QHC Workers Compensation Audit

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

WC Audit

Human Resources

• Is there a policy on reporting accidents?

  Yes

  No

  N/A

• Is there a policy that describes the Return to Work policy?

  Yes

  No

  N/A

• Obtain copy of policy

• Is there a dedicated staff member that manages the employee claims?

  Yes

  No

  N/A

• If yes, obtain NAME

• Is the TPA (Gallagher Bassett) contacted for assistance?

  Yes

  No

  N/A

• Is the Accident Report completed by the injured employee?

  Yes

  No

  N/A

• Is accident trending performed?

  Yes

  No

  N/A

• Who is the trending shared with?

• Is there a procedure required to investigate and/or follow up for causes of accidents?

  Yes

  No

  N/A

• Are the physical characteristics of the job included in the job description?

  Yes

  No

  N/A

• Is the employee health nurse involved in the accident PREVENTION program?

  Yes

  No

  N/A

• Is the Infection Control nurse involved in the accident prevention program?

  Yes

  No

  N/A

• Is there a annual education program provided to new employees that addresses safety AND accident prevention?

  Yes

  No

  N/A

• Is there an annual education program provided to existing employees based on TRENDS?

  Yes

  No

  N/A

• Are there methods to communicate safety issues to the staff?

  Yes

  No

  N/A

• Is there a budget for safety equipment or devices?

  Yes

  No

  N/A

• Is there patient transfer equipment available?

  Yes

  No

  N/A

Safety Program - Loss Prevention

Chief Nursing Officer

• Are Unit Directors or Supervisors held accountable at their annual performance evaluation for the frequency of accidents or safety record?

  Yes

  No

  N/A

• Is accident Prevention a part of annual education programs for the department/units?

  Yes

  No

  N/A

• What type of patient transfer equipment is available?

  Yes

  No

  N/A

• What type of patient transfer equipment is available?

  Yes

  No

  N/A

• Are employees with repeat accidents monitored?

  Yes

  No

  N/A

Facility Assessment

Chief Executive Officer

• How would you rate the morale of the hospital staff?

  Yes

  No

  N/A

• Select from range

Safety Culture

Morale of Facility

• Select from range