DealerComp ADAA Loss Control Visit

• Dealership

• Location

• Report Recipient

• CPAS #

• Prepared by

  Select

• Date of Visit

  Date

• Note

Loss Experience

• Date of Loss Runs Reviewed at Visit

• Total Number of Claims Reported

• Total Incurred Cost of Claims

Claims Management

• Please keep in mind that all claims, regardless of severity, should be reported to the fund within two days of their occurrence.
  Report claims by fax at (205) 933-0375 or by email to claims@bwood.com

• Designated claims person at dealership?

  Yes

  No

• Name of designated claims individual?

• Do you have a return-to-work program established and light duty positions identified when possible?

  Yes

  No

  N/A

• Claims reported in a timely manner (24-48 hrs)?

  Yes

  No

• Claim Lag Time is an important element of controlling losses. Industry studies show that a claim reported beyond 48 hours following the date of the incident can increase the cost of the claim by as much as 30-40%.

Accident Investigation

• Are accidents investigated and documented using the First Report of Injury Form?

  Yes

  No

• Are witness statements documented during investigations?

  Yes

  No

• Does the immediate supervisor of the injured employee conduct the accident investigation?

  Yes

  No

• Are the results of accident investigations as well as near misses used for training purposes to prevent future occurrences?

  Yes

  No

Safety Management

• Designated “responsible person” for safety and loss control efforts?

  Yes

  No

• Name of designated individual?

• Written Safety Program or policies in place?

  Yes

  No

• Personal Protective Equipment policy established?

  Yes

  No

• Do you require slip-resistant safety footwear?

  Yes

  No

• Do you supply employees with necessary PPE?

  Yes

  No

• Are newly hired employees required to complete safety orientation or training?

  Yes

  No

• Do you conduct routine safety meetings?

  Yes

  No

• Frequency of safety meeting?

  Weekly

  Monthly

  Quarterly

  Annually

• Are the safety meetings documented?

  Yes

  No

• Is there a drug testing policy?

  Yes

  No

• What type of drug tests are performed under the policy?

  Select Pre-Employment Post-Accident Random Reasonable Suspicion

  • Pre-Employment
  • Post-Accident
  • Random
  • Reasonable Suspicion

• Hazard Communication Program in place?

  Yes

  No

  N/A

• Do you keep updated Safety Data Sheets for hazardous chemical used or stored at your facility?

  Yes

  No

  N/A

• Safety Data Sheets can be stored in a binder or electronically, how does your organization store SDS to ensure they are readily available to employees?

  Select Binder Electronically

  • Binder
  • Electronically

• Additional Recommendation

  Yes

  N/A

• Additional Recommendation

  Yes

  N/A

Lifting Exposure

• Do you have material handling equipment available to prevent muscle strains injuries?

  Yes

  No

• Do you have a forklift?

  Yes

  N/A

• Forklift program satisfactory?

  Yes

  No

• Are materials stored in a manner to prevent/minimize muscle strain injuries?

  Yes

  No

• Do you conduct muscle strain prevention training annually?

  Yes

  No

• Do you conduct proper lifting training annually?

  Yes

  No

• Additional Recommendation

  Yes

  N/A

• Additional Recommendation

  Yes

  N/A

Motor Vehicle Controls

• MVR’s reviewed upon hire and evaluated against established criteria?

  Yes

  No

• Distracted driving policy established?

  Yes

  No

• Seat belt policy established?

  Yes

  No

• Speed limit established on property?

  Yes

  No

• Additional Recommendation

  Yes

  N/A

Facility Inspections

• Do you conduct Self-inspections of your facilities?

  Yes

  No

• Frequency of facility inspections?

  Weekly

  Monthly

  Quarterly

  Annually

• Are the inspections documented?

  Yes

  No

• Housekeeping satisfactory?

  Yes

  No

• Procedures in place to identify/mark and clean-up spills?

  Yes

  No

• Are trip and fall hazards in floors, walkways, and lots identified and guarded?

  Yes

  No

• Emergency exits identified and accessible?

  Yes

  No

• Compliant with all electrical standards?

  Yes

  No

• Fire extinguishers mounted, labeled, inspected and accessible?

  Yes

  No

• Are chemicals and secondary containers properly labeled?

  Yes

  No

  N/A

• Are flammable liquids and chemicals stored appropriately?

  Yes

  No

  N/A

• Eye wash stations in place, accessible, and in good working order?

  Yes

  No

  N/A

• Machine guarding satisfactory?

  Yes

  No

  N/A

• Compressed gas cylinders secured in place?

  Yes

  No

  N/A

• Documented lifts /crane inspections and training complete?

  Yes

  No

  N/A

• Vehicles properly chocked on automotive lifts?

  Yes

  No

  N/A

• Respiratory protection program and training satisfactory?

  Yes

  No

  N/A

• Additional Recommendation

  Yes

  N/A

• Additional Recommendation

  Yes

  N/A

• Additional Recommendation

  Yes

  N/A

• Additional Recommendation

  Yes

  N/A

• Additional Recommendation

  Yes

  N/A

• Additional Recommendation

  Yes

  N/A

• Additional Recommendation?

  Yes

  N/A

Recommendation Response

• Underwriting requires a documented response to the recommendations be sent, within 30 days of sending this report. Your cooperation with these matters is greatly appreciated and can have a direct effect on your contribution. Please feel free to contact your Loss Control Consultant for aid with corrective actions. Please send your response, including recommendation number and actions performed, to your loss control consultant by email.

• Recommendation Response Due Date

  Date