20 Key Components of Safety Self-Assessment Worksheet

A. EMPLOYER INVOLVEMENT

12	8	4	0
- Owner/CEO directly and actively participates in safety program - Instills personal accountability for safety throughout company - Tracks and annually reviews goals/objectives for safety - Solicits feedback on program and seeks ways to improve it - Commits reasonable resources (money, time, personnel, equipment, supplies, etc.) for program to achieve goals - Safety is a part of everyone’s performance appraisals - Integrates safety into other facets of company operations	- Management participate in safety program - Personal accountability for safety expected, but little or no recourse - Has safety program goals/objectives, but does not track progress - Provides resources for safety	- Wants and supports safety, but does not actively participate - Little personal accountability for safety – just “Be safe.” - Provides limited funds for safety	- Senior management not involved in safety program and demonstrates little interest for it - Safety left to site supervisory personnel to handle “as needed” - No accountability for safety - Little or no funding for safety activities

B. EMPLOYER POLICY STATEMENT ON SAFETY

6	4	2	0
- Is in writing and is signed and supported by owner/CEO - Explained to employees at time of new hire orientation - Explains value of safety in the company - Commits to protecting people and environment, continually improving program, involving employees and meeting regulatory obligations - States universal accountability for safety in company - Is posted or part of employee safety policy	- Policy exists and is in writing - Not explained to employees, but most know of its existence - Explains employer’s general commitment to a safe workplace - Is posted, part of employee safety policy or in company safety manual	- Policy exists “somewhere”, but not posted or in safety manual - Not explained to employees and most do not know of its existence	- No policy exists

C. RESPONSIBILITY FOR SAFETY

9	6	3	0
- Responsibilities for safety defined for everyone in company (e.g.: hazard reporting and correction, injury reporting, expected participation, PPE use, abide by safety policy, etc.) - Is in writing and is part of employee safety policy - Explained to employees at time of new hire orientation - Supervisory personnel have additional responsibilities that are reviewed with them at time of hire or promotion - A policy to hold everyone accountable for safety is in place and is universally applied and accepted	- Responsibility for safety defined for everyone in company - Is in writing, but not necessarily in employee safety policy - Generally known to employees and supervisory personnel - Accountability for safety is not always universally applied	- Responsibility for safety rests solely with a designated safety coordinator or safety committee - Responsibilities not in writing - All employees know is that they are responsible for “being safe” - Little or no accountability for safety	- Responsibility for safety has not been defined within the company - Little or no accountability for safety in the company

D. TRAILING INDICATORS (REVIEW OF CLAIMS AND KEY SAFETY RATES)

6	4	2	0
- Key company personnel trained to know meaning and relevance of key safety rates and numbers (mod factor, loss ratio incidence rate, DART rate) - Mod factor each of the past three years and the current year is below 0.800 (0.900 for companies with fewer than 100 employees) - Employer regularly reviews claims, claim costs and claims trends to gauge impact on company and guide resource allocation	- Key company personnel are familiar with key safety rates and numbers, but may not fully understand meaning or relevance - Mod factor each of the past three years and the current year is below 0.900 (1.000 for companies with fewer than 100 employees) - Employer reviews claims with insurer as part of workers comp policy renewal process	- Key company personnel are not familiar with key safety rates and numbers - Mod factor is at/below 1.000 and at least one of past two years, OR has decreased 2 of past 3 years	- Mod factor is unknown

E. RESOURCES FOR SAFETY

6	4	2	0
- All necessary resources (funds, time, personnel, equipment, supplies, etc.) are regularly budgeted or invested in safety - Return on safety investment is tracked to evaluate effectiveness of resource allocation and to guide future expenditure decisions - Resource availability and expectation is explained to supervisory personnel upon hire or promotion	- Reasonable resources are budgeted or invested in safety - Supervisory personnel are generally aware of company resources available for safety	- Minimal investments in safety - Money is taken from general funds as needed to react to safety needs (GC mandates, OSHA fines, accidents, etc.)	- Adequate resources are not made available for safety

F. SAFETY PROGRAM GOAL SETTING

9	6	3	0
- Formal process in place to annually assess safety program needs and establish goals - Action plans are developed, documented and communicated to assure goals accomplished in a timely manner - Progression of action plans tracked, with status reports and feedback from those assigned tasks - Employer reviews goals, action plans and status reports to provide feedback, direction and support of initiatives - Process in place to evaluate degree of effectiveness action plan had in achieving end goal	- Safety program goals are established periodically and are documented, but not necessarily annually or following a formal process - A plan to achieve goals has been decided, but not documented - Status of action plan informally checked, but with no set frequency and with little follow-up or solicitation of feedback - Employer plays minor part in safety goal setting process - No process in place to gauge effectiveness of action plan in achieving end goal	- Informal or infrequent safety program goals are established - No or little documentation and employee knowledge of goals - No realistic action plans developed to actually accomplish goals - Employer not involved - Goals seldom tracked or reviewed - Goals rarely achieved	- No process of safety program goal setting

G. EMPLOYER SUPERVISORY MEETINGS

9	6	3	0
- Employer conducts weekly supervisor meetings where safety is on the agenda - Meeting minutes taken and distributed for review - Meeting includes status report of site safety activities and pre-planning discussions - Review of “lessons learned” - Review of serious incidents	- At least monthly, employer conducts supervisor meetings where safety is on the agenda - Meeting includes status report of site safety activities - Review of serious incidents	- Occasional (less often than monthly) supervisor meetings where safety is on the agenda - General discussion of safety – information given to supervisors on safety - Serious accidents usually reviewed	- Employer holds no supervisor meetings where safety is an agenda item

H. PRE-PLANNING FOR JOBSITE SAFETY

6	4	2	0
- Supervisory and other key personnel are trained in pre-planning for safety - Safety pre-planning is integrated into the estimate, bid and pre-mobilization stages of projects - Check list(s) or similar document used to assure a consistent and comprehensive approach taken to exposure evaluation and resource needs - Plans regularly updated throughout life of project - Key components of pre-plan (including updates) are communicated with all site employees before implementation	- Supervisory personnel may have received some training in the safety pre-planning process, but not required - Safety pre-planning is required prior to start of site work - Check list or similar document serves as a guide through the process - Safety resources provided when and as needed	- No established procedure for project safety pre-planning, but some planning is done - No check list or other document used to guide - Safety resources often provided only after problems or needs have been encountered	- No safety pre-planning is done

I. EMPLOYEE PARTICIPATION

9	6	3	0
- Opportunities for employee participation in safety program are clearly identified (e.g.: safety surveys, hazard reporting, incident investigation, safety instruction, toolbox talks, policy development/auditing, new hire mentoring, committees, JSA development, pre-planning, etc.) - Supervisory personnel are informed of these opportunities and trained on how to actively solicit employee involvement - Participation opportunities explained to employees, along with expectation for active involvement - Participation opportunities evaluated to ensure they are meaningful, necessary resources are available (time, money, staff, equipment, etc.) and potential barriers are identified and eliminated	- Opportunities for employees to participate in safety program exist, but are not specifically documented - Supervisors provided limited training in soliciting employee participation, but nonetheless encourage involvement - Employees may be aware of opportunities, but no specific participation expectations - Limited focus on identifying and eliminating potential barriers to participation	- Employees encouraged to participate in safety program, but no concerted efforts made to engage them - “If you have any questions or concerns, speak with your foreman.” - Employee suggestion/comment process in place	- No opportunities for employees to participate in safety program

J. NEW EMPLOYEE ORIENTATION

6	4	2	0
- Documented orientation process in place for all new or transferred employees (who gets orientation, when, how and by whom and topics to be covered) - Orientation topics include: - Explanation of employer safety commitment and expectations; overview of management commitment to safety - Safety responsibilities; employee accountability - Review of drug & alcohol policy - PPE expectations - Key workplace safety rules that pertain to site and/or major job hazard exposures - Hazard communication - Identify key components persons and their specific roles - Hazard, injury and emergency reporting procedures - Key safety skills demonstration (wearing harness, adjusting guards, PPE use, etc.) -Combination of in-person presenter, videos, published training, and other written materials - New hires assigned a safety mentor until orientation process complete - New hire performance evaluation process established to give feedback to new hires on pre-determined frequency (30 and 60 days) - Records maintained showing dates, person(s) doing orientation, assigned mentor(s), topics covered and employee signature - Records maintained showing annual employee safety and health orientation	- Orientation is given to new employees, however process has not been “formalized” (exact process documented) - Orientation includes at a minimum: - Explanation of employers safety commitment and expectations; overview of management commitment to safety - Review of drug & alcohol policy - PPE expectations - Key workplace safety rules that pertain to site and/or major job hazard exposures - Hazard communication - Hazard, injury and emergency reporting procedures - Process may or may not involve safety mentors - No new hire performance evaluation process - Record of orientation, with employee signature, maintained	- Informal or on-the-job safety instruction is given to new hires - No uniform process or list of topics to cover - No documentation is maintained	- No orientation is given to new employees

