeled or color-coded appropriately. Sharps disposal containers are available in each nurse’s office. The school nurse will remove full sharp containers and dispose of them at an approved hazardous waste disposal facility (i.e., Brush Facility, West Iowa Ave. and Kenwood Blvd., Indianola, IA 50125) Bins and pails are cleaned and decontaminated by custodial staff as soon as feasible after visible contamination. Broken glassware, which may be contaminated, is picked up using mechanical means, such as a brush and dust pan. Laundry Handle contaminated laundry as little as possible, with minimal agitation ICSD/Personnel Revised April 2016 5 Place wet contaminated laundry in leak proof, labeled or color-coded container before transport. Wear gloves when handling and/or sorting contaminated laundry. Labels Building custodians will ensure warning labels are affixed or red bags are used as required if regulated waste or contaminated equipment is brought into the facility. Employees are to notify the building custodian if they discover regulated waste containers or other contaminated equipment, etc. without proper labels. HEPATITIS B VACCINATION The Superintendent or designee will provide training to employees on Hepatitis B vaccinations, addressing the safety, benefits, efficacy, methods of administration, and availability. The Hepatitis B vaccination series is available at no cost after training and within 10 days of initial assignment to employees identified in the exposure determination section of this plan. Vaccination is encouraged unless: 1) documentation exists that the employee has previously received the series, 2) antibody testing reveals that the employee is immune, or 3) medical evaluation shows that vaccination is contraindicated. However, if an employee chooses to decline vaccination, the employee must sign a declination form. Employees who decline may request and obtain the vaccination at a later date at no cost. Documentation of refusal of the vaccination is kept at the Central Office in personal files. Vaccination will be provided by Warren County Health Services. Refer to School Board Policies 403.3RI and 403.3EI for Hepatitis B Vaccination Information. PROCEDURES FOR EVALUATING THE CIRCUMSTANCES SURROUNDING AN EXPOSURE INCIDENT Department Directors will review the circumstances of all exposure incidents to determine: Engineering controls in use at the time Work practices followed A description of the device being used Protective equipment or clothing that was used at the time of the exposure incident (gloves, eye shields, etc.) Location of the incident (classroom, gym, playground, etc.) Procedure being performed when the incident occurred Employee’s training If it is determined that revisions need to be made, the Superintendent and/or the Department Director will ensure that appropriate changes are made to this ECP. ICSD/Personnel Revised April 2016 6 EMPLOYEE TRAINING All employees receive training conducted by Heartland and/or Department Director, or other. On-line trainings are available at http://www.aeapdonline.org/. All employees who have occupational exposure to bloodborne pathogens receive training on the epidemiology, symptoms, and transmission of bloodborne pathogen diseases. RECORDKEEPING Training Records Training records are completed for each employee upon completion of training. These documents will be kept for at least three years in the employee’s personal file. The training records consist of the dates of the training sessions. Medical Records Medical records are maintained for each employee with occupational exposure in accordance with 29 CFR 1910.20, "Access to Employee Exposure and Medical Records." The Indianola Community School District Human Resource Office is responsible for maintenance of the required medical records. These confidential records are kept at the Central Office for at least the duration of employment plus 30 years. OSHA Recordkeeping An exposure incident is evaluated to determine if the case meets OSHA's Recordkeeping Requirements (29 CFR 1904). This determination and the recording activities are done by Human Resource Office secretary or designee. HEPATITIS B VACCINE DECLINATION Form Refer to the School Board Policy 403.3RI and 403.3EI (see appendix). POST-EXPOSURE EVALUATION AND FOLLOW-UP Following a report of an exposure incident, the district shall make immediately available to the exposed employee, a confidential medical evaluation as specified in the standard. Follow-up of the incident shall include documentation of the route(s) of exposure, the circumstances surrounding exposure incidents, failures of control at the time of the exposure incident, and other elements as specified in the standard. It is recommended that employees who have an unexpected exposure follow the procedures outlined in the post exposure plan. Post-exposure plan Notify the building administrator ICSD/Personnel Revised April 2016 7 Wash the affected area with soap and water and remove affected clothes with due precautions and avoiding bodily contact. Fill out an incident report ASAP and provide to the building administrator who will comply with follow-up