The purpose of the Risk Management and Employee Safety Mentorship Guide is to provide the new risk manager with a foundation-level education on the principles and practices of healthcare risk management. Through the information and references to resources found in this Guide, novice risk managers will acquire an understanding of Enterprise Risk Management (ERM) and develop the competence to apply the risk management process to identify and assess employee safety risks, evaluate techniques to select and implement to prevent or mitigate risks, and establish or enhance the effectiveness of the risk management role within the healthcare organization. This Guide will not make a risk manager a subject matter expert in any one or all aspects of their scope of responsibility but will provide them with the framework upon which they can embark on their journey in healthcare risk management, continually advance their knowledge and skills, and develop a visible and respected risk management function within their organization.

Welcome to the Occupational Employee Health and Safety function in your organization. The BETA Healthcare Group Employee Safety and Health Mentorship Program was created to provide an overview of best practices, industry standards and regulatory requirements. The program is designed as a self-paced program with access to modules and resources to further your knowledge as an Occupational Employee Safety and Health professional.

The safety and health professional has an essential role in supporting continuous improvement and overseeing a safe and healthy environment for all employees. The mentorship program provides the following modules to serve as a guide:

• Injury and Illness Prevention Plan (IIPP) Program
• Reporting and Recordkeeping of Workers’ Compensation Claims
• Incident Investigation
• Data Analytics and Identifying Trends
• Mitigating Risks and Follow Up
• Purposeful Rounding
• Safety Committees
• Educational Opportunities

Also included are BETA Healthcare Group’s specific processes and programs:

• Employee Safety and Wellness Initiative (ESWI)
• Service Planning

As the employee safety and health officer, it is important to communicate with the organization’s Risk Manager. The Risk Manager identifies risks in the care and treatment of patients, which often intersect with the injuries of employees. BETA Healthcare Group offers a mentorship program for Risk Managers which also provides insight into best practices, industry standards and regulatory requirements. For more information on the Risk Management and Employee Mentorship Program please go to www.betahg.com.

Overview

When an injury occurs, there is a process to follow to ensure that the injured worker receives timely care. The process involves the completion of two forms, the DWC-1 Claim Form and the Employer’s Report of Occupational Injury, also known as the Form 5020. Once these forms have been completed it is essential that the injury is documented on the California Occupational Health and Safety Administration Injury and Illness Recordkeeping Forms 300, 300A and 301. Reporting and recordkeeping are an integral part of data collection and your role in Employee Safety and Health.

Reporting

Reporting a claim requires that the DWC-1 and the 5020 are completed and submitted to the organization’s workers’ compensation insurance carrier. Once these documents are completed and filed, the processing of the claim can begin. The timely care of an injured worker can potentially reduce the overall cost of a claim and modified duty may be offered to the employee to minimize lost time and keep them engaged with peers. The filing of a claim also starts the incident investigation process to identify all potential causes, including system failure or behavioral choices that lead to the underlying source of the injury or root cause. Once identified, prevention efforts can be developed and implemented, and all staff can be trained.

 

 

Forms

• Employer’s Report of Occupational Injury Form 5020 – The form needs to be completed and submitted to claims for review and processing. A best practice is to complete the form and provide as much detail as possible, as this is the start of developing the data story and trend analysis. The information provides the injury description, injury cause, location of the injury (number, street, city, zip) and occupation of the injured employee, which all filters into a dashboard. Dashboards are a data-driven approach to reducing loss in an organization and provide real-time injury trend information.
• DWC (Division of Workers’ Compensation) Workers’ Compensation Fact Sheet – This document was developed by the State of California, Department of Workers' Compensation to provide information to your new employees about workers' compensation. This should be provided to each new hire. There is no need to provide this document to current employees.
• DWC-1 Claim Form – If you have an online portal for employees to internally report workers’ compensation claims, this electronic version of the DWC-1 can be provided to the injured employee. The form can also be downloaded from Workers’ Compensation Claim Form (DWC-1) & Notice of Potential Eligibility (ca.gov). This form should be given to an injured employee within 24 hours of the employee’s knowledge of the claim.

 

 

When an Injury Occurs

• Provide the injured worker with immediate and appropriate medical care.
• Provide the injured worker with a Claim Form (DWC-1). The employer is required to authorize medical treatment within one working day of an employee filing a completed Claim Form.
• Complete the Employer’s Report of Occupational Injury (Form 5020) either electronically or in paper form.

 

Timely Reporting

Timely reporting matters according to a study conducted by Glen Pitruzzello at The Hartford Financial Services Group. Claims reported two weeks late = 18% higher costs; claims reported three to four weeks late = 30% higher costs; and after one month = 45% higher costs. Another factor to consider is that Claims Examiners only have 14 days from the employer’s date of knowledge to send out a good faith delay on questionable claims. This preserves a 90-day discovery window to investigate the facts of the injury. Delayed reporting shrinks the 90-day window, and some non-industrial claims may be presumed industrial if the claim is not denied within 90 days. Timely reporting not only helps control claim costs, but also impacts the overall adjusting of the claim.

Types of Claims

First Aid Claims

The law allows your organization to manage First Aid claims in-house and pay any associated charges internally. First Aid claims are administered internally to prevent them from impacting the experience modification factor (Ex-Mod) and future contributions or premiums.

Keeping track of near-misses and communicating with the employee to determine what events led to the near-miss help identify what interventions may prevent future occurrences.

Per Labor Code 5401 (a) First Aid Claims are defined as follows:
Any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters or other minor industrial injury, which do not ordinarily require medical care. This one-time treatment, and follow-up visit for the purpose of observation is considered first aid even though provided by a physician or registered professional personnel. “Minor industrial injury” shall not include serious exposure to a hazardous substance as defined in subdivision (i) of Section 6302.

Indemnity Claims

Indemnity Claims are claims in which there may be lost time or questions whether the injury was sustained in the course and scope of employment. These claims may involve legal counsel and benefits such as temporary disability and permanent disability.

Medical Only Claims

Medical Only Claims are claims in which treatment exceeds first aid but does not result in any time off work (exceeding 3 days). These claims are typically managed by the Claims Examiner’s assistant and fall within the three-day waiting period when no disability is owed.

Subrogation
Subrogation is the right of recovery when a workers’ compensation injury is caused by a negligent third party. For example, auto accidents, dog bites or machinery/equipment owned and maintained by a third party. A Claims Examiner will investigate these claims by gathering important items such as photos/surveillance tapes, police/CHP/Cal/OSHA reports, witness statements, leases and rental agreements. It is vitally important in Subrogation claims to protect and preserve all evidence.

