Benchmark Loss Control Report

• Site conducted

  Select

• Insured

• Policy Number

• Insured Contact

• Insured Email Address

• Underwriter

• Underwriter Email

• Agent

• Agent Email

• Inspection Location
  Address

• Conducted on

  Date

• Prepared by

• undefined

Investigation Form

• The company has a form for investigating all injury/damage related occurences.

  Yes

  No

  N/A

• There are accompanying instructions for proper completion of investigation forms.

  Yes

  No

  N/A

• The form contains or there is separate documentation for interviewing witnesses.

  Yes

  No

  N/A

• Root cause/safety alerts are developed afterward for distribution to employees.

  Yes

  No

  N/A

Investigation Accountability and Training

• The company defines responsibility for investigation of occurrences and close calls.

  Yes

  No

  N/A

• All supervisors are held accountable for participating in investigations.

  Yes

  No

  N/A

• Training is held on the value and completion of investigations.

  Yes

  No

  N/A

• Agenda includes techniques for fact finding, interviewing, and reconstruction.

  Yes

  No

  N/A

• Training is held on preserving evidence and taking pictures at the scene.

  Yes

  No

  N/A

Investigation Reports and Analysis

• Investigation reports are filed within an average of 24 hours after the accident/incident.

  Yes

  No

  N/A

• Reviews are initialized within 3 business days after reports are filed.

  Yes

  No

  N/A

• Reviews clearly display the use of root cause analysis.

  Yes

  No

  N/A

• Reviews attempt to identify at least one corrective action.

  Yes

  No

  N/A

• Reviews attempt to identify subrogation opportunities.

  Yes

  No

  N/A

Corrective Actions

• Minimal time frames have been established for corrective actions.

  Yes

  No

  N/A

• Corrective actions have been implemented.

  Yes

  No

  N/A

• Implemented corrective actions are evaluated for effectiveness.

  Yes

  No

  N/A

• Supervisors have the authority to immediately implement and monitor corrective actions.

  Yes

  No

  N/A

Injury/Illness Assessment and Medical Care

• The company reports every claim.

  Yes

  No

  N/A

• Someone in-house can determine when to send an employee for further medical evaluation.

  Yes

  No

  N/A

• Care is provided at time of reported injury.

  Yes

  No

  N/A

Claims Reporting and Coordination

• The company has a procedure for reporting claims immediately upon notification.

  Yes

  No

  N/A

• The company has a designated claims coordinator.

  Yes

  No

  N/A

• The claims coordinator has knowledge of special claims procedures (i.e., hot claims).

  Yes

  No

  N/A

• Personnel at all locations prepared to document and report occurrences to corporate or home office location.

  Yes

  No

  N/A

Transitional Duty/Return to Work

• A designated Medical Provider Network is utilized.

  Yes

  No

  N/A

• The company has implemented modified work tasks for employees injured in the past year.

  Yes

  No

  N/A

• There is a procedure for contacting employees while they are away from work.

  Yes

  No

  N/A

• The company has a formal return to work program.

  Yes

  No

  N/A

Loss Review

• There is satisfactory communication between the claims adjuster and the claims contact.

  Yes

  No

  N/A

• Loss information is communicated to key company personnel.

  Yes

  No

  N/A

• Claim reviews are scheduled as needed.

  Yes

  No

  N/A

• Monthly loss runs are reviewed.

  Yes

  No

  N/A

OSHA Recordkeeping

• The most current version of the OSHA forms are used.

  Yes

  No

  N/A

• OSHA 300A Summary(is) recordkeeping is accurate.

  Yes

  No

  N/A

• OSHA 300 A Summary(is) are posted between February 1st and April 30th of each year.

  Yes

  No

  N/A

• Recordkeeper(s) have demonstrated proficiency in OSHA recordkeeping.

  Yes

  No

  N/A

Target/Problem Loss Areas and Tasks

• Target/problem loss areas have been identified for each work location.

  Yes

  No

  N/A

• Safe work procedures have been developed for some target/problem loss areas.

  Yes

  No

  N/A

• Location surveys include a focus on these target/problem areas.

  Yes

  No

  N/A

• Supervisor/employee communication program has been implemented to provide more focus.