procedures. Employee Accident Report and workman’s compensation forms may need to be completed. Medical evaluation for possible Hepatitis B/HIV testing and/or treatment. ICSD/Personnel Revised April 2016 8 Code No. 403.3E1 Code No. 403.3 COMMUNICABLE DISEASES - EMPLOYEES Employees with a communicable disease will be allowed to perform their customary employment duties provided they are able to perform the essential functions of their position and their presence does not create a substantial risk of illness or transmission to students or employees. The term "communicable disease" means an infectious or contagious disease spread from person to person, or animal to person, or as defined by the law. Prevention and control of communicable diseases is included in the school district's bloodborne pathogens exposure control plan. The procedures will include scope and application, definitions, exposure control, methods of compliance, universal precautions, vaccination, post-exposure evaluation, follow-up, communication of hazards to employees and record keeping. This plan is reviewed annually by the superintendent and school nurse. The health risk to immunodepressed employees is determined by their personal physician. The health risk to others in the school district environment from the presence of an employee with a communicable disease is determined on a case-by-case basis by the employee's personal physician, a physician chosen by the school district or public health officials. Health data of an employee is confidential and will not be disclosed to third parties. Employee medical records are kept in a file separate from their personnel file. It is the responsibility of the superintendent, in conjunction with school nurses, to develop administrative regulations stating the procedures for dealing with employees with a communicable disease. Legal Reference: Board of Education of Nassau County v. Arline, 4800 U.S. 273 (1987). 29 U.S.C. §§ 794, -1910 (2010) 42 U.S.C. §§12101 et seq. (2010) 45 C.F. R. Pt. 84.3 (2010) Iowa Code chs. 139A; 141A (2011) 641 I.A.C. 1.2-.7. Cross Reference: 401.5 403.1 507.3 Approved Jan. 1994 Employee Records Employee Physical Examinations Communicable Diseases - Students Reviewed/Revised May 2013 INDIANOLA COMMUNITY SCHOOL DISTRICT BOARD OF DIRECTORS Code No. 403.3 INDIANOLA COMMUNITY SCHOOL DISTRICT Code No. 403.3E1 COMMUNICABLE DISEASES - EMPLOYEES Employees with a communicable disease will be allowed to perform their customary employment duties provided they are able to perform the essential functions of their position and their presence does not create a substantial risk of illness or transmission to students or employees. The term "communicable disease" means an infectious or contagious disease spread from person to person, or animal to person, or as defined by the law. Prevention and control of communicable diseases is included in the school district's bloodborne pathogens exposure control plan. The procedures will include scope and application, definitions, exposure control, methods of compliance, universal precautions, vaccination, post-exposure evaluation, follow-up, communication of hazards to employees and record keeping. This plan is reviewed annually by the superintendent and school nurse. The health risk to immunodepressed employees is determined by their personal physician. The health risk to others in the school district environment from the presence of an employee with a communicable disease is determined on a case-by-case basis by the employee's personal physician, a physician chosen by the school district or public health officials. Health data of an employee is confidential and will not be disclosed to third parties. Employee medical records are kept in a file separate from their personnel file. It is the responsibility of the superintendent, in conjunction with school nurses, to develop administrative regulations stating the procedures for dealing with employees with a communicable disease. Legal Reference: Board of Education of Nassau County v. Arline, 4800 U.S. 273 (1987). 29 U.S.C. §§ 794, -1910 (2010) 42 U.S.C. §§12101 et seq. (2010) 45 C.F. R. Pt. 84.3 (2010) Iowa Code chs. 139A; 141A (2011) 641 I.A.C. 1.2-.7. Cross Reference: 401.5 403.1 507.3 Approved Jan. 1994 Employee Records Employee Physical Examinations Communicable Diseases - Students Reviewed/Revised May 2013 INDIANOLA COMMUNITY SCHOOL DISTRICT BOARD OF DIRECTORS INDIANOLA COMMUNITY SCHOOL DISTRICT Code No. 403.3E1 HEPATITIS B VACCINE INFORMATION AND RECORD The Disease Hepatitis B is a viral infection caused by the Hepatitis B virus (HBV) which causes death in 1-2 percent of those infected. Most people with HBV recover completely, but approximately 5-10 percent become chronic carriers of the virus. Most of these people have no symptoms, but can continue to transmit the disease to others. Some may develop chronic active hepatitis and cirrhosis. HBV may be a causative factor in the development of liver cancer. Immunization against HBV can prevent acute hepatitis and its complications. The Vaccine The HBV vaccine is produced from yeast cells. It has been extensively tested