Bias Documentation

• Client / Site

• Conducted on

  Date

• Prepared by

Workers Compensation

• Workers Compensation?

  Yes

  No

Modified RTW

• Written policy in place?

  1

  0

  -1

  N/A

• Consistently accommodates MRTW in most or all cases?

  1

  0

  -1

  N/A

• Modified duty tasks are identified?

  1

  0

  -1

  N/A

• Written MRTW agreement with the employee?

  1

  0

  -1

  N/A

• Supervisory/oversight mechanism(s) in place for those on MRTW?

  1

  0

  -1

  N/A

• Medical provider is aware that the organization provides modified work for employees?

  1

  0

  -1

  N/A

• Duties are varied/changed every 2 weeks or less?

  1

  0

  -1

  N/A

Designated Medical Provider

• Organization has established a relationship with a medical provider?

  1

  0

  -1

  N/A

• Medical provider is an occupational medicine provider?

  1

  0

  -1

  N/A

• Established and consistent communication from medical provider to the organization?

  1

  0

  -1

  N/A

• All supervisors are aware of organizations medical provider, their location(s), hours, etc?

  1

  0

  -1

  N/A

• The organization attempts to limit use of the ER to true emergencies?

  1

  0

  -1

  N/A

Post-Offer Functional Screen

• Pre-employment physical through medical provider?

  1

  0

  -1

  N/A

• Post-offer functional screen through medical provider?

  1

  0

  -1

  N/A

• Written hiring policy in place specifies POFS after conditional job offer?

  1

  0

  -1

  N/A

Drug Testing

• Post-injury/accident testing?

  1

  0

  -1

  N/A

• Reasonable suspicion testing?

  1

  0

  -1

  N/A

• Random testing?

  1

  0

  -1

  N/A

• Pre-employment testing?

  1

  0

  -1

  N/A

• Written policy in place?

  1

  0

  -1

  N/A

• DOT compliant drug testing for those with CDL?

  1

  0

  -1

  N/A

Job Descriptions

• Written job descriptions present?

  1

  0

  -1

  N/A

• Job descriptions specify physical demands?

  1

  0

  -1

  N/A

• Reviewed annually?

  1

  0

  -1

  N/A

• Medical provider has copies on file for review?

  1

  0

  -1

  N/A

Safety Committee

• Safety committee in place?

  1

  0

  -1

  N/A

• Meets regularly, monthly, or quarterly?

  1

  0

  -1

  N/A

• Goals and mission statement?

  1

  0

  -1

  N/A

• Includes accident review process, possibly with involved employee?

  1

  0

  -1

  N/A

• Regular safety walk through/inspection of department?

  1

  0

  -1

  N/A

Claim Reporting and Submission

• Incident reporting policy in place?

  1

  0

  -1

  N/A

• Employee injury requires notification of employer within 24 hours or before end of shift?

  1

  0

  -1

  N/A

• Established claim contact within the organization?

  1

  0

  -1

  N/A

• Claims contact is utilizing in-sight to report claims?

  1

  0

  -1

  N/A

• Organization understands the importance of reporting, and reports "incident only" claims?

  1

  0

  -1

  N/A

• Average lag times are less than 5 days?

  1

  0

  -1

  N/A

Accident Investigation

• Supervisors trained in WC and accident investigation basics, refreshed annually?

  1

  0

  -1

  N/A

• Employee completes incident report?

  1

  0

  -1

  N/A

• Supervisor completes a supervisor's report?

  1

  0

  -1

  N/A

• Witness report used as applicable?

  1

  0

  -1

  N/A

• Organization claims contact is notified immediately/ASAP of incidents?

  1

  0

  -1

  N/A

• Paperwork is submitted to claims contact?

  1

  0

  -1

  N/A

Safety Training

• Required and best practices safety training is performed at required/recommended intervals?

  1

  0

  -1

  N/A

• Written training schedule includes topic, method, month/date?

  1

  0

  -1

  N/A

• Training records are kept for each employee?

  1

  0

  -1

  N/A

• Blood borne pathogens (for those with exposure)?