K. SAFETY RULES

9	6	3	0
- Rules are in writing and are part of employee safety policy - Explained to employees at time of new hire orientation - Clear, concise and easy to understand - Specific to trade and/or scope of work operations - Enforced equally among all employees - Regularly updated to reflect change in company policy and/or regulation - Subcontractors held equally responsible for safety rules	- Rules are in writing and posted, but not necessarily in employee safety policy - Explained to employees at one time or another - Specific to trade and/or scope of work operations - Usually enforced equally among all employees - Periodically updated to reflect change in company policy and/or regulation - Subcontractors held equally responsible for safety rules	- Some general safety rules exist, but are not posted or reviewed with employees - Rules that do exist are boilerplate rules and are not necessarily specific to company’s trade and/or scope of operations - Not regularly enforced - Rarely reviewed or updated - Subcontractors not responsible for following safety rules	- There are no safety rules

L. EMPLOYEE SAFETY TRAINING

12	8	4	0
- Based on annual safety training needs assessment (who needs what, when and who will train), an agenda is developed and instituted - Formal training topics include: - Recognition and control of hazards specific to trade/work tasks (e.g.: heavy equipment, lift operation, LOTO and arc flash, rigging, crane operation, confined space entry, temp traffic control, hot work, excavation safety, steel erection, blasting safety, noise, lead, asbestos, mold exposure, etc.) - First aid/CPR/AED - OSHA topics (e.g.: PPE, hazcom, electrical, scaffold, ladder/stairs, fire prevention and protection, tool safety, fall protection and prevention, etc.) - Driver safety - Environmental compliance - Pertinent DOT compliance and CDL annual training - Conducted by competent/qualified safety instructors - Employee training comprehension and understanding is verified and documented (e.g.: test, skills assessment, etc.) - Records kept of all training – date, attendees, topics covered and trainer	- Safety training needs are determined each year, but a formal assessment and training agenda are not necessarily used - Formal training topics include: - Recognition and control of hazards specific to trade/work tasks (e.g.: heavy equipment, lift operation, LOTO and arc flash, rigging, crane operation, confined space entry, temp traffic control, hot work, excavation safety, steel erection, blasting safety, noise, lead, asbestos, mold exposure, etc.) - First aid/CPR/AED - OSHA topics (e.g.: PPE, hazcom, electrical, scaffold, ladder/stairs, fire prevention and protection, tool safety, fall protection and prevention, etc.) - Conducted by competent/qualified safety instructors - Employees only retrained as required (OSHA) and when visibly lacking safety skills	- Informal or on-the-job safety training arranged as needed - No established training agenda - Limited or no training documentation kept	- No formal safety training provided

M. TOOLBOX SAFETY MEETINGS

6	4	2	0
- *Pre-shift tool box meetings held daily - *Employee lead talks - *Highest Level Supervisors are present and participating	- Regularly held at least weekly - Attendance and topic documentation kept - Supervisor actively solicits employee participation (ex: volunteer to present talk, share experience, Q&A, etc.) - Employees participate - Owner/CEO occasionally attends	- Attendance and topic documentation kept - Employees encouraged to participate	- -Toolbox meetings not held or held only occassionally (less than once per month)

N. INSPECTIONS

9	6	3	0
- Monthly jobsite safety inspection by a project management - Weekly job site inspections are made by the site supervisor - Inspection documented, along with assignment of responsibility and expected completion date - Potentially serious safety issues corrected immediately - Less serious safety issues corrected promptly - Follow-up process to confirm action taken and that it is producing expected results	- Quarterly jobsite safety inspections by a project management - Monthly job site inspections are made by site supervisor or an employer representative - Inspection documented, along with assignment of responsibility and expected completion date - Potentially serious safety issues corrected immediately - Less serious safety issues corrected promptly	- Informal job site inspections (walk-through) are made by the site supervisor - No documentation or follow-up - Safety issues corrected ASAP	- No inspections conducted

O. SUPERVISORY TRAINING TOPICS

9	6	3	0
- All supervisory personnel receive training in: - Company safety policy - Employer’s supervisor safety expectations - First Aid/CPR/AED - OSHA 30 - Competent person for trade/task-specific topics - Emergency response - Completing an incident investigation - Conducting a Jobsite safety inspection - Creating a Job Safety Analysis (JSA) - Basic Behavior Based Safety - Leadership and HR skills - Conducting effective meetings - Opportunities for professional development offered regularly and ongoing refresher training is provided - Supervisors have access to a safety professional - Training facilities conducive to learning and competent/qualified trainers are used	- All supervisory personnel receive training in: - Company safety policy - Employer’s supervisor safety expectations - First Aid/CPR/AED - OSHA-10 or greater - Competent person for trade/task-specific topics - Emergency response - Completing an accident investigation - Conducting a jobsite safety inspection - Competent/Qualified trainers are used - Supervisors have access to sources of safety information or knowledge	- Supervisory personnel receive safety training in at least half of the following and at least 2 of the 3 electives: - Company safety policy - Employer’s supervisor safety expectations - First Aid/CPR/AED - OSHA-10 or greater - Competent person for trade/task-specific topics - Emergency response - Completing an incident investigation - Conducting a jobsite safety inspection	- No specific training program for supervisory personnel

