Vehicle/Driving Safety

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

• Is proper PPE provided to the employees ?

  Yes

  No

  N/A

Vehicle safety

• Vehicle are inspected to ensure proper functioning of brakes, lights, tires, wipers, and other essential components?

  Yes

  No

  N/A

• Schedule routine maintenance, such as oil changes and tire rotations, as per manufacturer recommendations?

  Yes

  No

  N/A

• Check fluid levels, including oil, coolant, and windshield washer fluid, and maintain them at recommended levels?

  Yes

  No

  N/A

Driving Safety

• Do you require all drivers to have a valid drivers license?

  Yes

  No

  N/A

• Employees wear seat belts and ensure all passengers are buckled up before starting the vehicle?

  Yes

  No

  N/A

• Avoid using mobile devices while driving. Are hands-free options available to make or receive calls?

  Yes

  No

  N/A

• Employees are maintaining a safe following distance, at least three seconds, from the vehicle in front?

  Yes

  No

  N/A

• Observing and obeying all traffic laws, including speed limits, stop signs, and traffic signals?

  Yes

  No

  N/A

• Taking regular breaks during long drives to stretch, rest, and rehydrate?

  Yes

  No

  N/A

• Are employees wearing PPE if needed?

  Yes

  No

  N/A

• Are employees encouraged to participate in defensive driving courses or other relevant driver training programs?

  Yes

  No

  N/A

• Does the client have adequate liability and comprehensive insurance coverage? This protects both the company and its passengers in the event of an accident.

  Yes

  No

  N/A

• Accurate records of driver logs, vehicle inspections, and maintenance are kept up to date?

  Yes

  No

  N/A

Hazardous Materials and Cargo

• Following all regulations for transporting hazardous materials?

  Yes

  No

  N/A

• Ensure proper loading and securing of cargo to prevent shifting or falling during transit?

  Yes

  No

  N/A

• Items are properly secure and balance the load to prevent shifting or falling during transport?

  Yes

  No

  N/A

• Appropriate straps, chains, or other securing methods to hold the load in place?

  Yes

  No

  N/A

• Using proper lifting techniques when loading and unloading cargo?

  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