Recording and Recordkeeping

The California Occupational Safety and Health Administration (Cal/OSHA) requires that organizations with ten or more employees record and report work-related injuries, illnesses or fatalities according to Title 8, Section 7, Subchapter 1, Article 2. Work-related injuries, illnesses or fatalities must be recorded on the following: the Cal/OSHA Form 300; Log of Work-Related Injuries and Illnesses; the Cal/OSHA Form 300A, Annual Summary of Work-Related Injuries and Illnesses; and the Cal/OSHA Form 301, Injury and Illness Incident Report. The cases or injuries listed in the Log of Work-Related Injuries and Illnesses are not necessarily eligible for workers’ compensation or other benefits. Listing a case or injury on the log does not mean that the employer or worker was at fault for that a Cal/OSHA standard was violated.

Recording

The Cal/OSHA Form 300 Log of Work-Related Injuries recording requirement states that the employer is required to keep records of fatalities, injuries and illnesses that are new work-related cases. Within seven days of receiving information that an injury or illness has occurred a determination must be made as to whether it will be recorded. The determination is based on what is defined as a work-related case in a work environment and according to the general recording criteria. Work-related cases are defined as an event or exposure in the work environment that caused or contributed to the resulting condition or has significantly aggravated a pre-existing injury or illness. The work environment is defined where one or more employees are working as a condition of their employment and includes the physical location and equipment or materials used.

The general recording criteria are as follows:

• Death
• Days away from work
• Restricted work (modified duty) or transfer to another job
• Medical treatment beyond first aid
• Loss of consciousness
• A significant injury or illness diagnosed by a physician or other healthcare professional.

The death or serious illness of an employee is to be reported immediately or within 8 hours after the employer’s knowledge of the event. If the employer can prove exigent circumstances the time to report may be extended to 24 hours. Reporting is by telephone or through a specified online sign in with the Employer Identification Number (EIN).

The following list includes the type of wound or damage to the body occurring from an event in the work environment that would result in the classification of an injury:

• Skin Disorder
• Respiratory Conditions
• Poisoning
• Hearing Loss
• All other illnesses (heat illness, bloodborne pathogenic diseases such as AIDS, HIV, hepatitis B or C, etc.)

In the event the injury is related to a sharp or needlestick injury that is contaminated with another person’s blood or potentially other infectious material, the injury is recordable and the name of the injured employee can be withheld for privacy reasons per Subsections 14300.29(b)(6) through 14300.29(b)(9). (See § 14300.8. Recording Criteria for Needlestick and Sharps Injuries).

The Annual Summary Form 300A is to be completed even if no work-related injuries or illnesses occurred during the year. Using the log, count the individual entries made for each category then write the totals. If there are no cases or injuries to note, then mark with a “0.” If your organization meets the following criteria, they must electronically submit the Cal/OSHA 300A Summary data form to Cal/OSHA (300A Submission).

• Organizations with 250 or more employees at any time during the previous calendar year, or
• Organizations with 20 or more employees but fewer than 250 employees in designated industries at any time during the previous calendar year

 

Once the form is completed and submitted electronically it is to be posted at the worksite February 1 through April 30 of the year following the year covered by the form. Electronic submission is done with the Employer Identification Number (EIN). More information can be found at California Code of Regulations, Title 8, Section 14300.3. Keeping Records for More than One Agency.

The Cal/OSHA Form 301 Injury and Illness Incident Report is to be completed within seven days after you receive information that a recordable work-related injury or illness has occurred. Some state workers’ compensation insurance or other reports may be acceptable substitutes.

Recordkeeping

According to the CCR Title 8 Section 14300.33 Cal/OSHA recordkeeping rule you must keep the records for five years following the year in which it pertains.          If there are changes to lost days or modified duty days, it is important to update the records to reflect these changes.

BETA Processes

BETA Healthcare Group’s Workers’ Compensation Claims department offers a Work Comp 101 course titled “WC 101” that instructs Employee Health and Safety professionals on the following:

• How to file a claim
• The definition of terms associated with a claim
• The path of a claim
• Modified Duty
• Return to Work
• Settlement Processes

 

It is recommended that you contact your assigned BETA Claims Examiner to schedule a training session.

References
(2021) Cal/OSHA Brief Guide to Recordkeeping Requirements. Retrieved from: https://www.dir.ca.gov/dosh/dosh_publications/reckeepoverview.pdf

(2021) Cal/OSHA. Electronic Submission of Workplace Injury or Illness Records. Retrieved from: https://www.dir.ca.gov/dosh/calosha-updates/log300-reporting.html

(2021) Cal/OSHA Title 8 Regulations Table of Contents. Retrieved from: https://www.dir.ca.gov/samples/search/query.htm

Cal/OSHA Title 8, Chapter 7, Subchapter 1, Article 1. Reporting of Occupational Illness or Injury. Retrieved from: https://www.dir.ca.gov/T8/ch7sb1a1.html

Cal/OSHA Title 8, Chapter 7, Subchapter 1, Article 2. Employer Records of Occupational Injury or Illness. Retrieved from: https://www.dir.ca.gov/T8/ch7sb1a2.html

 

Cal/OSHA. Differences – Cal/OSHA and Fed/OSHA Recordkeeping. Retrieved from: https://www.dir.ca.gov/dosh/dosh_publications/cal_fed.html

(2016) Division of Workers’ Compensation Claim Form (DWC-1). Retrieved from: https://www.dir.ca.gov/dwc/DWCForm1.pdf

Introduction

Title 8 of the California Code of Regulations Section 3203 requires every California employer to establish a written Injury and Illness Prevention Plan (IIPP) Program. It is the employer’s responsibility to provide a safe and healthy workplace for all employees. Through the creation, implementation, and maintenance of a written IIPP it becomes the guide (or framework) to enhance the culture of safety in the organization. Organizations that treasure employee safety and integrate safety into the fiber of day-to-day activity are those with a lower frequency and severity of workers’ compensation claims. It is not the presence or absence of a written safety program that establishes the organization’s commitment to safety, and it is not the commitment to comply with Cal/OSHA regulations that determine the effectiveness of the program. The cost of Cal/OSHA fines is minimal compared to the increased cost of loss between an entity with an average commitment to safety and an entity with a strong safety culture.

When we ask employees and managers to express concepts their employer holds valuable, safety is rarely mentioned. This program model is intended to help establish accountability for safety within the management structure of the organization with the ultimate impact being that the employees will believe that safety is vital to the organization and a critical part of what they do. It is up to the organization’s leaders to model this priority in both words and action.

