Safety Services: RMA Risk Management Assessment

• Conducted on:

  Date
• Location:
  Address

• Policy name and Policy number:

• Contact name and Contact Number:

• Safety Consultant:

1. Management Commitment

• 1a. Direct commitment and participation by the highest-level of upper management.

  1

  2

  3

  4

  N/A

• 1b. Involved in developing goals and measuring results of a safety program

  1

  2

  3

  4

  N/A

• 1c. Based on results, hold supervisors accountable for those they supervise

  1

  2

  3

  4

  N/A

• 1d. Support of safety coordinator/committee

  1

  2

  3

  4

  N/A

• 1e. Budget provided for resources and training

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  2

  3

  4

  N/A

2. Safety Coordinator/Committee

• 2a. Competent safety person-education and authority

  1

  2

  3

  4

  N/A

• 2b. Safety commitment that meets regularly, with documentation

  1

  2

  3

  4

  N/A

• 2c. Employees are involved in making recommendations for improvement to the safety progra

  1

  2

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  4

  N/A

• 2d. Monitor employees and enforces safety program

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  4

  N/A

3. Safety Program

• 3a. A Job Hazard Analysis (JHA) has been performed to develop a safety program, and addressed OSHA required programs and PPE

  1

  2

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  4

  N/A

• 3b. Basic safety program that meets the criteria for Cost Containment Certification and is effectively implemented and reviewed annually

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  4

  N/A

• 3c. Safety rules and policies are enforced, documented and reviewed by:<br>-Safety coordinator<br>-Direct supervisor <br>-Upper management

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  4

  N/A

4. Training

• 4a. New-hire orientation is conducted and documented

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  4

  N/A

• 4b. Routine safety training is conducted and documented:<br>-weekly<br>-monthly<br>-quarterly

  1

  2

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  4

  N/A

• 4c. Training for required OSHA programs is conducted and documented

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  N/A

• 4d. Employees demonstrate competency with regards to the safety training

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  N/A

5. Claims Management

• 5a. Formal claims management procedures developed and implemented

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  4

  N/A

• 5b. Written designated of medical providers:<br>-Employee notification letter<br>-Letter to injured

  1

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  4

  N/A

• 5c. Formal return to work program- developed and implemented

  1

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  4

  N/A

6. Accident Investigation

• 6a. Formal accident investigation that identifies root cause:<br>-Employee accident report<br>-Management accident investigation form

  1

  2

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  4

  N/A

• 6b. Direct supervisor participates in the investigation, corrective actions and follow up, including additional training

  1

  2

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  4

  N/A

• 6c. Injury trends are identified using loss history reports

  1

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  4

  N/A

7. Business Investigation

• 7a. Radius of operation
  Address

• 7b. Hours of business

• 7c. Number of shifts

• 7d. Number of employees

• 7e. Classifications of employees

• 7f. Basic hiring practices

• 7g. Do you have a wellness program? If not, would you be interested in one?

• General comments

• Safety Consultant Signiture

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