  Yes

  No

  N/A

Certificates of Insurance

• The company requires certificates of insurance.

  Yes

  No

  N/A

• The company tracks and updates most certificates of insurance annually.

  Yes

  No

  N/A

• The company has established minimally acceptable coverage and limit standards.

  Yes

  No

  N/A

• The company reviews coverage endorsements.

  Yes

  No

  N/A

• Ratings and admittance status of each insurance company is closely monitored.

  Yes

  No

  N/A

• The company is protected when doing business with non-domestic suppliers.

  Yes

  No

  N/A

• Certificates are stored so they are easily retrievable when needed.

  Yes

  No

  N/A

• The company utilizes 1099 employees.

  Yes

  No

• The company leases employees.

  Yes

  No

• The company uses a temp agency.

  Yes

  No

Contractual Agreements/Indemnification

• The company reviews contracts for indemnification and hold harmless provisions.

  Yes

  No

  N/A

• Agreements are stored so they are easily retrievable when needed.

  Yes

  No

  N/A

• The company includes provisions on purchase orders and sales invoices.

  Yes

  No

  N/A

• Authorized company personnel are aware of these provisions and cannot be simply altered.

  Yes

  No

  N/A

Safety Policy Statement

• The company has a Safety policy statement.

  Yes

  No

  N/A

• The Safety policy statement is released to all employees. Employees sign an acknowledgment form.

  Yes

  No

  N/A

• The Safety policy statement is part of other Safety documents and is properly posted.

  Yes

  No

  N/A

• The Safety policy statement is signed by senior management.

  Yes

  No

  N/A

• The Safety policy statement is reviewed annually.

  Yes

  No

  N/A

Safety Manual/ Policies/ Procedures

• The company has a written Injury and Illness Prevention Program (IIPP) or other written safety manual.

  Yes

  No

  N/A

• The company will implement a written safety manual.

• The Safety manual is up-to-date and is made available to all employees.

  Yes

  No

  N/A

• Update and Distribute updated IIPP

• The Safety manual contains at least the following sections: Safety policy statement, Safety training section, General Safety rules, Safety committee, Accident investigation, and Required Recordkeeping.

  Yes

  No

  N/A

• The Safety manual contains required Safety programs.

  Yes

  No

  N/A

• The Safety manual contains Hazard Survey/Correction and Job Safety Analysis.

  Yes

  No

  N/A

• Each section has a person responsible and/or competent person. The Safety manual's last reviewed date was within the last year.

  Yes

  No

  N/A

Supervisor Responsibility and Accountability

• Supervisors have a job description with Safety responsibilities displayed.

  Yes

  No

  N/A

• Supervisors are held accountable and sign an acknowledgement form.

  Yes

  No

  N/A

• Supervisor receives an annual performance review, including Safety performance.

  Yes

  No

  N/A

Employee Responsibility and Accountability

• Employees have job Safety responsibilities and accountabilities.

  Yes

  No

  N/A

• Employees sign an acknowledgment form.

  Yes

  No

  N/A

• Employees clearly understand how to report unsafe acts and conditions.

  Yes

  No

  N/A

• Employees are empowered to stop work if unsafe conditions or actions are identified.

  Yes

  No

  N/A

• Employees receive an annual performance review, including Safety performance and promotion.

  Yes

  No

  N/A

Hazard Reporting System

• A system for hazard reporting exists and the system has been used.

  Yes

  No

  N/A

• Supervisors have a procedure for evaluating and responding to hazard reports.

  Yes

  No

  N/A

• Employees receive periodic instruction in hazard identification and reporting.

  Yes

  No

  N/A

• Management conducts surveys of employee observations to ensure system performance.

  Yes

  No

  N/A

• Management respond to reports in writing or in person.

  Yes

  No

  N/A

Employee Participation and Recognition

• Employees may participate freely in Safety and health activities.

  Yes

  No

  N/A

• Employees are involved in inspections and permitted to observe monitoring and receive results.

  Yes

  No

  N/A

• Employees participate in workplace analysis, investigations, and development of control strategies.

  Yes

  No

  N/A

• Employees participate in audits and program reviews conducted by management and third parties.