Glossary of Terms

Accident Investigation – A primary tool used to identify and recognize the cause(s) of an accident or near-miss occurrence.

Assignment of Responsibilities – Person(s) with authority and responsibility for worker safety and health program.

Hazard – A system state or set of conditions that, together with specific environmental conditions, can lead to an accident or loss.

Hazard Risks – Risks that arise from property, liability or personnel loss exposures and are the subject of insurance.

Operational Risks – Arises from people, processes, systems or controls.

Safety Communications – a system of communicating with employees in a form readily understandable to all, regarding occupational safety and health.

Overview

The IIPP is a guiding document that looks at nine (9) elements required to ensure the safety of all employees. Healthcare organizations are complex and must meet specific requirements. It is important to capture all nine elements when drafting your IIPP. They are:

1. Responsibility
2. Compliance
3. Communication
4. Hazard Assessment
5. Accident/Exposure Investigation
6. Hazard Correction
7. Training and Instruction
8. Employee access to the IIPP Program documentation
9. Recordkeeping

When drafting your IIPP, whether using a template or drafting one from scratch, it is important to customize it to meet your organization’s specific needs. To make it more personal, incorporate the name of the facility or organization and avoid using terms such as “this facility” or “our company.” BETA’s Risk Management and Safety professionals can review your IIPP document and provide input towards the development of a best practice IIPP Program.

The IIPP is subject to change and should therefore be reviewed on an annual basis. If changes are made to the IIPP, insert a footer with a revised date (i.e., rev. mm/yyyy) on each page of the document and communicate to all staff that changes have been made.

Management Commitment

The organization's leadership and management commitment are shown by the emphasis and priority that is placed on ensuring a safe environment for their workforce. This commitment is illustrated in organizational policies and procedures that are transparent and accessible to the workforce. It is further demonstrated to staff when organizational leaders actively participate in the employee safety program and supply input and resources to support continuous improvement of the program. Voice is given to employees to ensure unsafe practices are identified early, addressed and corrected. Individuals are encouraged to express concerns and identify and report hazards and near-misses to ensure action is taken. While accountability rests with the organization’s leaders, a safe and healthy workplace is everyone’s responsibility.

Roles and Responsibilities

Chief Executive Officer
The responsibility of the Chief Executive Officer (CEO) is to oversee the implementation of the IIPP. The CEO and the senior leadership team are responsible for integrating safety into the culture of the organization. Demonstrating interest and support in safety-specific issues and programs, providing proper training for all employees to perform their duties safely, making the necessary financial investment and participating in Safety Committee meetings are hallmarks of a strong leadership culture.

Program Administrator
The Program Administrator assists the CEO in overseeing the implementation of the IIPP. The administrator can be a single person (Employee Safety Officer), or it can be a department (Human Resources). It is important that this information is kept current and that their contact information is included. The Program Administrator's responsibilities include:

• Advising senior management on safety and health issues.

• Working with senior management to develop safety and health guidelines and policies.
• Preparing and distributing the guidelines, policies and procedures on safety and health issues.
• Maintaining current information on local, state and federal safety and health regulations.
• Serving as liaison with governmental agencies on safety-related issues.
• Assisting managers with planning, organizing and coordinating safety training.
  • Helping managers and department heads develop their codes of safe practices and inspection guidelines.
  • Supporting managers’ efforts to develop safety and health inspection procedures and monitoring to ensure that inspections are conducted, and necessary corrective actions are taken and completed.
  • Establishing, supporting and maintaining an injury/illness/accident report and investigation procedure for use by the supervisors and managers.
  • Reviewing and reporting on injury and illness trends.

• Establishing a system for maintaining the inspection, hazard abatement and training records.
• Assisting supervisors in conducting workplace hazard assessments to identify, evaluate and correct hazards.
• Providing training and technical assistance to managers and supervisors on the implementation of the IIPP.
• Reviewing, updating and evaluating the overall effectiveness of the IIPP.
• Evaluating the adequacy and consistency of the training designed by departments, etc.

• Coordinating the annual review and revision of the IIPP and communicating changes to all staff.

It is critically important to note that it is not the Program Administrator’s responsibility to manage the safety program. Responsibility for the implementation, administration and management of the safety program rests with the organization’s top management.

Department Directors
The department directors are responsible for fostering a safety culture and demonstrating that safety is important. By providing resources and funding to implement health and safety policies, practices and programs, senior leaders and department directors are creating the foundation for a strong safety culture. A review of the supervisor's safety performance record and that of the department they lead will indicate if the areas under their management follow the organization’s health and safety programs and policies.

Supervisors
A supervisor's responsibility starts with implementing the IIPP and setting an example. Each supervisor is to participate in the proper training of staff in workplace safety and health practices, policies and procedures. The training enables the supervisor to establish safety-related rules and procedures for all operations within the department. Enforcement of these rules and procedures is done fairly and uniformly related to the job performance and compliance on the part of each employee. All employees are encouraged to report workplace hazards or near-misses without fear of reprisal. Open communication allows employees to speak up about items that may pose a hazard and collaborate with supervisors and the organization in support of safety culture.

The supervisor or an individual assigned by a supervisor must conduct regularly scheduled safety inspections and workplace hazard inspections. Leadership needs to be involved in the safety rounds. Department directors, managers and frontline staff should also participate. Documentation of the inspection (either handwritten or through a computer program) is sent to the Program Administrator. During the inspections, if a safety hazard is noted, it is then the responsibility of the supervisor to request a work order to have the hazard fixed. A work order initiates a task and provides the supervisor and facility with a mechanism for monitoring progress and tracking completion of the fix. If the hazard is a piece of equipment, then the Lockout/Tagout process is to be followed, and the equipment is taken out of service to avoid the risk of future injuries to an employee or patient.

In the event that an injury or illness occurs, the supervisor is responsible for conducting an accident investigation to determine the cause and take corrective action when necessary. It is best practice to acknowledge if the injury or illness was caused by human error, a failure in a system or process, or by reckless behavior. If there is a system or process failure, then enhancements to the system or process must be developed and implemented. Another example of open communication is asking the employees involved in using the system or a particular process where the breakdown occurred.

Employees
Responsibility for following all requirements of the IIPP and keeping themselves safe and healthy falls to employees. As part of learning to stay safe, employees are to attend all safety training programs that are related to their daily work practices and for those areas in which they are cross-trained. The employees are to advise their supervisors of potential hazards without fear of reprisal. The reporting of all accidents, injuries, and unsafe conditions demonstrates the employee’s efforts to promote a safe culture.

Compliance

Management is responsible for ensuring that all safety and health policies and procedures are communicated to and understood by all employees. Managers and supervisors are expected to enforce the rules fairly and uniformly.