  1

  0

  -1

  N/A

• Lockout/Tagout (for those with exposure)?

  1

  0

  -1

  N/A

• Hazcom (for those with exposure)

  1

  0

  -1

  N/A

• PPE (for those with exposure)?

  1

  0

  -1

  N/A

• Confined space entry (for those with exposure)?

  1

  0

  -1

  N/A

• Trenching / shoring (for those with exposure)?

  1

  0

  -1

  N/A

• Ergonomics / spine safety / injury prevention?

  1

  0

  -1

  N/A

Pre-Hire Integrity / Safety Testing

• Utilization of MIS pre-hire integrity test, post-application, but pre-interview?

  1

  0

  -1

  N/A

• Utilization of TC SQ or DSG (depending on position) on candidates, pre-interview?

  1

  0

  -1

  N/A

• SQ / DSQ utilization for existing employees?

  1

  0

  -1

  N/A

Written Safety Programs

• Blood borne pathogens (for those with exposure)?

  1

  0

  -1

  N/A

• Hazcom (for those with exposure)?

  1

  0

  -1

  N/A

• Lockout / Tagout (for those with exposure)?

  1

  0

  -1

  N/A

• PPE (for those with exposure)?

  1

  0

  -1

  N/A

Property

• Property?

  Yes

  No

Property Inspection

• CBIZ inspection within last 3 years

  1

  0

  -1

  N/A

• CBIZ deficits addressed and remedied?

  1

  0

  -1

  N/A

Consultant Safety Walkthrough

• Performed every other year minimally?

  1

  0

  -1

  N/A

• Safety hazards (GL/WC) identified?

  1

  0

  -1

  N/A

• Safety hazards remedied by account in timely fashion?

  1

  0

  -1

  N/A

Emergency Action Plan

• Exists?

  1

  0

  -1

  N/A

• ServPro plan established, if applicable?

  1

  0

  -1

  N/A

Employment Practice Policy

• Employment Practice Policy?

  Yes

  No

Employment Practice Policy

• Policies are reviewed and updated annually?

  1

  0

  -1

  N/A

• Policy review by OKGC or formal legal review within the last 2 years?

  1

  0

  -1

  N/A

Training

• Sexual harassment annually?

  1

  0

  -1

  N/A

• General harassment?

  1

  0

  -1

  N/A

• Discrimination?

  1

  0

  -1

  N/A

• Supervisors: hiring and firing?

  1

  0

  -1

  N/A

• Supervisors performance evaluation training annually?

  1

  0

  -1

  N/A

• EEOC laws annually?

  1

  0

  -1

  N/A

Performance Evaluations

• Annual or more frequent performance reviews are in place?

  1

  0

  -1

  N/A

• Criteria based on job functions?

  1

  0

  -1

  N/A

• Performed evaluations are performed?

  1

  0

  -1

  N/A

FOIA

• FOIA officer designated?

  1

  0

  -1

  N/A

• FOIA officer completed annual training via IAG website?

  1

  0

  -1

  N/A

• Backup FOIA officer designated?

  1

  0

  -1

  N/A

OMA

• All current elected and appointed officials have completed OMA training via the IAG website?

  1

  0

  -1

  N/A

• Newly elected / appointed officials are required to complete OMA training via the IAG website within 90 days after taking the oath of office or otherwise assuming responsibilities?

  1

  0

  -1

  N/A

Critical Policies

• Accident reporting?

  1

  0

  -1

  N/A

• Against concealed firearms?

  1

  0

  -1

  N/A

• Against violence in the workplace?

  1

  0

  -1

  N/A

• Anti-harassment and discrimination?

  1

  0

  -1

  N/A

• At will employment?

  1

  0

  -1

  N/A

• Attendance?

  1

  0

  -1

  N/A

• Conflict of interest?

  1

  0

  -1

  N/A

• Drug testing / drug-free workplace?

  1

  0

  -1

  N/A

• FMLA

  1

  0

  -1

  N/A

• Handbook acknowledgment exists?

  1

  0

  -1

  N/A

• Internet and email?

  1

  0

  -1

  N/A

• Modified return to work?