for safety and effectiveness in large scale clinical trials. Approximately 90 percent of healthy people who receive two doses of the vaccine and a third dose as a booster achieve high levels of surface antibody (anti-HBs) and protection against the virus. The HBV vaccine is recommended for workers with potential for contact with blood or body fluids. Full immunization requires three doses of the vaccine over a six-month period, although some persons may not develop immunity even after three doses. There is no evidence that the vaccine has ever caused Hepatitis B. However, persons who have been infected with HBV prior to receiving the vaccine may go on to develop clinical hepatitis in spite of immunization. Dosage and Administration The vaccine is given in three intramuscular doses in the deltoid muscle. Two initial doses are given one month apart and the third dose is given six months after the first. Possible Vaccine Side Effects The incidence of side effects is very low. No serious side effects have been reported with the vaccine. Ten to 20 percent of persons experience tenderness and redness at the site of injection and low grade fever. Rash, nausea, joint pain, and mild fatigue have also been reported. The possibility exists that other side effects may be identified with more extensive use. INDIANOLA COMMUNITY SCHOOL DISTRICT Code No. 403.3E1 HEPATITIS B VACCINE INFORMATION AND RECORD CONSENT OF HEPATITIS B VACCINATION I have knowledge of Hepatitis B and the Hepatitis B vaccination. I have had an opportunity to ask questions of a qualified nurse or physician and understand the benefits and risks of Hepatitis B vaccination. I understand that I must have three doses of the vaccine to obtain the immunity. However, as with all medical treatment, there is no guarantee that I will become immune or that I will not experience side effects from the vaccine. I give my consent to be vaccinated for Hepatitis B. Signature of Employee (consent for Hepatitis B vaccination) Date Signature of Witness Date REFUSAL OF HEPATITIS B VACCINATION I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring the Hepatitis B virus infection. I have been given the opportunity to be vaccinated with the Hepatitis B vaccine at no charge. However, I decline the Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious material and I want to be vaccinated with the Hepatitis B vaccine, I can receive the vaccination series at no charge. Signature of Employee (refusal for Hepatitis B vaccination) Date Signature of Witness Date I refuse because I believe I have (check one) started the series _ completed the series INDIANOLA COMMUNITY SCHOOL DISTRICT Code No. 403.3E1 HEPATITIS B VACCINE INFORMATION AND RECORD RELEASE FOR HEPATITIS B MEDICAL INFORMATION I hereby authorize (individual or organization holding Hepatitis B records and address) to release to the Indianola Community School District, my Hepatitis B vaccination records for required employee records. I hereby authorize release of my Hepatitis B status to a health care provider, in the event of an exposure incident. Signature of Employee Date Signature of Witness Date INDIANOLA COMMUNITY SCHOOL DISTRICT Code No. 403.3E1 HEPATITIS B VACCINE INFORMATION AND RECORD CONFIDENTIAL RECORD Employee Name (last, first, middle) Social Security No. Job Title: Hepatitis B Vaccination Date: Lot Number: Site: Administered by: 1. 2. 3. Additional Hepatitis B status information: Post-exposure incident: (Date, time, circumstances, route under which exposure occurred) Identification and documentation of source individual: Source blood testing consent: Description of employee's duties as related to the exposure incident: Copy of information provided to health care professional evaluating an employee after an exposure incident: Attach a copy of all results of examinations, medical testing, follow-up procedures, and health care professional's written opinion. INDIANOLA COMMUNITY SCHOOL DISTRICT Code No. 403.3E1 INCIDENT REPORT Date: Due to the circumstances in the case of unable to put on the appropriate apparel and was exposed to body fluids. I was Signature Witness Administrator Please include documentation of the route(s) of exposure, the circumstances surrounding exposure incidents, failures of control at the time of the exposure incident, and other elements as specified in the standard. INDIANOLA COMMUNITY SCHOOL DISTRICT CONFIDENTIAL EMPLOYEE RECORD EXPSOSURE TO BLOOD BORNE PATHOGENS Employee Name (last, first, middle) Social Security Number Job Title: Hepatitis B Vaccination Date Lot Number Site Administered by 1 2 3 Additional Hepatitis B status information: Post-exposure incident: Date, time, circumstances, route under which exposure occurred) Identification and documentation of source individual: Source blood testing consent: Description of employee’s duties as they relate to exposure incident: Copy of information provided to healthcare professional evaluating an employee after exposure incident: Attach a copy of all results of examinations, medical testing, follow-up procedures, and healthcare professional's written opinion. Training Record: (Date, time, instructor, location of training summary) INDIANOLA COMMUNITY SCHOOL DISTRICT LATEX REACTION School District Employees may use gloves or other products made with latex. Latex (the sap from the Hevea brasiliensis tree) is often used to make “rubber” gloves.2 Some children or adults may react to latex products. The reaction may be mild to severe. Some people may have watery eyes or skin irritation on the hands. Others may have severe allergic reactions like breathing difficulty or collapse. 