The system of ensuring that all workers comply with the rules and maintain a safe work environment includes:

• Informing workers of the provisions of the organization’s IIPP Program.
• Evaluating the safety performance of all workers.
• Recognizing employees who perform safe and healthful work practices.
• Providing training for workers whose safety performance is deficient.
• Disciplining workers for failure to comply with safe and healthful work practices.
• The following practices: [Enter information on additional means of ensuring employee compliance]

 

All employees are responsible for using safe work practices, for following all directives, policies and procedures and for maintaining a safe work environment. Employee job descriptions and performance appraisals are to include health and safety practices as part of the job role. If an employee fails to follow safe and healthy work practices, the employee may then face disciplinary action. All cases of failing to comply must be investigated to understand why the employee did not follow the health and safety practices. An employee may have chosen not to follow these established practices due to human error, at-risk behavior or a system or process breakdown. Understanding the reason is another way of identifying safe and unsafe practices.

Communication

The IIPP is written to communicate safety practices to all levels of employees and is written in a form that is easily understandable on all matters related to occupational health and safety. Communication is also in the form of open two-way communication between the leaders of the organization and employees on all matters of safety and health. The following system of communication is designed to facilitate a continuous flow of safety and health information between management and staff and consists of one or more of the following items:

• New worker orientation includes a discussion of safety and health policies and procedures.
• Review of the IIPP Program.
• Workplace safety and health training programs.
• Regularly scheduled safety meetings.
• Effective communication of safety and health concerns between workers and supervisors, including translation where appropriate.
• Posted or distributed safety information.
• A system for workers to anonymously inform management about workplace hazards.
• The establishment has less than ten employees and communicates with and instructs employees orally about general safe work practices and concerning hazards unique to each employee's job assignment.
•  A labor/management safety and health committee that meets regularly and prepares written records of the safety and health committee's meetings, reviews results of the periodic scheduled inspections, reviews investigations of accidents and exposures, and makes suggestions to management for the prevention of future incidents. The Safety Committee reviews investigations of alleged hazardous conditions and submits recommendations to assist in the evaluation of employee safety suggestions.

Hazard Assessment

Periodic inspections shall be conducted to identify and evaluate workplace hazards. The IIPP should name the individuals who will conduct these evaluations and observations in the workplace.

Competent Observer	Area
[Name of observer]	[Name of area]

 

Periodic inspections are performed according to the following schedule:

• Enter the frequency (daily, weekly, monthly, etc.)
• At the inception of the IIPP Program.
• When new substances, processes, procedures, or equipment that present potential new hazards are introduced into the workplace.
• When new, previously unidentified hazards are recognized.
• When occupational injuries and illnesses occur.
• When new hires onboard, and upon reassignment as permanent or intermittent workers to processes, operations, or tasks for which a hazard evaluation has not been previously conducted.
• Whenever workplace conditions warrant an inspection.

Periodic inspections consist of identifying and evaluating workplace hazards utilizing applicable sections of Hazard Assessment Checklist (located in the Appendix) and any other effective methods. The inspections identify areas of risk and enforce hazard assessment and control procedures. An in-depth hazard assessment survey can provide the basis and guide for the creation of the hazard control system. The hazard control system is the basis for the development of safe work practices.

Identifying existing or potential hazards in the workplace is a sign of an effective Injury and Illness Prevention Plan Program. If an injury or illness occurs and reoccurs it can serve as an indicator of a breakdown in the system.

Training employees to identify hazards and offer suggestions as to how best to correct the issues contributes to building a culture of safety. A written assessment provides documentation and assists in prioritizing actions and verifying the completion of previous corrective actions. The assessments are reviewed and held by management or the safety committee for 5 years. Follow up with the employee when the hazard or system process has been corrected. By demonstrating that each report is taken seriously, and actions are taken it will encourage employees to report hazards and near misses and create a system by which employees will continue to report hazards.

Equipment

All workplace equipment shall be maintained in safe and good working condition. If maintained by an outside entity, all records need to be available for review in the event of an audit by Cal/OSHA, The Joint Commission (TJC) and Commission on Accreditation of Rehabilitation Facilities (CARF). Following the Lockout/Tagout policy and procedure applies to all equipment including but not limited to; office equipment, patient handling equipment, monitors, pumps, beds, and other pieces of equipment used to conduct business. Proper maintenance of equipment ensures that the equipment is in working order and safe to use, preventing breakdowns, patient injury, employee injury, and undue exposures.

Personal Protective Equipment (PPE) is stored and maintained according to the manufacturer’s specifications. All PPE is rotated to avoid the equipment becoming expired (and then unusable). If the PPE does expire, it is to be replaced with the same quantity as expired PPE lost. Senate Bill 275 Section 6403.1(d) (1) states that “effective January 1, 2023, or 365 days after regulations are adopted pursuant to subdivision (h), whichever is later, healthcare employers shall have an inventory at least sufficient for 45 days of surge consumption, as determined by those regulations. The regulations shall not establish policies or standards that are less protective or prescriptive than any federal, state, or local law on PPE standards.”

Emergency Temporary Standards

An Emergency Temporary Standard (ETS) may be implemented by OSHA (Occupational Safety and Health Administration) to take effect immediately until a permanent standard is determined. OSHA will publish the ETS in the Federal Register where it will then be subject to the usual procedures to adopt it as permanent within a 6-month period.

An example of an ETS is the COVID Prevention Program (CPP) which has been issued to control exposures in the workplace. All employers must have a COVID Prevention Program (CPP) that outlines safe work practices, the following directives, policies, and procedures to assist in maintaining a safe work environment. A reference to the CPP needs to be included in the IIPP that instructs employees where they can access the complete policy and plan. (The COVID emergency temporary standard is subject to change as the situation evolves or resolves. Please note all updates can be found on the OSHA or Cal/OSHA websites).

In a healthcare setting, exceptions are made to the Emergency Temporary Standard as the healthcare organization is covered under the Aerosol Transmissible Diseases (ATD) standard. As with the CPP, the ATD standard shall be incorporated into the IIPP and instructs employees on the location of the policy, plan, and training on equipment. The ATD standard applies to the following healthcare facilities, services, or operations:

1. Hospitals
2. Skilled Nursing Facilities
3. Clinics, Medical offices, and other outpatient medical facilities
4. Facilities where high hazard procedures, as defined in subsection (b), are performed
5. Home healthcare
6. Long-term healthcare facilities and hospices
7. Medical outreach services
8. Paramedic and emergency medical services including those services when provided by firefighters and other emergency responders
9. Medical transport

 

Accident/Exposure Investigation

The IIPP must contain a section related to a near miss, accident, or exposure investigation and the process thereof. For example, who conducts the investigation, what steps are carried out, and what tools or resources are deployed to assist with the investigation? Once trained, then an investigation can be conducted using the organization's accident investigation questionnaire or checklist. The following questions can help prompt answers from the injured worker:

• What happened?
• Why did the incident happen?
• What should be done?
  • Ask how this could be avoided in the future
  • Hazard or risk identified that contributed to the event
  • Place a work order for repairs
  • Create or revise a system or process
• What action has been taken?

 

Cognitive Interviewing

Cognitive Interviewing (CI) introduces the fundamentals of fact-finding interviews for individuals who investigate safety related events. The basic principles are the introduction, open ended narrative, specific questions, additional probing, review and closing. The principles are accomplished through CI techniques which involve memory recall, interviews, reverse-order and sketching of an event. For more information on how to perform a cognitive interview please contact the Risk Management and Safety department at BETA Healthcare Group.

Hazard Correction

Once the hazard has been identified, it should be immediately corrected. If it cannot be immediately fixed, then a target date for correction should be determined based on the probability and severity of an injury or illness resulting from the hazard; the availability of needed equipment, materials, and personnel; time for delivery, installation, modification, or construction; and training periods.

Hazards shall be corrected according to the following procedures:

• When observed or discovered.
• When an imminent hazard exists that cannot be immediately abated without endangering employee(s) and property, the facility will remove all exposed workers from the area except those necessary to correct the existing condition. Workers necessary to correct the hazardous condition shall be provided with the necessary protection.
•  All such actions are taken and the dates they are completed shall be documented on the appropriate forms.

Provide interim protection to employees while corrections are being completed. A written system or electronic incident reporting system can aid in the monitoring of progress.

Training and Instruction

The training and instruction of all employees provide an opportunity to increase safety and awareness of the task, reduce injuries and illnesses, and improve overall productivity. The success of the training is based on the content provided to each level of employee.

Training and instruction shall be provided as follows:

• When the IIPP Program was first established.
• To all new workers (except for construction workers who are provided training through a Cal/OSHA approved construction industry occupational safety and health training program).
• To all workers given new job assignments for which training has not previously been provided.
• Whenever new substances, processes, procedures, or equipment are introduced into the workplace, and represent a new hazard.
• Whenever the employer is made aware of a new or previously unrecognized hazard.
• To supervisors to familiarize them with the safety and health hazards that their workers may be exposed to.
• To all workers with respect to hazards specific to each employee's job assignment.

Workplace safety and health practices for all industries include (but are not limited to), the following:

• Explanation of the employer's IIPP Program and measures for reporting any unsafe conditions, work practices, injuries, and when additional instruction is needed.
• Use of appropriate clothing, including gloves, footwear, and personal protective equipment.
• Information about chemical hazards to which employees could be exposed and other hazard communication program information.
• Availability of toilets, handwashing, and drinking water facilities.
• Provisions for medical services and first aid including emergency procedures.

Also, it is important to provide specific instructions to all workers regarding hazards unique to their job assignment, to the extent that such information was not covered in other training. See the Worker Training and Instruction Record document in the Appendix.

Employee Access to the IIPP

Employees (or their designated representatives) have the right to examine and receive a copy of the IIPP. Two methods can be utilized:

1. Provide access in a reasonable time, place, and manner, but in no event later than five (5) business days after the request for access is received from an employee or designated representative:

•  Whenever an employee or designated representative requests a copy of the IIPP Program, the organization must provide the requestor with a printed copy of the Program, unless the employee or designated representative agrees to receive an electronic copy of the Program.

• One printed copy of the Program will be provided free of charge. If the employee or designated representative requests additional copies of the Program within one (1) year of the previous request (and the Program has not been updated with current information since the prior copy was provided), a charge can be applied for the reasonable, non-discriminatory reproduction costs for the additional copies. Provide unobstructed access through a company server or website, which allows an employee to review, print, and email the current version of the Program. Unobstructed access means that the employee, as part of their regular work duties, predictably and routinely uses the electronic means to communicate with management or coworkers. Also, describe how the organization will communicate the right and procedure to access the IIPP Program to all employees.

• Any copy provided to an employee (or their designated representative), need not include any of the records of the steps taken to implement and maintain the written IIPP Program.
• If the organization has distinctly different and separate operations with distinctly separate and different IIPPs (Injury and Illness Prevention Plans), access can be limited to the IIPP Program applicable to the employee requesting it.

2. An employee must provide written authorization to make someone their “designated representative.” A recognized or certified collective bargaining agent will be treated automatically as a designated representative for the purpose of access to the company IIPP. The written authorization must include the following information:

• The name and signature of the employee authorizing the designated representative.
• The date of the request.
• The name of the designated representative.
• The date upon which the written authorization will expire (if less than 1 year).

 

Recordkeeping

Recordkeeping documents pertaining to incidents and injuries along with assessments of the organization's campus create a document that can be tracked and recorded. The documents can be referred to in the event corrective actions need to be taken to ensure the organization's employees' safety. It is essential that all records are kept for a period of no less than five years. See the Cal/OSHA Hazard Assessment and Correction Record and Accident/Exposure Investigation Report in the Appendix.

Cal/OSHA’s recordkeeping regulation provides information on how to record work-related injuries and illnesses on the Cal/OSHA 300 log. The log is kept on a calendar year basis and is maintained in 3 forms to include the 300, 300A and the 301. The Form 300 is a complete accounting of work-related injuries, illnesses, and days away from work. Form 300A is a less detailed summary and is to be posted for the period from February 1^st through April 30^th in an area where employees may view it. Finally, Form 301 is the detailed accounting of the injury in an incident report that is only visible to the supervisor and human resources.

Assessments of the organization's campus, including all buildings and facility grounds, are kept in accordance with the categories listed below. The organization has checked one of the following categories as the recordkeeping policy to be implemented.

Category 1:

If the organization is on a designated high-hazard industry list. We have taken the following steps to implement and maintain our IIPP Program:

• Records of hazard assessment inspections, including the person(s) or persons conducting the inspection, the unsafe conditions and work practices that have been identified, and the actions taken to correct the identified unsafe conditions and work practices, are recorded on a hazard assessment and correction form; and
• Documentation of safety and health training for each worker, including the worker's name or other identifier, training dates, type(s) of training, and training providers are recorded on a worker training and instruction form. We also include the records relating to worker training provided by a construction industry occupational safety and health program approved by Cal/OSHA.

