Risk Score (General)

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Select the statement that best reflects the current status of your business:

1-Opportunity for Improvement
2-Average
3-Industry Leading
Your Risk Score reflects how you compare to Industry Leading Practices.
A Risk Score between 50%-83% is in the average range.

Management Leadership and Employee Participation

Question #1 Management & Leadership 0

1: Management demonstrates no policy, goals, objectives or interest in safety and health issues. 2: Management follows all safety and health guidelines, and gives visible support to the safety and health effort. 3: Management clearly demonstrates, (by involvement, support and example) the importance of safety and health for everyone in the organization. Safety and health issues are regularly included on agendas of management operations meetings.
Comments and Observation

Question #2 Workforce Participation

1: The workforce is not encouraged to participate in safety and health concerns. Incentive programs are in place that have the effect of discouraging reporting incidents, injuries, or potential hazards. 2: The workforce is involved in the safety and health program, in inspection of work area, and are permitted review results. A documented policy and procedure is in place for expressing concern on hazards and receiving timely employer response. 3: The workforce participates fully in the development and implementation of the safety and health program and content of training and education. Workers participate in audits, program reviews conducted by management and have the necessary formal training and education to participate in such reviews.
Comments and Observation

Question #3 Tools used to Implement

1: Tools necessary to implement a safety and health program are inadequate or missing. 2: Tools necessary to supplement a safety and health program are available, but not effectively used. 3: Tools necessary to supplement a good safety and health program are available and effectively used.
Comments and Observation

Question #4: Safety Focus

1: The workplace safety and health program is directed primarily at full time employees with little additional consideration for non employees. 2: The workplace safety and health program is focused primarily on employees with some consideration given to the safety of non employees such as visitors. 3: The workplace safety and health program reliably ensures protection of everyone employed at the work site including full-time employees, contractors, temporary part-time workers, vendors, visitors, etc.
Comments and Observation

Question #5: Executive Goal Setting

1: Executives provide little in the way of setting safety goals and those that are used are quantitative only. 2: Executives provide goal setting using trailing indicators such as EMR, OSHA RIR, injury frequency/severity, etc. 3: Executives provide goal setting (using leading as well as trailing indicator measurements) and leadership to the safety effort.
Comments and Observation

Question #6: Safety Coordinator

1: A safety coordinator or committee has not been named or formed to promote safety. 2: A safety coordinator is responsible for safety or safety committee has been formed and perhaps meets periodically, but lacks direction and is ineffective. 3: A safety coordinator or safety committee is supported and is provided adequate resources, including the periodic use of outside experts, to be effective. The committee is chaired by someone from management that has broad decision making authority.
Comments and Observation

Question #7: Medical Clinics

1: Medical clinic(s) have been identified for injury care, but there is no involvement of the occupational medical provider in terms of worksite analysis. 2: There is open communication with the occupational clinic but the medical professional(s) haven't been on site to see the tasks first hand. 3: Occupational medical provider assists with on-site hazard analysis including assistance with matching job demands with job descriptions.
Comments and Observation

Question #8: Safety Budget

1: There is no formal safety budget. Supervisors must seek permission before spending money on safety equipment or training. 2: The safety budget is not well understood by supervisors but the generally get what they ask for in terms of equipment and training for their departments. 3: Safety and health budgets and funding procedures are reviewed periodically for adequacy.
Comments and Observation

Question #9: Measurement of Safety Culture

1: There is no formal measurement of the safety culture of the organization. 2: Management has some clues regarding the safety culture via employee communication forums such as employee meetings or suggestion boxes. 3: Analyses (gap analysis, safety perception surveys, etc.) done periodically to assess the safety climate and results used at the executive level.
Comments and Observation

Question #10: Safety Incentives

1: Safety incentive program are used which measure injury rates and other trailing indicators. 2: Safety incentive programs are used that measure leading indicators but the rewards are far removed (in time) from the results. 3: Safety incentive programs, if used, measure leading indicators and are used narrowly to create safety awareness and are changed periodically. Alternatively, safety incentive programs are not used.
Comments and Observation

