Information
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Client:
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Conducted on:
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Prepared by:
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Client representative(s) present during assessment:
Business Information
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Business operations:
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Operations include commercial new construction.
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Operations include commercial remodeling.
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Operations include commercial service/repair.
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Operations include residential new construction.
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Operations include residential remodeling.
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Operations include residential service/repair.
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Equipment used by workers:
- Hand tools
- Basic power tools
- Ladders
- Scaffolds
- Forklifts
- Cranes
- Aerial lifts
- Scissor lifts
- Other
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Other equipment used:
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Equipment new and/or maintained?
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Does the company use sub-contractors?
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Certificates of insurance are obtained and verified.
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Subcontractors are screened/pre-qualified for safety performance.
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Subcontractors screening/pre-qualification efforts include:
- Past OSHA violations
- OSHA incidence rates
- Verify subcontractor safety program
- Reputation/past experience
- Other
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Other subcontractor screening/pre-qualification efforts include:
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Radius of operations
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Out of state operations:
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Ownership change in the past year?
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Does this company have any secondary businesses?
Employee screening
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How does the company find applicants?
- Advertising (newspaper, Craigslist, etc.)
- Walk-ins
- Employee Referals
- Union
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Written applications required.
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Applications and/or written job descriptions list the essential functions of the job (climbing ladders, lifting and carrying up to 75 pounds, crawling).
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Criminal background checks conducted.
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Criminal checks performed:
- County records checked
- State records checked
- Federal records checked
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Workers compensation background checks conducted.
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Work references veriied.
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Integrity testing conducted.
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Pre-hire drug testing is conducted.
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Post-accident drug testing is conducted.
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Suspicion drug testing is conducted.
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Random drug testing is conducted. If yes, explain how many are tested how often.
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DOT drug testing guidelines are followed for CDL holders.
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Drug testing conducted per project contract, such as government projects.
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Post-offer/pre-placement physicals performed.
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MVR checks conducted.
Workforce
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Total number of employees:
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Number of unskilled laborers:
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Number of skilled (foremen, carpenters, jouneymen) craft workers:
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Number of full-time drivers:
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Number of mechanics:
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Number of office management and administration staff (sales, estimating, HR):
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Number of contract (1099) workers:
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Number of other workers (specify by job title):
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Company utilizes temporary and/or day labor.
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Labor is paid:
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Percentage of shifts worked that exceed 10 hours per day:
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Average annual turnover rate:
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Percent of employees who's primary language is not English:
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How are language barriers managed?
- Informally through bilingual co-workers
- Company documentation and training is bilingual
- Field supervision is bilingual.
- Safety coordinator is bilingual
Employee Benefits
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Is health insurance offered to emloyees?
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How soon are health insurance benefits available to employees?
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What percentage of premium does the company pay for the employee?
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What percentage of workers participate in healthcare coverage?
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Does the company offer a wellness program?
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Does the company offer an Employee Assistance Program (EAP)?
Safety Coordinator
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Designated safety coordinator in place with documented roles and responsibilities.
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Percentage of time safety coordinator commits to safety.
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Safety coordinator is in the field regularly to assess safety, correct unsafe conditions, assess/address needs for proper tools and PPE.
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Safety coordinator is knowledgeable in field operations, hazard identification, applicable regulatory requirements, and applicable safety controls.
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Safety coordinator has pursued professional development opportunities in the past year to improve technical expertise and effectiveness of safety efforts. If yes, list any training, seminars, or conferences attended.
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Safety coordinator has identified loss trends using insurance carrier loss history reports or other loss data in the last year.
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Written action plans based off of loss trends are developed and shared with management and/or safety committee for implementation.
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Other comments regarding safety coordinator:
Safety Program - Safety Training
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New Hire Safety Training
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Weekly toolbox talks documented.
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Daily safety huddles/task-hazard-analysis conducted.<br>
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Daily safety huddles/task-hazard analysis are documented and signed by crew.
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Routine company-wide safety meetings/training conducted:
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OSHA 10-Hour training is provided.
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OSHA 10-Hour training is provided to:
- Non-supervisory field employees
- Field supervisors/foremen
- Company-authorized operators
- Company-designated "competent persons"
- All company employees
- Safety coordinator
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OSHA 30-Hour training is provided.
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OSHA 30-Hour training is provided to:
- Non-supervisory field employees
- Field supervisors/foremen
- Company-authorized operators
- Company-designated "competent persons"
- All company employees
- Safety coordinator
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Documented scaffold competent person training is provided.
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Scaffold competent person training is provided to:
- Non-supervisory field employees
- Field supervisors/foremen
- Company-authorized operators
- Company-designated "competent persons"
- All company employees
- Safety coordinator
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Documented fall protection competent training is provided.
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Fall protecton training is provided to:
- Non-supervisory field employees
- Field supervisors/foremen
- Company-authorized operators
- Company-designated "competent persons"
- All company employees
- Safety coordinator
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Documented excavation competent person training is provided.
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Excavation competent person training is provided to:
- Non-supervisory field employees
- Field supervisors/foremen
- Company-authorized operators
- Company-designated "competent persons"
- All company employees
- Safety coordinator
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First aid training is provided.
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First aid training is provided to:
- Non-supervisory field employees
- Field supervisors/foremen
- Company-authorized operators
- Company-designated "competent persons"
- All company employees
- Safety coordinator
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CPR training is provided.
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CPR training is provided to:
- Non-supervisory field employees
- Field supervisors/foremen
- Company-authorized operators
- Company-designated "competent persons"
- All company employees
- Safety coordinator
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Documented forklift training is provided to company-authorized forklift operators.
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Other safety training is provided. If yes, list topics.
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Other comments regarding safety training:
Safety Program - Enforcement of Safety Rules and Safe Working Conditions
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Safety program includes a written safety rule enforcement policy.
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Workplace safety inspections
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Corrective actions are documented on inspection documents to verify completion.
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Safety violations
Safety Program - Safety Rules
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Safety rules are:
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Rules are reviewed and updated annually. Rules are dated to confirm last review/revision.
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Employees received training on rules updated over the past year.
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Other comments regarding safety rules:
Safety Program - Claims Management
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Formal claims management procedure in place.
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Claims procedure is company-specific (lists designated medical providers, policy number, claim reporting instructions)
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New hires are informed in writing of company's designated medical providers.
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Injured workers are informed in writing of company's designated medical providers.
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Other comments regarding claims management:
Accident Investigation
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Accident investigations are documented.
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Accidents are investigated by:
- Direct supervisor
- Safety coordinator
- Superintendent or project manager
- Top management of company
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Investigations identify contributing factors.
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Investigations identify root causes.
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Findings have stimulated changes in training, tools, processes, safety rules, or enforcement in the past year. If yes, provide specific example.
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Injured worker completes accident statement outlining event and injuries incurred.
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Other comments regarding accident investigation.
Return-to-Work
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Return-to-work implementation.
Evaluation Signature and Date
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Evaluator's signature: