Skeleton Safety Inspection

Client Details Pre Visit

• Client name & ID

• Conducted on

  Date

• Policy start date

  Date

• Total # of claims to date

• Total # of open claims

• Total # of employees

• WC Codes currently in use

• NAICS

• FEIN

• States operating in

• Prepared by

• Location
  Address

Confirmation Questions

• Does the total number of employees seem accurate?

  Yes

  No

  N/A

• Do the current worker’s comp codes seem accurate?

  Yes

  No

  N/A

• Are the states the client operates in accurate?

  Yes

  No

  N/A

• Does the NAICS seem accurate?

  Yes

  No

  N/A

• Areas of concern the business contact has surrounding safety/WC that they want inspected for sure before the end of the visit.

Site Visit Questions

• Do you currently have an existing and updated IIPP?

  Yes

  No

  N/A

• Would the client be interested in additional help in this area?

  Yes

  No

  N/A

• Do you currently have an existing and updated Emergency Action Plan?

  Yes

  No

  N/A

• Would the client be interested in additional help in this area?

  Yes

  No

  N/A

• Do you currently have a Safety Committee?

  Yes

  No

  N/A

• How frequently do they meet?

  Weekly

  Quarterly

  Semi-annually

  Other

• Would you like more information on this?

  Yes

  No

  N/A

• Do you currently have an updates SDS Binder?

  Yes

  No

  N/A

• Would you like some assistance in setting one up?

  Yes

  No

  N/A

• Has client been sited by OSHA in the last year?

  Yes

  No

  N/A

• Do you have a return to work program in place?

  Yes

  No

  N/A

• Are all proper OSHA & labor laws posted and completed

  Yes

  No

  N/A

PPE

• Is personal protective equipment (PPE) provided as needed (coveralls, gloves, eye protection, respirators, earplugs, etc)?

  Yes

  No

  N/A

• Are employees wearing PPE correctly?

  Yes

  No

  N/A

• Is PPE cleaned, maintained, and stored properly?

  Yes

  No

  N/A

• Are multiple sizes of PPE available to different workers?

  Yes

  No

  N/A

• Have workers using PPE been trained in its proper use?

  Yes

  No

  N/A

• Work areas have readily accessible first aid kits that are properly stocked?

  Yes

  No

  N/A

Fire Safety

• Are all fire extinguishers currently up-to-date on their monthly checks?

  Yes

  No

  N/A

• Who is responsible for monthly safety inspections of Fire Extinguishers?

• Are the fire alarm system and sprinkler system regularly tested?

• Are there regular fire drills?

• Smoking policy in place?

• Is there a sprinkler system in place?

  Yes

  No

  N/A

• What company is responsible for completing sprinkler system checks?

  Yes

  No

  N/A

• How often does the 3rd party company check the system?

  Yes

  No

  N/A

FLOORS AND WALKWAYS

• Are walkways and stairways kept clear of obstructions?

  Yes

  No

  N/A

• Are buckets and mops available to clean up spills so no one will slip?

  Yes

  No

  N/A

• Are non-slip mats, grates, or slip-free coatings used in wet areas to revent falls?

  Yes

  No

  N/A

• Do stairways have handrails?

  Yes

  No

  N/A

• Are carpets and rugs causing a potential trip hazard?

  Yes

  No

  N/A

Ergonomics and Manual Handling

• Proper lifting techniques to prevent strains and sprains?

  Yes

  No

  N/A

• Use of mechanical aids and equipment to reduce manual handling tasks?

  Yes

  No

  N/A

• Stretching and warm-up exercises to prevent injuries?

  Yes

  No

  N/A

Innoworks Support Questions

• Do you currently utilize the Innoworks-provided AFLAC plan to reduce false Worker’s Comp claims (free of charge)

  Yes

  No

  N/A

• Would you like more information on this plan and how it can help reduce costs?

  Yes

  No

  N/A

• Would you like more information on other Innoworks-provided services, such as medical insurance benefits and 401(K)?

  Yes

  No

  N/A

• What would you like more information about?

  Medical Benefits

  401K

SIGNATURE

• Site Safety Rep Signature

  Sign