  Yes

  No

  N/A

• The company recognizes employees for achievement and promotion of Safe operations. (Safety Incentive Program)

  Yes

  No

  N/A

Action Plan

• The company has an Action Plan for reducing claim frequency or related critical exposure.

  Yes

  No

  N/A

• The loss prevention consultant assisted with the development of the Action Plan.

  Yes

  No

  N/A

• A clear goal with related action items was stated.

  Yes

  No

  N/A

• A true leading indicator for measuring progress towards the goal was formulated.

  Yes

  No

  N/A

• Senior management approved the Action Plan.

  Yes

  No

  N/A

Safety Director

• The company has a Safety Director/Coordinator.

  Yes

  No

  N/A

• Are they Full Time or Part Time?

  Full Time

  Part Time

• Name:

• The Safety Director reports directly to senior management on Safety and health issues.

  Yes

  No

  N/A

• The Safety Director has designations/certifications from attending workshops, seminars, and classes.

  Yes

  No

  N/A

• The Safety Director is empowered to stop work if unsafe conditions/practices are observed.

  Yes

  No

  N/A

Safety Committee

• The company has an active Safety Committee.

  Yes

  No

  N/A

• The Safety Committee is active as follows: meets regularly (minimum every 4-8 weeks), has meeting agendas, and records meeting minutes.

  Yes

  No

  N/A

• The Safety Committee is further active as follows: conducts regular inspections of the facility or jobs, reviews close-call incidents, and makes recommendations to management for loss prevention.

  Yes

  No

  N/A

• Senior management (owner, president, etc.) attends meetings.

  Yes

  No

  N/A

Job Safety Analysis (JSA)

• The company has a Job Safety Analysis (JSA) program.

  Yes

  No

  N/A

• The JSA program consists of the following steps: exposure to hazard analysis, complete SOP's, Safety precaution list, JSA's posted near work stations/areas, training has been provided for all affected workers.

  Yes

  No

  N/A

Disciplinary Action

• The company has a procedure for Safety program violations.

  Yes

  No

  N/A

• Training is provided for all supervisors in the use of the procedure.

  Yes

  No

  N/A

• Application of the procedure is uniform for all personnel.

  Yes

  No

  N/A

• Violation analysis takes place to determine root cause.

  Yes

  No

  N/A

Accountability Company Subdivisions

• The company does a regular loss analysis of satellite locations, departments, etc.

  Yes

  No

  N/A

• Frequency/severity/loss experience are shared with subdivision heads.

  Yes

  No

  N/A

• Plans for improvement with timelines are required of subdivisions with high frequency/experience.

  Yes

  No

  N/A

• Methods like charge-backs, bonuses, consultant concentration are utilized by the company.

  Yes

  No

  N/A

Orientation and Training

• The company has a formal employee Safety orientation.

  Yes

  No

  N/A

• Orientation is given to all new hires, transfers, and temporary employees.

  Yes

  No

  N/A

• Managers/supervisors attend training provided to employees under their direction.

  Yes

  No

  N/A

• Test/exercises are used and past scores and training records are easily retrievable.

  Yes

  No

  N/A

• Computer/web-based training modules and recordkeeping system is used.

  Yes

  No

  N/A

• New employees receive job training.

  Yes

  No

  N/A

Employee Benefits

• All employees receive paid sick hours.

  Yes

  No

• All employees receive paid vacation.

  Yes

  No

• All employees are provided group health insurance.

  Yes

  No

• What percentage participate?

• Who is eligible?

• Any additional employee benefits offered?

  Yes

  No

• What kind?

Working from home.

• Employees who are able to work remotely are doing so.

  Yes

  No

  N/A

• How many employees?

• Who is working remotely?

Physical Distancing

• Notices are up around the workplace advising to keep at least 6 feet between employees.

  Yes

  No

  N/A

• Put up notices

• Work stations have been moved to allow physical distancing.

  Yes

  No

  N/A

• If not able to move workstations are plexiglass barriers used.

  Yes

  No

  N/A

• Common areas such as break rooms do not allow for multiple employees to gather.