  1

  0

  -1

  N/A

• MVR checks?

  1

  0

  -1

  N/A

• Performance evaluation?

  1

  0

  -1

  N/A

• Progressive discipline and corrective action?

  1

  0

  -1

  N/A

• Reasonable accommodation?

  1

  0

  -1

  N/A

• Record retention?

  1

  0

  -1

  N/A

• Safety?

  1

  0

  -1

  N/A

• Social media?

  1

  0

  -1

  N/A

• USERRA

  1

  0

  -1

  N/A

• VESSA

  1

  0

  -1

  N/A

• Whistleblower policy?

  1

  0

  -1

  N/A

Auto

• Auto?

  Yes

  No

MVR Checks

• Annual MVR check for all employees that drive on organization business?

  1

  0

  -1

  N/A

• Annual MVR check written policy in place?

  1

  0

  -1

  N/A

Training

• Defensive driving training annually?

  1

  0

  -1

  N/A

• Winter driving safety annually?

  1

  0

  -1

  N/A

• Other job specific driving training (fire/police)?

  1

  0

  -1

  N/A

DOT / CDL

• Compliant with all DOT regulations required for CDL holders?

  1

  0

  -1

  N/A

Fleet Maintenance

• Written fleet maintenance program?

  1

  0

  -1

  N/A

• Pre-trip visual inspection by user(s)?

  1

  0

  -1

  N/A

• 360 degree circle of safety?

  1

  0

  -1

  N/A

• Regular maintenance / inspections for all fleet vehicles, with written records of such?

  1

  0

  -1

  N/A

Law Enforcement Liability

• Law Enforcement Liability?

  Yes

  No

LLRMI Portal

• Access for entire department for training?

  1

  0

  -1

  N/A

• Access for admin to obtain policies?

  1

  0

  -1

  N/A

• Access for jail admin for policies?

  1

  0

  -1

  N/A

• Access for corrections officer for training?

  1

  0

  -1

  N/A

Training

• Training plan in place for officers?

  1

  0

  -1

  N/A

• Training documents kept on file for each employee?

  1

  0

  -1

  N/A

Video Monitoring Use

• Body camera?

  1

  0

  -1

  N/A

• Dash camera?

  1

  0

  -1

  N/A

• Building camera within jail?

  1

  0

  -1

  N/A

Policies

• LLRMI policy within 5 years?

  1

  0

  -1

  N/A

• LLRMI jail policies audit within 5 years?

  1

  0

  -1

  N/A

• Training documents kept on file for each employee?

  1

  0

  -1

  N/A

• Critical task jail policies in place - same listing for jails, suicide prevention policy?

  1

  0

  -1

  N/A

• 10 high risk critical task policies in place and followed?:

  Select Use of Force Emergency Vehicle Operation Arrest, Search, and Seizure Care, Custody, Control, and Restraint of prisoners Employee - involved domestic misconduct Property and Evidence Armed Officers / Off Duty Action Sexual Harassment, Discrimination, and Misconduct Hiring, Selection, Retention Internal Affairs Investigation

  • Use of Force
  • Emergency Vehicle Operation
  • Arrest, Search, and Seizure
  • Care, Custody, Control, and Restraint of prisoners
  • Employee - involved domestic misconduct
  • Property and Evidence
  • Armed Officers / Off Duty Action
  • Sexual Harassment, Discrimination, and Misconduct
  • Hiring, Selection, Retention
  • Internal Affairs Investigation

• Suicide Prevention Policy?

  1

  0

  -1

  N/A

• Safe guards in place for tasers and other response to resistance?

  1

  0

  -1

  N/A

• Utilization of LLRMI policy review?

  1

  0

  -1

  N/A

Seminars

• Department members utilizing LLRMI seminars put on by ICRMT?

  1

  0

  -1

  N/A

• Department members utilizing LLRMI courses throughout region?

  1

  0

  -1

  N/A

Webinars

• Department members utilizing LLRMI webinars?

  1

  0

  -1

  N/A

Safety Grant

• Grant Application?

  1

  0

  -1

  N/A

• Grant Reward?

  Yes

  No

  N/A

• What Year?