Landscaping/Tree service

Client Details Pre Visit

• Client name & ID

• Conducted on

  Date

• Policy start date

  Date

• Total # of claims to date

• Total # of open claims

• Total # of employees

• WC Codes currently in use

• NAICS

• FEIN

• States operating in

• Prepared by

• Location
  Address

Confirmation Questions

• Does the total number of employees seem accurate?

  Yes

  No

  N/A

• Do the current worker’s comp codes seem accurate?

  Yes

  No

  N/A

• Are the states the client operates in accurate?

  Yes

  No

  N/A

• Does the NAICS seem accurate?

  Yes

  No

  N/A

• Areas of concern the business contact has surrounding safety/WC that they want inspected for sure before the end of the visit.

Site Visit Questions

• Do you currently have an existing and updated IIPP?

  Yes

  No

  N/A

• Would the client be interested in additional help in this area?

  Yes

  No

  N/A

• Do you currently have an existing and updated Emergency Action Plan?

  Yes

  No

  N/A

• Would the client be interested in additional help in this area?

  Yes

  No

  N/A

• Do you currently have a Safety Committee?

  Yes

  No

  N/A

• How frequently do they meet?

  Weekly

  Quarterly

  Semi-annually

  Other

• Would you like more information on this?

  Yes

  No

  N/A

• Do you currently have an updates SDS Binder?

  Yes

  No

  N/A

• Would you like some assistance in setting one up?

  Yes

  No

  N/A

• Has client been sited by OSHA in the last year?

  Yes

  No

  N/A

• Do you have a return to work program in place?

  Yes

  No

  N/A

• Are all proper OSHA & labor laws posted and completed

  Yes

  No

  N/A

Landscaping

• Have your landscapers been trained about the necessary safety precautions when doing landscaping work?

  Yes

  No

  N/A

• Is proper PPE provided to the employees ?

  Yes

  No

  N/A

• Are employees wearing the provided PPE?

  Yes

  No

  N/A

• Are employees aware of the different types of dangerous plants and animals?

  Yes

  No

  N/A

• Is adequate water readily available at all times?

  Yes

  No

  N/A

• Access to shade and rest breaks?

  Yes

  No

  N/A

• Have employees been trained on recognizing the signs and symptoms of heat exhaustion and heatstroke?

  Yes

  No

  N/A

• Are proper lifting techniques being used while lifting?

  Yes

  No

  N/A

• Employees handling, storing, and disposing of hazardous substances, such as fertilizers, pesticides, and herbicides?

  Yes

  No

  N/A

• Are employees using powered grounds keeping equipment wearing necessary PPE? <br>

  Yes

  No

  N/A

• Electrical tools and equipment are grounded and insulated?

  Yes

  No

  N/A

• Following lockout/tagout procedures when working on or near electrical equipment?

  Yes

  No

  N/A

Tree Maintenance

• Ensure tools are sharp and functioning properly?

  Yes

  No

  N/A

• Assess trees and work areas before starting a job to identify potential hazards, such as weak branches, power lines, or unstable ground?

  Yes

  No

  N/A

• While climbing a tree, the employee must be tied in or secured at all times.<br>(Two lines are required, such as a climbing line and work-positioning lanyard)?

  Yes

  No

  N/A

• Use fall arrest systems, such as harnesses and lifelines, and ensure they are correctly fitted and anchored?

  Yes

  No

  N/A

• Belts and harnesses free of cracks, cuts and<br>broken stitching?

  Yes

  No

  N/A

• Clips, buckles and rivets not loose or<br>broken?

  Yes

  No

  N/A

• Ropes and lanyards are dry and show<br>no signs of fraying, intense wear or sun<br>damage?

  Yes

  No

  N/A

• Warning signs and rumble strips are being<br>used, when necessary, if the site is near a<br>roadway?

  Yes

  No

  N/A

• Cones and flaggers are used to divert traffic,<br>when necessary?

  Yes

  No

  N/A

• Ensure chainsaws are operated and maintained onsite, per the operator’s<br>manual?<br>

  Yes

  No

  N/A

• Ensure all staff are trained prior to beginning work. (Training examples include<br>use of harnesses, belts, tree saddles, etc. Training also includes administering<br>first aid)?

  Yes

  No

  N/A

• Do workers carry the chainsaw properly when it’s not in use? (Below waist level,<br>with the engine off, and guide bar pointing down and to the rear?

  Yes

  No

  N/A

• Established exclusion zones to ensure workers and the public are kept at a safe distance from falling objects?

  Yes

  No

  N/A

MACHINE GUARDING AND MECHANICAL SAFETY

• Are emergency cut-of switches easily located and identified, and do employees know where they are?

  Yes

  No

  N/A

• Have employees been trained in how to work safely around machines?

  Yes

  No

  N/A

• Have employees been told to report missing machine guards to their supervisors?

  Yes

  No

  N/A

• Do machines have guards on them?

  Yes

  No

  N/A

• Conduct regular inspections of all tree service equipment, such as chainsaws, chippers, and aerial lifts, to ensure they are in proper working condition.

  Yes

  No

  N/A

Innoworks Support Questions

• Do you currently utilize the Innoworks-provided AFLAC plan to reduce false Worker’s Comp claims (free of charge)

  Yes

  No

  N/A

• Would you like more information on this plan and how it can help reduce costs?

  Yes

  No

  N/A

• Would you like more information on other Innoworks-provided services, such as medical insurance benefits and 401(K)?

  Yes

  No

  N/A

• What would you like more information about?

  Medical Benefits

  401K

SIGNATURE

• Site Safety Rep Signature

  Sign