P. INCIDENT (& Good Catch) INVESTIGATION

9	6	3	0
- Employer reviews all Incidents and Good Catches - Supervisors trained in the techniques of accident investigation - Incidents and good catches are investigated promptly by the supervisor misses are investigated promptly by site supervisor and Safety Department - Reports are completed for all incidents and Good Catches - Causal factors determined and documented - Documented follow-up to assure corrective actions taken - “Lessons learned” shared with other jobsites - RCA (Root Cause Analysis) performed for all triggered events	- Supervisors receive a basic level of incident investigation training - Incidents and good catches are investigated by site supervisor - Reports are completed for all incidents and Good Catches - Remedial actions taken to prevent recurrence of similar incidents or Good Catches - Employer reviews only very serious incidents or Good Catches - Notification of incident communicated to all stake holders	- Supervisors receive little or no incident investigation training - Incidents and Good Catches usually investigated by supervisor, but may be investigated by someone else - Reports not always completed and communicated - Little or no attempt to identify causal factors or take corrective actions - “Lessons learned” not shared	- Incidents and Good Catches are not investigated to determine cause

Q. USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE)

9	6	3	0
- Written PPE policy - Annual documented assessment of PPE needs - Company continually invests in new and updated PPE, as needed - Process instituted by which suitability and effectiveness of PPE is evaluated by field personnel - Employees informed of PPE requirements for each job - Employees trained prior to use and in at least annually in PPE selection, inspection, use and care - Company PPE policy consistently and universally enforced	- Written PPE policy - Employees informed of PPE requirements for each job - Employees trained in PPE selection/approval, inspection, use and care - Company PPE policy usually enforced	- PPE policy exists, but is rarely enforced without pressure from site GC - PPE is provided and its use encouraged - Some training on PPE use is arranged	- No PPE policy - Use of PPE is left to the discretion of each employee, resulting in rare use

R. SAFETY PROGRAM PERFORMANCE REVIEW

6	4	2	0
- Owner/CEO reviews safety program performance every six months - Emphasis of review is on whether or not program is producing expected results and on where opportunities for improvement exist - Defined criteria exist against which performance is measured (e.g.: safety surveys conducted, trainings held, incidence rates, loss ratios, progress toward annual goals, safety meetings, OSHA inspection record, prevention of recurring incidents/hazards, employee participation, etc.) - Results are documented - Results become part of safety staff and/or supervisor evaluations - Following each review, meeting conducted with safety staff and/or supervisory personnel to discuss results and expectations	- Owner/CEO is involved in an annual review of safety program to determine if it is producing expected results - Some criteria exist against which performance is measured - Process is generally not documented - Results do not weight significantly on safety staff and/or supervisor evaluations - Results are eventually discussed with safety staff and/or supervisory personnel	- No regular (pre-determined frequency) reviews of safety program performance - Limited owner/CEO involvement – mainly left to someone else (safety administrator, insurance company, etc.) - Subjective review of safety activities – mainly serves as a “year-in-review” and not an assessment of performance and improvement opportunity - Results may or may not be reviewed with supervisory personnel	- No review made of safety program performance

S. SUBSTANCE ABUSE PROGRAM

6	4	2	0
- Employee safety policy contains strict rules regarding drug and alcohol use - Drug/alcohol testing for pre-hire, post accident and reasonable suspicion - Policy actively enforced - Supervisory personnel trained in workplace substance abuse - Employee substance abuse prevention education initiatives - Company has an Employee Assistance Program - Company keeps counseling and testing records - If you are a General Contractor, subcontractors are required by contract to have programs equal to or exceeding the GC	- Company has substance abuse verbiage in employee safety policy - No drug/alcohol testing, or “for cause” only - Company makes effort to enforce policy - Supervisors are trained in hazards of drugs and alcohol on the job - If you are a General Contractor, subcontractors are required by contract to have “for cause” and/or post-accident as allowed by law	- Company has substance abuse verbiage in safety manual - No drug/alcohol testing - Company makes no or little effort to enforce policy - If you are a General Contractor, subcontract language does not include its subcontractors	- Company has no policy regarding workplace substance abuse - If you are a General Contractor, no policy for subcontractor compliance