Workplace Analysis

Question #11: Hazard Analysis

1: No system or requirement exists for hazard review of planned/changed/new operations. There is no evidence of a comprehensive survey for safety or health hazards or for routine job hazard analysis. 2: Process, task, and environmental surveys are conducted by knowledgeable person. Current hazard analyses are written for high-hazard jobs and communicated to affected employees. 3: Regular, written surveys included documented comprehensive workplace hazard evaluations are conducted by qualified safety people. Corrective actions are documented and tracked.
Comments and Observations

Question #12: Workplace Safety Inspections

1: No physical workplace inspection is conducted. 2: A knowledgeable person conducts inspections with involvement of employees. Items in need of correction are documented. 3: Workplace inspections are planned and overseen by a qualified safety professional. Random compliance audits are conducted with all elements of the safety and health program being evaluated. Observations are analyzed to evaluate progress.
Comments and Observations

Question #13: Safety Rules

1: Safety rules have been defined but little exists in the way of training or enforcement. 2: Safety rules are in place and sometimes posted, but no formal step by step safety analysis is done on job tasks. 3: Job hazard analyses are used to evaluate hazards and identify controls both from a major operations standpoint as well as an individual worker's daily hazard assessment.
Comments and Observations

Question #14: Hazard Reporting

1: No formal hazard reporting procedure exists, or employees are reluctant to report hazards. 2: A formal system for hazard reporting exists. Employee reports of hazards are documented, corrective action is scheduled and records maintained. 3: Management responds to reports of hazards in writing within specific time frames. The workforce readily identifies and self corrects hazards with full support of management.
Comments and Observations

Hazard Prevention and Control

Question #15: Hazard Control

1: Hazard control is seriously lacking or absent from the facility. 2: Hazard controls are in place for significant hazards. Some serious hazards may exist. 3: Hazard controls are in place, known and supported by the workforce, with a focus on engineering controls.
Comments and Observations

Question #16: Preventive Maintenance

1: No preventive maintenance program is in place. 2: A preventive maintenance schedule is implemented for areas where it is most needed. Safety device checks are documented. 3: There is a comprehensive, written and enforced safety and preventive maintenance program in place.
Comments and Observations

Question #17: Supervisory Involvement

1: Supervisors are uninvolved in worksite hazard analysis and any discipline for safety is done post injury, not prior to an injury occurring 2: Supervisors participate sporadically in work site safety analysis but the effort is in tandem with other activities and not focused on safety. 3: Supervisors participate fully in the work site hazard analysis, ensure physical protection, reinforce training, and enforce discipline.
Comments and Observations

Question #18: Ergonomics

1: Ergonomic loss prevention is not given much attention. "It's a hard job" is the prevailing attitude. 2: Supervision is responsive to ergonomics but operates in a reactive mode to employee complaints 3: Ergonomic injury prevention efforts are integrated into the work habits. (Such as MoveSMART, ErgoMed or Stretch n Flex, Pre-Care)
Comments and Observations

Question #19. Medical Monitoring

1: Employer is unaware of, or unresponsive to medical needs. Required medical surveillance, monitoring, and reporting are absent or inadequate. 2: Medical surveillance and reporting comply with applicable standards. Employees report early signs/symptoms of job-related injury or illness and receive appropriate treatment. 3: Healthcare providers provide follow-up on employee treatment protocols and/or involved in the hazard identification and control process.
Comments and Observations

Question #20: Drug/Alcohol Testing

1: No drug/alcohol testing is done beyond prehire. 2: Pre-employment and post injury alcohol/drug testing is done. No drug abuse awareness training is done. 3: Employer requires pre-employment, post injury, for-cause as well as random drug and alcohol testing.
Comments and Observations

Contractor and Vendor Management

Question #21: Contracts

1: Contracts and purchase orders are not considered high important. Some agreements are written and others are verbal. 2: Agreements are used for larger providers of services and the insurance provisions are not verified. 3: All contracts/purchase orders are reviewed by a competent resource before signing to ensure that insurance provisions are well understood.
Comments and Observations

Question #22: Contract Review

1: Contracts and purchase orders are not reviewed for the indemnity/hold harmless provisions. 2: Some contracts and purchase order provisions are reviewed but there is no system to monitor what is signed and what is not. 3: Checks and balances are in place to ensure desired indemnity language and hold harmless provisions.
Comments and Observations

