Post-accident procedure audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Accident Investigation

• Are ALL employee injuries reviewed for corrective actions?

  Yes

  No

  N/A

• What percentage of injuries are reviewed for corrective actions?

• Is an accident investigation form completed for each employee injury?

  Yes

  No

  N/A

• Does the accident investigation form identify root causes that led to the employee injury?

  Yes

  No

  N/A

• Does the accident investigation document have a section for corrective actions?

  Yes

  No

  N/A

• Is there a safety committee in place to review accidents?

  Yes

  No

  N/A

• Would you like assistance starting a certified safety committee?

  Yes, I'd like to start a safety committee.

  Not at this time.

  Possibly. Let me think about it.

• Does the safety committee discuss and document corrective actions?

  Yes

  No

  N/A

Return-to-Work

• Can modified duty be accommodated within the injured workers department?

  Yes

  No

  N/A

• If accommodation can't be made in the injured employees regular department, can you transition an injured worker to a different department?

  Yes

  No

  N/A

• Has a list of modified duty tasks been developed?

  Yes

  No

  N/A

• Has a policy statement been developed that communicates to employees your Return-to-Work commitment after a workplace injury has occurred?

  Yes

  No

  N/A

• Has the policy been reviewed and signed by all current employees and new hires?

  Yes

  No

  N/A