Safety Management Self-Assessment Company name Policy number Industry type Total number of employees This assessment is intended to help employers evaluate their safety and claims management systems and identify opportunities for improvement. It should be completed by the person(s) in the organization who is most familiar with the current safety and claims management process. Please read each of the statements below and select the rating that best represents your level of agreement with that statement. The estimated time to complete this assessment is 15 minutes. Upon completion of the assessment, please refer to the Resource Guide on the Industry-Specific Safety Program page for a list of suggested activities and BWC Division of Safety & Hygiene resources you can use in the areas you wish to improve. If you would like personal assistance completing the safety review or implementing any of the suggested activities, please call 1-800-644-6292. Rating scale: 1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, NS = not sure A. Management commitment ­ The level of commitment that management demonstrates to the safety and health process 1. A concise, documented policy that establishes safety and health as a core value that is equally important as production, service and quality has been communicated to all employees by top management. n 1 n 2 n 3 n 4 n NS 2. Management allocates adequate time and resources to support the organization's safety and health efforts. n 1 n 2 n 3 n 4 n NS 3. Top management establishes safety and health program goals, and regularly evaluates and communicates the organization's safety performance. n 1 n 2 n 3 n 4 n NS B. Accountability ­ The process that is used to assign safety and health management responsibilities and to evaluate, recognize and reward performance 1. Safety and health responsibilities are assigned to the appropriate personnel and are specifically addressed in the performance review of each employee. n 1 n 2 n 3 n 4 n NS 2. Individuals with assigned safety and health responsibilities are provided with the skills, knowledge, resources and authority to perform their duties effectively. n 1 n 2 n 3 n 4 n NS 3. Supervisors conduct regularly scheduled safety inspections, safety briefings, observations, coaching and other assigned activities. n 1 n 2 n 3 n 4 n NS Employee participation ­The extent to which the employees participate in and are encouraged to be involved in the safety and health of the workplace 1. Opportunities are provided for employees to participate in the safety process through activities such as safety committee meetings, safety team projects and safety awareness event planning. n 1 n 2 n 3 n 4 n NS 2. Employees are involved in safety goal setting, strategy development and safety process improvements. n 1 n 2 n 3 n 4 n NS 3. Employees actively participate in safety and health training by identifying needed training topics, assisting with development and delivery of training, and assisting with on-the-job training and mentoring of new employees. n 1 n 2 n 3 n 4 n NS Safety culture ­ The organizational values, management style, environment and social norms related to safety and health 1. The organization fosters trust and open communication on occupational safety and health issues by encouraging discussion and feedback on all issues that are raised. n 1 n 2 n 3 n 4 n NS 2. Collaboration and teaming on safety and health projects, activities and goals are used to ensure involvement and support from people in all areas. n 1 n 2 n 3 n 4 n NS 3. Employee safety and health issues are a standard topic of discussion in all organizational meetings and an essential consideration in all business decisions. n 1 n 2 n 3 n 4 n NS 1 | Page American LegalNet, Inc. www.FormsWorkFlow.com C. D. BWC-6625 (Rev. 3/19/2012) SH-26 Rating scale: 1 = strongly disagree, E. 2 = disagree, 3 = agree, 4 = strongly agree, NS = not sure Hazard prevention and control ­ The process to identify and correct unsafe acts and unsafe conditions 1. Employees at all levels are encouraged to promptly report safety and health hazards and unsafe acts to their supervisor and/or safety contacts for follow-up action. n 1 n 2 n 3 n 4 n NS 2. Safety inspections are performed regularly to identify unsafe acts, and conditions and hazards are effectively eliminated or minimized in a timely fashion. n 1 n 2 n 3 n 4 n NS 3. New equipment, tools, materials and methods are evaluated before purchase, implementation and use to ensure that they do not create safety and health hazards n 1 n 2 n 3 n 4 n NS Safety and health training and education ­ The process of making sure that safety education and training is provided to people at all levels and that skills are assessed to ensure understanding 1. Individuals at all levels in the organization receive the appropriate level of job-specific safety training along with all OSHA required training and a thorough explanation of the organization's safety and health management process, opportunities to participate and expectations for performance. n 1 n 2 n 3 n 4 n NS 2. Supervisors and managers are knowledgeable with regard to the potential hazards and the safe practices for all jobs they oversee and are trained in safety observations, coaching and mentoring techniques to promote safe and healthy work practices. n 1 n 2 n 3 n 4 n NS 3. Employees are informed of all potential hazards in their jobs, provided with documentation of safe work practices, and periodically evaluated to ensure understanding and compliance. n 1 n 2 n 3 n 4 n NS F. G. Accident analysis ­ The method of gathering and analyzing information and accident facts, determining root causes, and identifying safety improvements to prevent future accidents 1. Supervisors document accidents, incidents and near misses, and conduct thorough accident analysis in a timely manner. n 1 n 2 n 3 n 4 n NS 2. Supervisors work with safety coordinators and employees to determine root causes of accidents and near misses to ensure that effective corrective actions are taken. n 1 n 2 n 3 n 4 n NS 3. Top management regularly reviews accident trends and workers' compensation costs and uses the information to help develop goals and objectives. n 1 n 2 n 3 n 4 n NS H. Workers' compensation claims management ­ The management process for ensuring timely filing of claims, care for the injured workers and minimizing the financial impact of claims on the organization 1. A clear and efficient pr