  Yes

  No

  N/A

Handwashing and Hygiene

• Hand sanitizer stations are set up around the workplace including at all entry and exit points.

  Yes

  No

  N/A

• Bathrooms are well stocked with paper towels and soap.

  Yes

  No

  N/A

• Posters with handwashing instructions are at every handwashing station.

  Yes

  No

  N/A

Cleaning

• Areas frequented by workers/others are cleaned at least daily with disenfectant.

  Yes

  No

  N/A

• Frequently touched surface areas are disinfected several times a day. Eg. Tools, door knobs etc

  Yes

  No

  N/A

Monitor Symptoms/

• Daily temperature checks upon arrival.

  Yes

  No

  N/A

• Designated COVID-19 supervisor/contact.

  Yes

  No

  N/A

• Who?

• Written COVID-19 management plan.

  Yes

  No

  N/A

• Establish written COVID-19 Safety Plan

• Employees who show symptoms are advised to stay home and quarantine.

  Yes

  No

  N/A

• Employees are notified of possible exposure.

  Yes

  No

  N/A

• Masks are worn at all times.

  Yes

  No

  N/A

• Driving Exposure?

  Yes

  No

• Driving Radius

• Driving Frequency

  Daily

  Weekly

• Nature of driving exposure.

Driver Quality Assurance

• The company has a policy for screening employee drivers.

  Yes

  No

  N/A

• The company checks MVR's prior to hiring people who may drive for company business.

  Yes

  No

  N/A

• The company has an established procedure for reviewing MVR's

  Yes

  No

  N/A

• The company has a driver road test (behind the wheel) program in place.

  Yes

  No

  N/A

• The company has a driver check ride (behind the wheel) program in place.

  Yes

  No

  N/A

• The minimum age of new drivers is 21 years or older.

  Yes

  No

  N/A

• New drivers have three or fewer moving violations in the past three years.

  Yes

  No

  N/A

• Maximum of one serious moving violation in the past five years.

  Yes

  No

  N/A

• Does not allow operation of a company vehicle prior to a negative drug screen.

  Yes

  No

  N/A

• Maximum of three at-fault accidents in three years.

  Yes

  No

  N/A

Vehicle Safety Procedures

• Company vehicles used

  Yes

  No

• Are company vehicles taken home?

  Yes

  No

• Accident report forms and proof of insurance cards are provided in all company vehicles.

  Yes

  No

  N/A

• There is a procedure in case of vehicle breakdown.

  Yes

  No

  N/A

• Cameras are available in vehicles (driver cell, PDA) for accident documentation purposes.

  Yes

  No

  N/A

• The company has vehicle Safety procedures that are communicated to employees.

  Yes

  No

  N/A

• Drivers receive instruction on what photos to take or not take at the occurrence scene.

  Yes

  No

  N/A

• The company has a formal vehicle selection and maintenance program.

  Yes

  No

  N/A

• Group Transportation - 5 or more employees per vehicle.

  Yes

  No

• Max employees allowed to travel per vehicle.

• Percentage of driving exposure with 5 or more employees?

• Radius of driving exposure with 5 or more employees.

Driver Training

• The company provides driver improvement training.

  Yes

  No

  N/A

• The company has a distracted driving policy.

  Yes

  No

  N/A

• The driver improvement training includes the following topics; backing, intersections, speed and following distance, lane change and merging, night driving, and inclement weather.

  Yes

  No

  N/A

• The driver improvement training includes policies and procedures for; distraction and cell phone use and road rage.

  Yes

  No

  N/A

• Computer/web-based training modules and recordkeeping system is used.

  Yes

  No

  N/A

Use of Personal Vehicles

• The company allows use of personal vehicles.

  Yes

  No

• The company has a policy for personal use of vehicles on company business.

  Yes

  No

  N/A

• An inspection checklist is furnished to drivers to help maintain their vehicles.

  Yes

  No

  N/A

• Drivers carry personal auto insurance that meets or exceeds state minimum requirements.

  Yes

  No

  N/A

• Employee drivers have received training on vehicle Safety.

  Yes

  No

  N/A

Equipment

• The company has a process that includes workstation assessment and medical management.

