Page 16 - Delaware Department of Insurance

Workplace safety program questionnaire
SAFETY PROGRAMS/PHILOSOPHY
1. Do you have a complete safety program with a written policy statement?
2. Who is your Safety Director/ Coordinator?
3. Do you have a safety committee?
4. How often do you conduct safety
meetings?
5. Do you follow OSHA records
keeping procedures?
(Please have your latest OSHA 300/300A log available.)
6. Do you maintain written programs on the following?
• Emergency Plan and Fire Prevention Plan
• Occupational Noise Program
• Tag/Lockout Program
• Chemical Hazard
Communication (MSDS)
• Driver/Vehicle Safety
• Industrial Truck Operators’
Program
• Respiratory Protection Program
• Personal Protective Equipment/
Clothing
• Lifting/ Back Safety
• Ergonomics
• Blood Borne Pathogens
• Portable ladders and stairway
safety training
• Scaffold Safety
• Fall Protection o. Cranes/Hoists
(material/personnel)
• Welding and Cutting
• Steel Erection
• Excavations
• Aerial Lifts
• Confined Space
• Drug & Alcohol
7. Which chemicals are commonly used in the workplace?
8. Please check any of the following tools you use to train your employees on safety:
• On the job supervised training • Videos
• Safety Seminars
• Safety Consultant
• Insurance Agent/Carrrier
• Other
9. What actions have you taken
within the last 6 to 12 months to enhance a safer work environment?
FIRST AID
1. Are emergency phone numbers posted in prominent places?
16 | Delaware Department of Insurance
2. Do you keep first aid supplies highly visible, close to employees, inspected and replenished continuously?
3. Do you have an AED kit on hand? 4. Are batteries and chest pads
current? Who is trained in
First Aid/CPR?
5. Is training Red Cross approved? 6. Do you have ANSI approved
eyewash/emergency shower
facilities?
7. Do employees work outside? 8. If applicable, are first aid and
fire extinguishers provided on job sites?
HOUSEKEEPING AND MAINTENANCE
1. Are any electrical cords strung across walkways? If so, are they properly marked and guarded?
2. Are any loose floor mats safety- edged?
3. Any worn or frayed carpet, open carpet seams or curled edges?
4. Any holes, uncovered drains, protruding nails, splinters, loose boards or projections in floors?
5. Are there any false floors or platforms used to provide dry standing & walking surfaces?
6. Are all floors free of debris, lint, dust, oil, grease, paint or spray residue, granular materials, sand, mud, ice or other slippery traction-robbing material?
7. Is there continual good housekeeping, including immediate cleanup of unavoidable spills?
8. Is lighting adequate for all operations?
9. Do you have emergency lighting 10. What type of sprinkler and/or
smoke detection system do
you have?
• When was it last tested?
• Do you have specific storage
areas?
• Is stock stored 18” below
sprinkler heads?
• Are all exits clearly marked
and unobstructed?
• Are there frequent refuse
pickups?
AUTOMOBILE
(This section applies if you have employees who drive cars or trucks as a regular part of their work; and where employees drive their own
cars on company business)
1. Are employees taught how to inspect vehicles/equipment before use?
2. Do employees required to operate motor vehicles participate in a Defensive Driving Program?
3. Are scheduling & driving speeds reflective of this? 4. Are employees required
to have CDLs?
5. Are Motor Vehicle Reports
(MVR’s) requested on all
drivers at regular intervals? 6. Do you have a written drug/
alcohol policy program? 7. Are MVR’s requested on
all prospective employees, covering all states in which they have been licensed?
8. How do you enforce the Delaware cell phone/texting law?
9. Are employees required to use seatbelts?
10. Are horns and back up alarms provided and operable on equipment/ vehicles that require them?
11. How often are driver training and safety meetings held?
12. What actions are taken in connection with accidents or violations, and have they proven effective? Describe.
13. Are there any time pressures inherent in your operations? If “yes”, describe.
14. Are fully stocked first aid kits and fire extinguishers maintained on vehicles?
GENERAL INFORMATION
1. When did your insurance carrier last conduct an engineering & loss control inspection of your premises and operations.
2. What worker’s compensation recommendations have been made by your insurance carrier?
3. Have they been complied with? 4. Has an OSHA inspection ever
been done? If so, were any recommendations made, citations issued; fines or penalties levied? If “yes”, explain.
5. What regulatory authorities inspect your operations? How often?