Title Page

  • Site conducted

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

WC Audit

Human Resources

  • Is there a policy on reporting accidents?

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

  • Obtain copy of policy

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

  • If yes, obtain NAME

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

  • Is the Accident Report completed by the injured employee?

  • Is accident trending performed?

  • Who is the trending shared with?

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

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

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

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

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

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

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

  • Is there a budget for safety equipment or devices?

  • Is there patient transfer equipment available?

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?

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

  • What type of patient transfer equipment is available?

  • What type of patient transfer equipment is available?

  • Are employees with repeat accidents monitored?

Facility Assessment

Chief Executive Officer

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

  • Select from range

Safety Culture

Morale of Facility

  • Select from range

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.