Inspection records and training documentation will be maintained according to the following checked schedule:

• For one year, except for training records of employees who have worked for less than one year that are provided to the worker upon termination of employment; or

 

• Since the organization has less than ten workers, including managers and supervisors, we maintain inspection records only until the hazard is corrected and only maintain a log of instructions to workers with respect to worker job assignments when they are first hired or assigned new duties.

Category 2:

The organization are a local governmental entity (any county, city, or district, and any public or quasi-public corporation or public agency therein) and the organization are not required to keep written records of the steps taken to implement and maintain our IIPP Program.

Resources

• Workplace Violence Prevention
  • California Code of Regulations, title 8, section 3342 § 3342(a). Retrieved from: https://www.dir.ca.gov/title8/3342.html

• Patient Handling
  • §5120. Healthcare Worker Back and Musculoskeletal Injury Prevention Subchapter 7. General Industry Safety Orders, Group 15. Occupational Noise
    Article 106. Ergonomics Retrieved from: https://www.dir.ca.gov/title8/5120.html

 

• Heat and Illness Prevention Plan
  • §3395. Heat Illness Prevention in Outdoor Places of Employment. Subchapter 7. General Industry Safety Orders, Group 2. Safe Practices and Personal Protection, Article 10. Personal Safety Devices and Safeguards. Retrieved from: https://www.dir.ca.gov/title8/3395.html

 

References
American Institute for Chartered Property Casualty Underwriters, “Introduction to Risk Assessment and Treatment,” October 2012, pp. 1.4, 1.15, 1.18, 1.27-1.33

Cal/OSHA (08/2020). Cal/OSHA Guide to Developing Your Workplace Injury and Illness Prevention Program. Retrieved from: https://www.dir.ca.gov/dosh/dosh_publications/iipp.pdf

Cal/OSHA (10/2014) Cal/OSHA §5120. Healthcare Worker Back and Musculoskeletal Injury Prevention Subchapter 7. General Industry Safety Orders Group 15. Occupational Noise
Article 106. Ergonomics. Retrieved from: https://www.dir.ca.gov/title8/5120.html

Cal/OSHA (05/2015) Cal/OSHA §3395. Heat Illness Prevention in Outdoor Places of Employment. Subchapter 7. General Industry Safety Orders, Group 2. Safe Practices and Personal Protection, Article 10. Personal Safety Devices and Safeguards. Retrieved from: https://www.dir.ca.gov/title8/3395.html

Cal/OSHA (04/2017) Cal/OSHA Workplace Violence Code of Regulations, Title 8, Section 3342, § 3342(a). Retrieved from: https://www.dir.ca.gov/title8/3342.html

A key to furthering your efforts to promote the safety and wellness of your workforce is to learn from near-misses and/or incidents. This chapter focuses on a structured process for conducting incident investigations. Often, incident investigations aim at finding fault, which can be the sole reason organizations fail at uncovering systemic factors. Organizations that follow too prescriptive of a procedure can inhibit contemplative thought and may not lead to uncovering the underlying or root cause of the incident. When an organization defaults to operator error it will lead to ongoing incidents. Instead, the objective is to figure out why the mechanism put in place to control the incident malfunctioned. A thorough investigation into the inadequacies of the control mechanism can help identify what reinforcements are needed to negate future occurrences. Using good investigative tools such as CAST (Causal Analysis based on System Theory) will help you refine your incident investigation process to cut down your investigative time and limit incidents needing investigation. The environment, employee attitudes, and systems are constantly evolving and so we need to be vigilant in looking at leading indicators to adapt our control methods accordingly. Viewing near-misses as a gift and addressing them using the proper investigative tools and implementing corrective actions will help reduce the likelihood of serious injury and prevent losses.

Glossary of Terms

Accident or Mishap – An undesired, unacceptable, and unplanned event that results in a loss.

System Goals – The reason the system was created in the first place.

System Constraints – The ways in which the goals can be achieved.

Incident or Near-Miss – An undesired, unacceptable, and unplanned event that does not result in a loss (but could have under different conditions or in a different environment).

Hazard – A system state or set of conditions that, together with specific environmental conditions, can lead to an accident or loss.

CAST (Causal Analysis based on System Theory) - Used to understand the systemic cause of any adverse or undesired event that leads to a loss that stakeholders wish to avoid in the future (e.g., financial loss, environmental pollution, mission loss, damage to company reputation, and any consequence that can justify the investment of resources to avoid). While CAST and structured accident analysis methods have been primarily proposed for and applied to accidents involving physical systems, CAST can very effectively be used on social system “incidents,” which may entail major disruptions, loss of life, or financial system losses.

SMS (Safety Management System) – An effective Safety Management System investigates incidents and applies lessons learned.

STPA (System Theoretic Process Analysis) – System Theoretic Process Analysis is a hazard analysis tool based on the same powerful model of causality as CAST. In contrast to CAST, its proactive analysis can identify all potential scenarios that may lead to losses, not just the scenario that occurred. These potential scenarios produced by STPA can then be used to prevent accidents before they occur. CAST, in contrast, assists in identifying only the incident that occurred. STPA can be used early in the concept development stage of an incident (before a design is created), and it can be used to design safety and security into a system from the start. Designing safety and security into systems from the beginning can decrease the cost significantly. Finding potential safety and security flaws late in the design and implementation process can significantly increase development costs. CAST analysis of past incidents assists in the STPA process by identifying plausible scenarios that need to be eliminated or controlled to prevent further losses.

Safety Culture – The values and assumptions in the industry and/or organization used to make safety-related decisions.

Learning from Close Calls (Near-Misses)

To prevent future losses, an organization must be willing to learn from their past incidents and loss experience. An organization’s culture will determine if employees feel safe to come forward and report a near-miss incident without fear of reprisal. A near-miss is an event which occurs and does not result in an injury to an employee or harm to a patient. The early reporting of an incident allows employees and leadership to identify whether it is a system failure or a need for more training. If it is a system failure the incident will need to be reviewed, a new process established through a policy and a plan, and training delivered onto the new process to ensure employees are aware of the changes made to make the system safe.

Learning Objectives when Investigating Accidents

The overall objective in incident investigations is to find the cause of incidents. A way to remain objective in incident investigations, and locate the true origin of a hazard, is to refrain from assigning responsibility. A thorough account of all sources involved will help develop a global view and will lead to the prevention of similar losses in the future. During the investigation, it is important to investigate all causal factors and not fixate on one factor or root cause. Looking at the system from the ground up is the best practice to identify areas of weakness, leading indicators and operations that present the greatest risk. Using workarounds instead of a definitive solution can be more costly and a misuse of capital. Organizations plagued with numerous hazards can decrease future incidents exponentially by thoroughly investigating and correcting system issues. The organization will realize a better return on investment by resolving system and/or procedural related defects than defaulting to user error. Integrating questions such as “what” and “why,” rather than “who” and “why,” into incident investigations helps determine objectively why a system may have broken down or why an individual responded inappropriately.

