DFSP Safety Review Company name Policy number This safety review is intended to help employers evaluate their safety processes and identify opportunities for improvement. The following categories are critical elements in an effective safety and health process. Please read each of the statements below and select the rating that best represents how your company currently manages that issue. BWC will provide a list of suggested activities and available resources when the safety review is completed. If you would like personal assistance completing the safety review or implementing any of the suggested activities, please call the Division of Safety & Hygiene - Call Center @ 1-800-OHIO-BWC. A BWC safety consultant is available to assist. Rating Scale 1 = Never; 2 = Rarely; 3 = Sometimes; 4 = Consistent; 5 = Always Accident analysis The methods of gathering and analyzing accident information, determining root causes and identifying safety improvements to prevent future accidents. 1. Supervisors document incidents and conduct complete accident analysis in a timely period. 1 2 3 4 5 2. Supervisors determine root causes and recommend management changes. 1 2 3 4 5 3. Supervisors develop meaningful and lasting corrective action plans. 1 2 3 4 5 4. Supervisor and managers analyze injury/illness data to identify causes and trends. 1 2 3 4 5 5. Top management (President/CEO) regularly reviews accident trends and worker compensation costs. 1 2 3 4 5 Avg. Score Management commitment The systems that controls the safety culture, roles of managers, company policy, management active participation and procedures. 1. Management has a policy that establishes safety and health as a core value. 1 2 3 4 5 2. Managers allocate the resources needed to support the organization’s safety and health efforts. 1 2 3 4 5 3. Top management is involved in the planning and evaluation of the company’s safety performance. 1 2 3 4 5 4. Management provides leadership and actively participates in the safety process. 1 2 3 4 5 5. Safety is considered equally with production, service and quality in the operations. 1 2 3 4 5 Avg. Score Accountability Company evaluation of safety performance, safety reinforcement, defined expectations for safety activities, management identifies safety activities for supervisors, measures activities and holds supervisors accountable. 1. Safety and health program tasks are specifically assigned for performance and coordination. 1 2 3 4 5 2. Individuals with assigned responsibilities have the skills, knowledge and resources to perform their duties effectively. 1 2 3 4 5 3. Safe behavior is recognized and reinforced through personal contact or written praise. 1 2 3 4 5 4. Supervisors have established activities for safety and safety is included in performance reviews. 1 2 3 4 5 5. Supervisors conduct daily safety inspections, correct safety hazards and recognize good safety behavior. Avg. Score 1 2 3 4 5 BWC-1585 (pg. 1 of 2) DFSP-2 American LegalNet, Inc. www.FormsWorkFlow.com Hazard control The process to identify and correct unsafe acts and unsafe conditions. 1. Employees are encouraged to promptly report all safety hazards and unsafe acts. 1 2 3 4 5 2. Effective safety inspections are performed regularly. 1 2 3 4 5 3. Identified hazards are corrected in a timely fashion. 1 2 3 4 5 4. Supervisors promote safe behaviors and hazard prevention before an injury occurs. 1 2 3 4 5 5. Hazards are reviewed for permanent solutions such as engineering and administrative controls. 1 2 3 4 5 Avg. Score Safety education Safety training is integrated into overall operations, including all levels of management, skills are assessed. 1. Individuals with assigned safety responsibilities have the necessary knowledge and skills to complete assigned tasks. 1 2 3 4 5 2. Employees and supervisors receive safety orientation and specific safety training including all OSHA required training. 1 2 3 4 5 3. Supervisors and managers are trained in safety observations, coaching and mentoring techniques to promote safety. 1 2 3 4 5 4. Employees are informed of all potential hazards in their jobs and provided documented safe work practices. 1 2 3 4 5 5. Supervisors are knowledgeable of the potential hazards and the safe practices for all jobs they supervise. Avg. Score 1 2 3 4 5 Employee participation The extent the employees participate in and are encouraged to be involved in the safety of the workplace. 1. Employees actively participate in the safety process and are involved in safety improvement decisions. 1 2 3 4 5 2. A safety committee/team is established with employee participation. 1 2 3 4 5 3. Management achieves open communications and encourages employees to make suggestions and raise safety concerns. 1 2 3 4 5 4. Employees are formally involved in safety goal setting and safety process improvements. 1 2 3 4 5 Avg. Score 5. Employees are encouraged to shut down unsafe machinery, equipment or stop an unsafe work process. 1 2 3 4 5 Safety culture The management style, operational environment, social norms, company systems, values, accountability and responsibility. 1. Trust and open communication on safety issues is achieved in the operations. 1 2 3 4 5 2. Communication is effective and flows well in all directions of the organization. 1 2 3 4 5 3. Teaming concepts achieves involvement and cooperation in safety activities. 1 2 3 4 5 4. Safety responsibilities and accountabilities are clearly defined within all aspects of the company. 1 2 3 4 5 Avg. Score 5. Safety activities are established from the CEO to the employee level and are clearly tracked and measured. 1 2 3 Completed by 4 5 Job title X Employer’s Signature BWC-1585 (pg. 2 of 2) DFSP-2 Date signed American LegalNet, Inc. www.FormsWorkFlow.com