  Yes

  No

  N/A

• Workstations are assessed after an employee complaint or an injury/illness occurs.

  Yes

  No

  N/A

• An ergonomic team; has been established, has been trained and selects workstations based on the risk presented.

  Yes

  No

  N/A

• Management and associates have been trained on basic ergonomic concepts.

  Yes

  No

  N/A

Engineering Controls

• The company considers size and weight during the selection of materials.

  Yes

  No

  N/A

• Material handling is considered important because the company; has established defined material handling weights, has considered injury potential/cost in determining packaging weight, and provides alternative shaped containers or containers with handles.

  Yes

  No

  N/A

• There are successes in reducing ergonomic exposures from material handling.

  Yes

  No

  N/A

Soft Tissue Injury Prevention

• The company trains on safe lifting, material handling, and out of position tasks.

  Yes

  No

  N/A

• The company provides ergonomic guidelines for layout and staging areas.

  Yes

  No

  N/A

• Tasks, equipment, etc. are identified in advance requiring two-person or machine-assisted lifts.

  Yes

  No

  N/A

• Job pre-planning/scheduling process identifies methods and procedures for injury prevention.

  Yes

  No

  N/A

Machine Safeguarding

• The company has a machine safeguarding policy.

  Yes

  No

  N/A

• The machine safeguarding policy contains the following; purchasing standards for new equipment and new equipment inspection and placement into service.

  Yes

  No

  N/A

• The machine safeguarding policy further contains the following; regular inspection procedure and training for equipment operators.

  Yes

  No

  N/A

• All machines and tools are safeguarded to OSHA standards.

  Yes

  No

  N/A

Powered Industrial Trucks

• The company has a powered industrial truck Safety program.

  Yes

  No

  N/A

• Performance of operators is evaluated at least every three years.

  Yes

  No

  N/A

• All operators are properly trained.

  Yes

  No

  N/A

• Industrial trucks are operated in a Safe manner.

  Yes

  No

  N/A

• Operators receive refresher training after an accident or unsafe operations.

  Yes

  No

  N/A

Walking and Working Surfaces

• Walking and work surfaces is included on inspection checklist.

  Yes

  No

  N/A

• Ladders are maintained and stored properly.

  Yes

  No

  N/A

• Steps and stairways comply with handrail standards.

  Yes

  No

  N/A

• Elevated platforms comply with OSHA standards.

  Yes

  No

  N/A

• Walkways are free and clear of storage and clutter.

  Yes

  No

  N/A

Electrical Safety

• The company has an electrical Safety policy and procedure(s).

  Yes

  No

  N/A

• Existing electrical Safety conditions include the following; junction boxes/electrical boxes and fittings are covered, flex cords and temporary wiring is not used as permanent wiring, and GFCI's are provided during construction, maintenance, repair, tasks, etc.

  Yes

  No

  N/A

• Existing electrical Safety conditions further include; only authorized/trained personnel access electrical panels and controls, electrical panels/breakers are properly labeled, and electrical utility rooms are posted "Authorized Personnel Only" and secured.

  Yes

  No

  N/A

Control of Hazardous Energy

• The company has a lockout/tagout program.

  Yes

  No

  N/A

• There are procedures for equipment with multiple power sources.

  Yes

  No

  N/A

• There is an equipment inventory with definitions of power sources for each piece.

  Yes

  No

  N/A

• Lockout/tagout readiness includes the following; authorized/affected associates have been trained according to the standard, a list of authorized associates is maintained, and lockout/tagout procedures are assessed annually and certified.

  Yes

  No

  N/A

• Lockout/tagout readiness further includes; group lockout and lockout/tagout procedures are reviewed with outside contractors.

  Yes

  No

  N/A

Crane, Hoist, and Rigging Equipment

• The company has a program for crane, hoist, and rigging equipment.

  Yes

  No

  N/A

• An exposure inventory has been taken of all applicable equipment.

  Yes

  No

  N/A

• Load capacity ratings are clearly marked.

  Yes

  No

  N/A

Confined Space Entry

• The company has a confined space entry program.

  Yes

  No

  N/A

• An exposure inventory has been taken and all confined spaces have been marked.