Cognitive Interviewing

Cognitive Interviewing (CI) introduces the fundamentals of fact-finding interviews for individuals who investigate safety related events. The basic principles are the introduction, open-ended narrative, specific questions, additional probing, review and closing. The principles are accomplished through CI techniques which involve memory recall, interviews, reverse-order and sketching of an event. For more information on how to perform a cognitive interview, please contact the Risk Management and Safety team at BETA.

Asking the Right Questions

Identifying and asking the right questions will elicit a response from the injured worker that will aid the investigation. Avoid questions that would only provide a yes or no answer. Ask clarifying questions, never assume that you understand how the incident occurred. If there is a witness to the incident it is essential that they give their version of events of their own volition and in their own words. With the CI techniques, the questions below can be answered using the approach of building rapport with the individual(s).

1. Who: Who was involved in the accident?
2. When: When did the incident occur?
3. Where: Where did the incident happen (location: parking lot, clinic, cafeteria)?
4. What: What was the individual doing at the time the accident occurred?
5. Why: Why did the accident happen?
6. What: What needs to be corrected to prevent this from happening again?

The 5 Why’s method is another way of asking the right questions. The method can be helpful but may not always provide the root cause of the incident. Here is the premise of the 5 Why’s method:

Employee Needlestick Injury

- Why was the employee stuck? Did not use the safety needle properly.

- Why did the employee not use the safety needle correctly? The employee was distracted.

- Why was the employee distracted? The employee was moving quickly and forgot to enable the safety device.

- Why did the employee forget to enable the safety device? The employee was not trained on the equipment prior to using it.

- Why was the employee moving too quickly? An overbooked schedule.

As shown the root cause was both the lack of training on the equipment and the scheduling process. The discovery requires processes to be implemented for training and a written policy.

Refining Accident Investigations

The objective of accident investigations is to learn from our mistakes and to create a learning environment. The following steps should be integrated into the process:

1. Do not get fixated on uncovering the source of the problem and instead include all factors that may be involved.
2.  Remain objective and limit any prejudices.
3. Take a structured approach in analyzing employee perceptions.
4. Integrate questions such as “what” and “why” rather than “who” into your accident investigations.
5. Utilize the appropriate investigative tools necessary to understand why a system control may have failed or how to increase control to prevent additional incidents.

After accident investigations, parties often find that the safety framework lacked the necessary controls that could have prevented the accident. Therefore, the principal task of the investigation is to discover what portion of the framework needs strengthening to prevent similar accidents.

Causal Analysis Based on Systems Theory (CAST)

A great tool to use to expose any weak links of your safety framework is called CAST (Causal Analysis Based on Systems Theory). This approach helps uncover any gaps in the system or process and what data may be required in formalizing a plan to prevent future losses.

Elements for a successful CAST analysis:

1. Gather all relevant information needed to conduct the review.

1. Determine the system or process incorporated and confines
2. Include the incident and source
3. Pinpoint what structural components are necessary for prevention
4. Characterize the circumstances involved and integrate questions such as what and why
5. Investigate the engineering controls utilized to mitigate the loss (e.g., system design, equipment, process, safety culture, and environment)

1. Correlate the current safety framework with the identified threat.
2. Review each segment of the safety controls to identify where the flaws exist and what circumstance caused the employee’s behavior.
3. Expose any built-in system vulnerabilities that may have caused the incident.
4. Provide suggestions on how to modify controls to avoid future losses and if necessary, include the identified risk in your Injury and Illness Prevention Plan (IIPP) Program so it receives an annual review and improvement.

Although it is not vital to initiating your CAST analysis, it is best practice to review all circumstances immediately preceding the incident to develop questions that need to be satisfied as part of your investigation (e.g., were there enough qualified staff available to manage the number of assignments at the time). The first task is to collect all vital information surrounding the occurrence to focus on your objective. Conducting a CAST analysis is not a linear process and the organization may determine that steps need to occur in a different order to reveal unsafe controls and hazard constraints.

Principles in Accident Investigation

Essential Job Knowledge

Providing employees with detailed job descriptions and accurate work instructions is fundamental in ensuring that they have a clear mental model of where they fit within the system. Similarly, employees should have prerequisite job training to safely perform all aspects of their job. Job descriptions and training should not be so intricate that one cannot follow them. Highly trained staff that operate within the confines of the system and follow the correct safety procedures can help neutralize incidents. These employees will also be more adept at preventing incidents that arise from unexpected events. Any risks or job duties that are deemed too complex for an employee to safely control themselves should be either eliminated, automated in the system design, or controlled by additional equipment/machines.

Communication

A system or process may change over time, or an unexpected environmental condition may force an adjustment. Accidents often occur during these pivotal times. These system changes must be communicated to everyone involved and across the organization. Ensuring that communication channels are open and viable during these times and that proper warning systems are utilized is critical to mitigating losses. Supervisors can help employees adapt to these system changes by providing updated work instructions that are easily understandable. Emergency and disaster recovery efforts should be designed into crucial system components to help minimize business interruptions. Sometimes the best way to detect that a system or process is evolving is to see if the original safety controls built into the system still apply. If not, it is a suitable time to reassess the design of the system or process and make necessary modifications.

Proximal Events

Hazards are typically introduced after some type of change in a system or process. These may be scheduled adjustments or unforeseen circumstances. Examples include eliminating a process or starting a new one. Incidents can also occur during the upkeep of an item or when we place a temporary workaround as a makeshift resolution to a problem. To help manage these proximal events that can introduce error, it is best practice to integrate change management policies/procedures.

Designing Effective Systems

Identifying underlying threats can be a complex process. The organization can only manage incidents that are confined within the borders of the system or safety control. As such, creators of the system or safety control must think in terms of experiencing an ultimate loss and prepare for the unexpected. A typical system design mistake that is made is building a system around one component instead of all components. A system architect should treat an unsafe act from an employee as a cause of a hazard and not a system hazard. Analyzing the system first and then including all relevant system risks and associated safety controls will help minimize overlooking potential causal factors. Risks are typically abated by implementing an environmentally suitable system, adding an adequate amount of safety controls, having trained employees monitoring the system, and putting backups in place in case any system components fail.