T. RECORDKEEPING AND DOCUMENTS

6	4	2	0
Company maintains accurate and up-to-date records and documents for: - OSHA injury and illness records (reports, #300 log and #300A summary log - Safety training, including verification of learning (test, skills evaluation, etc.) - OSHA-required written programs - Employee safety policy - Incident investigations - Site inspections/surveys, including verification of action taken - Safety orientations - Safety pre-planning - Loss runs - Employee exposure and monitoring data and reports - Job safety analysis (JSA) - Safety committee/meeting minutes - Task Specific Planning forms	Company maintains records and documents for: - OSHA injury and illness records (reports, #300 log and #300A summary log) - Safety training - OSHA-required written programs - Employee safety policy - Incident investigations - Safety inspections/surveys	Company maintains minimal records, which may or may not be up-to-date: - OSHA injury and illness records (reports, #300 log and #300A summary log - Basic safety policy	- No records are kept for safety related activities or policies

U. Task Specific Planning

9	6	3	0
- A policy has been established it is consistently used across all company operations, annual review by senior management takes place. - All personnel are trained in using the template - Each operation is reviewed separately, and the template is completed. - Safety huddles are utilized to explain the operation, workers sign after understanding the work the hazards and the mitigation process. - Operations are completed as outlined in the TSP - Change of conditions require work to be stopped, the TSP is reviewed and altered to complete the work - Template includes the following: - Define the scope of work - Analyze the hazards - Develop and implement hazard controls - Perform work within the established controls - Provide feedback for continuous improvements	- A policy exists and is utilized on site - Supervisory personnel have received training on completing the task specific planning - TSP template is completed prior to the start of onsite operations - When conditions change the template is reviewed for corrections - Safety resources are available to assist teams with TSP - Employees read and sign off the TSP, so they understand the work to be completed	- Policy exists but is not consistently utilized on site - Template for task planning exists but is only completed for hi hazard/risk operations - Forms are not reviewed after the work is completed	- No program exists

V. BEHAVIORAL-BASED SAFETY OBSERVATIONS

9	6	3	0
- Observation program is written policy/procedure - Observations conducted daily - Data collected daily via formal process - Weekly analysis of datay - Trend analysis conducted across two or more weeks - Participation is required and is procedure - Program allows employees to submit observations anonymously - Owner/CEO, corporate management reviews data [weekly, monthly] - Formal process (i.e., process is in a procedure) - Construction site management reviews data weekly and modifies work practices to reduce trends - BS data shared with site personnel weekly	- Observation program is written policy/procedure - Observations conducted weekly with the use of a form - Observation data collected weekly - Weekly analysis of data - Participation required - Program allows employees to submit observations anonymously - Owner/CEO, corporate management reviews data [monthly] - Construction site management reviews data monthly and modifies work practices to reduce trends - BBS data shared with site personnel bi-weekly	- Observation program in place but not formal policy or procedure - Observations conducted at least monthly - Participation by employees recommended - Construction site management reviews data monthly - BBS data shared with site personnel monthly	- No observation program in place

W. LEADING INDICATORS

6	4	2	0
- Owner/CEO reviews Leading Indicator data - Leading Indicators are defined; are not post injury related - Leading indicator data collected daily and inputted into a format (e.g., spreadsheet, safety app) for analysis - Site management reviews Leading Indicator data weekly - Leading Indicator data analyzed for trends against previous week(s) - Construction site management reviews Leading Indicator data weekly and adjust work practices accordingly - Company has identified a minimum of four Leading Indicators	- Leading Indicators are defined; are not post injury related - Leading indicator data collected weekly and inputted into a format (e.g., spreadsheet, safety app) for analysis - Site management reviews Leading Indicator data monthly - Company has identified a minimum of two Leading Indicators that are not injury related	- Leading indicator data collected monthly - Company has identified a Leading Indicator that is not injury related	- No process in place to track Leading Indicators

X. Wellness Programs

9	6	3	0
- Employee Assistance Program available to all company employees - Smoking cessation program available to all employees - Free Annual Flu vaccinations available to all employees through company health insurance - Free annual physicals are made available to employees through company health insurance - Conduct employee health surveys to evaluate the personal wellness interests and needs of employees - Weight loss programs are made available to employees	- Employee Assistance Program available to all company employees - Smoking cessation program available to all employees - Free Annual Flu vaccinations available to all employees through company health insurance - Conduct employee health surveys to evaluate the personal wellness interests and needs of employees	- Employee Assistance Program available to all company employees - Free Annual Flu vaccinations available to all employees through company health insurance	- Company has no wellness programs