  Yes

  No

  N/A

• Confined space entry Safety includes; worker training as required by the standard, entry equipment is maintained and ready, rescue has been reviewed and outside or inside teams has been determined, and training has been completed at the actual confined spaces.

  Yes

  No

  N/A

• A permit procedure has been established and is used consistently.

  Yes

  No

  N/A

Personal Protective Equipment

• A personal protective equipment hazard assessment has been completed.

  Yes

  No

  N/A

• Personal protective equipment requirements are defined on all job tasks.

  Yes

  No

  N/A

• PPE procedures include; workers are trained on the proper use and maintenance of PPE, PPE use is strictly enforced, and most workers are offered different options on PPE.

  Yes

  No

  N/A

• Types of PPE used.

Fall Protection Program

• The company has a fall protection program in place.

  Yes

  No

  N/A

• Type of fall protection

• Height fall protection is required at in feet.

• Max height exposure.

• Fall Protection is keep in good working order.

  Yes

  No

  N/A

Exposure Monitoring/ Industrial Hygiene

• The company has an industrial hygiene monitoring process.

  Yes

  No

  N/A

• Periodic monitoring is performed on a scheduled basis.

  Yes

  No

  N/A

• Basic IH sampling has taken place and is performed when operations of conditions change.

  Yes

  No

  N/A

• The IH process includes; a monitoring plan that is reviewed and updated annually, affected workers are informed of test results, and engineering controls are utilized to reduce exposure.

  Yes

  No

  N/A

Hearing Conservation

• The company has a hearing conservation program.

  Yes

  No

  N/A

• The compliance features further include; workers receiving hearing conservation training on an annual basis, enforcement of hearing protection use.

  Yes

  No

  N/A

• Employees are notified of STS shifts of 10 db. or greater within 21 days.

  Yes

  No

  N/A

• The compliance features include; an annual review and update, audiometric testing is performed on a pre-placement and annual basis, noise sampling has defined noise levels through the facility, and warning signs are posted.

  Yes

  No

  N/A

Respiratory Protection

• The company has a respiratory protection program.

  Yes

  No

  N/A

• Engineering controls are utilized to reduce exposure.

  Yes

  No

  N/A

• The compliance features include; workers annually trained on proper use, fit, cleaning and storage of respirators, and respirator fit testing.

  Yes

  No

  N/A

• Health evaluations/medical surveillance performed on a pre-placement and annual basis.

  Yes

  No

  N/A

Hazard Communication

• The company has a hazard communication program.

  Yes

  No

  N/A

• The compliance features include; annual updating, SDS are immediately available to associates, employees have been trained on GHS and chemicals related to their jobs.

  Yes

  No

  N/A

• A chemical inventory is complete and updated annually.

  Yes

  No

  N/A

• The compliance features further include; new chemical introduction and SDS management protocol, and SDS are retained and available for 30 years after use.

  Yes

  No

  N/A

Bloodborne Pathogens

• The company has a bloodborne pathogens (BBP) program.

  Yes

  No

  N/A

• Implement a BBP Program

• A BBP exposure evaluation has been completed.

  Yes

  No

  N/A

• The compliance features include; universal precautions are standard protocols for all bloodborne exposures, employees routinely exposed to BBP have been trained per the standard, and the program is reviewed and updated annually.

  Yes

  No

  N/A

• The compliance features further include; exposure control that is provided and accessible, janitorial service workers have been trained, and post-exposure evaluations are completed per the standard.

  Yes

  No

  N/A

Fire Safety

• Fire Extinguishers have current inspection tag and no more than 12 months since inspection.

  Yes

  No

  N/A

• Fire Extinguishers are easily accessed and proper clearance is maintained.

  Yes

  No

  N/A

• Evacuation plans are available and up to date.

  Yes

  No

  N/A

• Fire drill was conducted within the last 12 months.

  Yes

  No

  N/A

First Aid

• First Aid Kit's are available.

  Yes

  No

  N/A

• The basic supplies are fully stocked and not expired.

  Yes

  No

  N/A

• Staff members are trained and certified in both first aid and CPR.

  Yes

  No

  N/A

• Emergency eyewash station is available.

  Yes

  No

  N/A

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