3 How do you know if you will react or if the children in your care will react to latex? Workers may not know they will have a reaction to latex until they are exposed and have symptoms. The reaction may be mistaken for a skin reaction from frequent hand washing or a mild “cold” (watery eyes, runny nose, sneeze or cough). Parents of infants or other young children may not know their child will react to latex. When a latex reaction is suspected, the person needs a medical evaluation. Employers should urge workers to seek medical evaluation and to receive medical guidance about work tasks. When children are suspected of having a latex reaction, school district employees should work with parents to secure medical evaluation and guidance for the school setting. What does a medical evaluation for latex reaction mean? The health care provider will ask many questions about why a person suspects they have a latex reaction. Questions about the type of reaction, frequency of reaction, and exposure to latex are typical. The health care provider will examine any skin reactions. You may have blood tests to determine the level of latex sensitivity. Your health care provider may ask you to see a medical specialist depending on your reaction. Written guidelines and information should be given to you to assist you in determining work tasks to limit or prevent exposure to latex. What should workers with a known latex reaction do? People with latex reaction should wear a medical identification bracelet or other device stating the latex sensitivity. Workers sensitive to latex should obtain guidelines from their health care provider about appropriate products to use when doing tasks. Guidelines for workers should be shared with the district and job tasks reviewed. Nonlatex products should be available at diaper changing areas, first aid kits, emergency supplies, food service, and in play spaces. Workers with latex reaction should read the label of all products suspected of containing latex. If you chose to use latex gloves, use the powder-free gloves with reduced protein content. 2 Latex is used to make rubber gloves, balloons, rubber pants, elastic, baby bottle nipples or pacifiers and other common household products. 3 Preventing Allergic Reactions to Natural Rubber Latex in the Workplace, National Institute of Occupational Safety and Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Publication No. 97-135, July 1998. Latex Allergy, A Prevention Guide, National Institute of Occupational Safety and Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Publication No. 98-113, Feb. 1999. INDIANOLA COMMUNITY SCHOOL DISTRICT What if a child has a latex reaction? All district employees within the facility need to be aware of any child with latex reaction. Latex products should not be used for these children. District employees should work with parents and follow the child’s medical guidelines for using non-latex products. Non-latex products should be available at diaper changing areas, first aid kits, emergency supplies, and in play spaces. Is latex reaction really a serious concern? The latex reaction usually is seen as skin irritation to the hands or mild symptoms like runny nose and watering eyes. But for some people, the reaction to latex can be life threatening. Workers and older children with latex allergy should wear identification noting the latex sensitivity. It is not practical or safe for young children to wear medical identification—so parents and district employees must be diligent about notifying all employees of the child’s latex sensitivity. Where can I learn more about latex sensitivity? Ask your public library to help you find appropriate information sources. Your health care provider should have written information for patients with latex reactions. The U.S. government has several agencies that oversee latex production and sales. Resources Consumer Product Safety Commission, Office of Information and Public Affairs, Washington, D.C., 20207. Telephone voice 800-638-2772, TTY 800-638-8270. Internet: ww.cpsc.gov Food and Drug Administration, HFI-40, Rockville, Email:[email protected]. Internet: www.fda.gov MD 20857. Telephone 1-888-463-6332. National Institute of Occupational Safety and Health, Centers for Disease Control and Prevention, Telephone 1-800-356-4674. Email: [email protected]. Internet: www.cdc.gov/niosh. Published by: Healthy Child Care Iowa is a project of the Iowa Departments of Human Services and Public Health through the Child Care and Development Fund, Maternal and Child Health Block Grant of the U.S. Department of Health and Human Services. November 2003 INDIANOLA COMMUNITY SCHOOL DISTRICT