Question #23: Additional Insured Status

1: Additional insured provisions in contracts are not highly important and discounted. 2: Additional insured provisions are reviewed on larger contracts, but not others. 3: A formal system is in place for monitoring certificates of insurance for desired limits and additional insured provisions.
Comments and Observations

Question #24: Contractor Prequalification

1: Lowest bid is the primary consideration 2: Some prequalification requirements are in place but disqualification is applied with inconsistent criteria. 3: A thorough system is in place for the prequalification of contractors, including safety metrics such as EMR, safety program, OSHA recordable rates, OSHA citation history, etc.
Comments and Observations

Emergency Response

Question #25: Emergency Preparedness

1: Little or no effective effort to prepare for emergencies. 2: Emergency response plans have been prepared by persons with specific training. Appropriate alarm systems are present and employees are trained in emergency procedures. 3: There is a designated emergency response team with adequate training in the workplace. The plan is formally reviewed by the local fire department and reevaluated at least annually.
Comments and Observations

Question #26: First Aid

1: Neither on-site nor nearby community aid can be ensured. 2: Personnel have appropriate first aid skills specific to the likely hazards are available. 3: Medical treatment providers are identified in advance and site personnel are trained in first aid and/or emergency medical care.
Comments and Observations

Question #27: Crisis Management

1: There is no formal crisis management plan nor has one been considered. 2: The feasibility of a crisis management plan has been formally evaluated but a decision has been made to not implement. 3: A crisis management plan is in place and employees are aware of the protocol/procedures as well as their personal responsibilities in the event of a crisis.
Comments and Observations

Safety and Health Training

Question #28: Safety Training

1: Facility depends on experience and peer training to meet safety and health training needs. Managers/supervisors demonstrate little or no involvement in safety and health training duties. 2: Training includes OSHA rights and access to information. Training required by applicable standards is provided to all site employees with supervisors in attendance. Training records are kept. 3: Knowledgeable persons conduct safety and health training that is scheduled, assessed and documented. Retrievable record keeping system provides for appropriate employee retraining, makeup training and modifications to training as a result of formal evaluations.
Comments and Observations

Question #29: New Hire Safety Training

1: New hire safety training consists of some remarks from mgmt about safety, given a handbook to read/sign and then put to work. 2: New hire safety training involves some formal classroom training, and records are kept of such. 3: New hires and transfer employees are provided substantial formal safety training prior to starting their job.
Comments and Observations

Question #30: On-going Safety Training

1: A short safety orientation is provided for new employees but ongoing safety training is not provided 2: Ongoing safety training is provided on an irregular basis. 3: Ongoing safety training is provided for all production employees on a frequent and consistent basis.
Comments and Observations

Question #31: Supervisory Safety Training

1: Managers/supervisors are provided no ongoing safety training. 2: Managers/supervisors are irregularly provided with safety training specific to their role as supervisors. 3: Managers/supervisors are provided with an increased breadth and depth of safety training than that provided to production employees.
Comments and Observations

Financial and Incident Record Analyses

Question #32: Accident Reporting

1: Injuries requiring medical treatment are reported, but near misses and minor injuries are generally not reported. 2: OSHA-101 is completed for all recordable incidents and the 300 log is current. 3: Injuries/illnesses are promptly reported as are near misses and other significant occurrences.
Comments and Observations

Question #33: Accident Investigation

1: Accident investigations are informal and not written. 2: Accident investigations are primarily for claims reporting purposes and there is no formal mechanism for follow-up. 3: The incident investigation is formal and thorough with written follow up until root causes are identified and corrected.
Comments and Observations

Question #34: OSHA Injury/Illness Data

1: Little or no review of injury/illness records is done to identify trends. 2: Injury/illness logs and exposure records are kept correctly and reviewed by top management. 3: Information gleaned from injury/illness logs is analyzed and shared with management and supervisors.
Comments and Observations

Question #35: Experience Modification Rate

1: The EMR is vaguely familiar to the client but not fully appreciated. 2: The impact of the EMR is understood but not thought to be controllable or affected by the client. 3: Workers' compensation EMR analysis is completed annually to verify accuracy and evaluate the effect of deductibles.
Comments and Observations

Question #36: OSHA Incidence Rate

1: OSHA frequency/severity rates are not calculated or well understood 2: OSHA incidence rate is average or worse but well understood 3: OSHA frequency and severity rate is well understood and is below industry average.
Comments and Observations

Question #37: Loss Analysis

1: Loss data is not analyzed or well understood 2: Loss data is inconsistently reviewed but understood 3: Loss data trends are fully analyzed and communicated.
Comments and Observations

Hiring Procedures

Question #38: Job Applications

1: A written job application is required by no verification is done. 2: A written job application is required and past employment is verified. 3: Written job applications required and reference checked of all desired candidates.
Comments and Observations

Question #39: Use of Psychometric Testing

1: No pre-employment "psychometric" testing is done on applicants and has not been considered. 2: Providers have been evaluated but not used. 3: Pre-employment testing includes "psychometric" testing such as Integrity Testing, Job Candidate Profiling or other predictive analysis.
Comments and Observations

Question #40: Pre-placement Medical Exams

1: No pre-placement medical testing is done and has not been considered. 2: Providers have been evaluated but not used. 3: Pre-placement testing such as physicals, functional capacity analyses, range of motion testing, CRT, etc.
Comments and Observations

Post Injury Procedures

Question #41: Post Injury Drug Testing

1: No post injury drug testing is done nor has it been considered. 2: Providers have been evaluated but not used. 3: Post injury drug/alcohol testing in place for all medical clinic cases.
Comments and Observations

Question #42: Return-to-Work

1: There is no formal or informal return to work program in place 2: A return to work program is in place but it is used when convenient. 3: An aggressive return-to-work procedure in place with a designated person on staff to handle such.
Comments and Observations

Question #43: Injury Management

1: Injured workers seek their own medical treatment with no follow up by the employer. 2: Injured workers are directed to desired clinics but not accompanied. 3: Supervisor accompanies the injured worker to the treatment clinic.
Comments and Observations

Question #44: Communication with Clinic

1: Staff person waits for communication from the clinic and there is no sense of urgency on the part of the employer. 2: Staff person receives information on treatment from clinic and does little with such information. 3: Staff person forces communication with clinic and claims adjuster.
Comments and Observations

Question #45: Authorization for Treatment

1: Employee is instructed to seek treatment and the Workers' Compensation Claim Adjuster will advise employee on how to get treatment properly billed. 2: Employer provides injured worker with the name, policy number and phone number for their WC carrier to provide to the clinic. 3: Employer provides an Authorization for Treatment which includes the Workers' Compensation carrier, insurance policy number, designated provider and follow up procedures for the injured worker.
Comments and Observations

Question #46: Claim Coordinator

1: Employer does not have a designated person to manage WC claims. 2: Employer has a designated person to contact in case of a WC injury; however, this is one of the many tasks for which this individual is responsible and isn't highly engaged in the claim process. 3: Management has designated a person as a claim coordinator within the organization which is supported by upper management and provided adequate resources to make this role effective.
Comments and Observations

Question #47: WC Claim Tracking

1: Employer does not track their WC claims. 2: Employer tracks their high exposure or lost time claims. 3: Employer has an internal tracking system for monitoring WC claims.
Comments and Observations

Automobile Liability Analysis

Question #48: Driver Selection

1: Employees are permitted to use company vehicles or their own vehicles on company business with little or no selection criteria. 2: Drivers of company and personal vehicles are subject to some purposeful selection criteria but it is applied inconsistently or only at time of hire with no periodic follow-up. 3: Drivers of company vehicles and personal vehicles used for company business are selected after a review of past MVR history and checked against a minimally acceptable criteria. MVR's are checked at least annually and compared to criteria.
Comments and Observations

Question #49: Driver Training

1: No initial or ongoing driver training is provided for those who drive company vehicles or personal vehicles on company business. 2: Driver training is provided at time of hire but not thereafter for those who drive company vehicles or personal vehicles on company business. 3: Drivers of company vehicles or those who driver personal vehicles on company business are provided with driver training at least once every few years.
Comments and Observations

Question #50: Technology Solutions

1: Technology solutions have not been considered and are not used. 2: Technology solutions have been considered but not implemented. 3: Technology solutions are used to evaluate driver safety performance. (DriverCam, OBDI port monitoring, Geomonitoring, phone disabling software, etc)
Comments and Observations