Root Cause

It is human nature to take the path of least resistance. When there is a problem identified in a system or process, we want an immediate solution. Discovering the root cause is only the beginning. If one stops with the root cause, causal factors can be missed, and underlying causes may remain.

Safety Culture

No matter how strong of a safety system is built, it can always be undermined by an ailing safety culture. Leadership needs to take a genuine stance on safety if they want staff to emulate the characteristics of a strong safety culture. Leadership should set the tone by communicating what attributes they want to see in their employees and in the organization. Leadership should back the program and model the appropriate behaviors. If leadership does not exhibit a culture of safety, employees will become complacent, and injuries will occur. Leaders should not expect employees to practice safety if they themselves are unwilling to do so. To foster a culture of safety, show compassion and appreciation towards employees who bring their safety concerns forward as this information can help avoid potential incidents. Create a Just Culture by having an open line of communication that is free of reprisal. This will go a long way in setting up a strong safety foundation.

Implementation

At the conclusion of your accident investigation, it is time to implement the recommended changes and build up any weak or missing safety controls. Adding these recommended changes to your IIPP and global risk management program will ensure that the identified threats are addressed. The recommended changes may take a great deal of capital and labor to implement, so remember to include them in the capital budget when planning. Instead of bypassing these larger issues, it is best practice to set a realistic timeframe of when the goals can be accomplished. By including issues in the budget and setting a timeline, the issues are not only documented but are also more likely to be addressed in the allotted timeframe. The organization can ensure the newly implemented safety controls are successful by (1) appointing staff to manage the items that you have the bandwidth to address immediately, (2) following up to make sure the changes were enforced and (3) assessing the results of your Safety Management System to see if the changes were effective. Additional tools that can help you verify that the changes were effective are safety audits, hazard assessments, dashboard reports and learning from near-miss incidents. Constant improvement of your overall safety structure will result in declining injury trends.

 

Hindsight Bias

Hindsight is always 20/20, and the reality is that people struggle with forecasting future events unless they have experienced a similar incident. It is quite easy to identify causal factors after an incident occurs because you can clearly see what happened. However, it is still important to resist the urge to blame others for the event. Not being able to predict changes in our environment makes it tough for architects to design proactive safety systems and controls that encompass all incidents or events.

Tracking Incidents and Implementing Proper Controls

Resolving system and procedural related defects is just one part of the equation when trying to prevent future losses from occurring. A review of supervisory and regulatory influences assists in determining the source of the event. To manage a safe system, the organization often assigns an employee responsible for implementing controls and keeping the systems running smoothly. The application of pertinent skills, behaviors, policies, procedures, and governance of an organization can decrease the risk of injury or illness. Incidents typically occur when the individual assigned to control the system does not have a clear picture of how the system or process was designed to operate or the environment in which the system or process is operating changes unexpectedly. An essential element is to integrate warning notices into the system or process architecture when incorrect controls are applied. Timely warning notices allow system controllers to course-correct and mitigate incidents from occurring even if an incorrect input is applied or the environment changes.

Assessment results are stored in their own Safety Management System independent of Business Management Systems. The Stakeholders will then be able to access the results and can implement changes. The key is to learn from our mistakes and not assign blame, by remaining open-minded and bias free. The greatest learning opportunities happen when the organization refuses to become complacent and focuses on safety. It is easy for a well-designed and functioning safety system to drift back into an undesired state. Informing decision-makers with accurate loss data can help keep your safety program running efficiently.

References
BETA Healthcare Group (2021) Cognitive Interviewing Training

Nancy G. Leveson (2019) CAST Handbook: How to Learn More from Incidents and Accidents, 6-103

NPSF National Patient Safety Foundation (2016) RCA2: Improving Root Cause Analyses and Actions to Prevent Harm, 31-34, 20-23, 1-22

Introduction

The quality and speed of information delivery can dramatically impact healthcare facility operations and improve in-house procedures that help reduce claims and losses. Maintaining your organization's workers' compensation incidents in a customizable dashboard report will allow you to analyze what areas of the facility may present hazards and where a particular system or process improvement is necessary to reduce further injuries. An electronic Member Dashboard is available to all BETA Workers’ Compensation participants. The Dashboard may be accessed after your organization completes the Opt-In agreement and MAAAF form, participate with your BETA Risk and Employee Safety representative in a data scrub, and agree to use the electronic Claims Intake Portal. Conducting a data scrub and using the Clams Intake Portal optimizes the data set portrayed in the dashboard. The Member Dashboard allows real-time access to your data; this data is also shared during Risk and Safety meetings and used as a tool to produce Risk Management and Employee Safety strategies. Utilizing dashboard report technology to capture real-time incidents can help organizations reduce costs, develop solutions, and make more informed decisions.

Glossary of Terms

California Workers’ Compensation Institute (CWCI) – Due to its research capabilities, reputation, and broad-based industry perspective, CWCI is uniquely positioned to provide data, practical analyses, and real-world expertise on issues and trends affecting California workers' compensation. BETA, along with California healthcare providers, submits claims data to contribute to CWCI’s benchmarking initiatives.

Claim Frequency – Number of claims per $1 million payroll or number of claims per 100 full-time equivalent employees.

Claim Number – Unique numeric identifier assigned to classify an employee’s injury and the policy year the claim was filed.

Claim Severity – The cost of claims over a given period divided by the number of claims or occupied bed equivalent (OBEs) or mature base equivalent (MBEs) in the same period.

Claim Status – Identifies whether a claim is open, re-opened, or closed.

Date of Injury (DOI) – Describes the date of injury or illness reported on the employer's report of injury (Form 5020).

Department – Identifies the department where the employee is assigned (e.g., Medical/Surgical, Surgical Services, Imaging, Clinic, Home Health, Hospice, Skilled Nursing).

Drift – An employee’s deviation from a policy/procedure, system process, or outlined workflow based on factors such as workload, staffing issues, time constraints, and complexity of the procedure.

Employers Report of Occupational Injury or Illness (Form 5020) – Employers are required to file a complete report of every occupational injury or illness that results in time lost or requires medical treatment beyond first aid.

Experience Modification Factor (Ex-Mod) – A factor derived from comparing an employer’s actual loss history to industry expected losses and applied to the premium calculation.

Full Time Equivalent (FTE) - is a metric that quantifies an employer's number of full-time employees regardless of how many hours each employee works.

Future Medical Claim – Estimated future costs associated with medical treatment for a workers’ compensation injury for the duration of the injured employee’s life expectancy.

Indemnity Claim – A claim where the injury results in time off from work, permanent disability, litigation, investigation, or a delay or denial of benefits.

Injury Cause – Identifies the object, substance, bodily motion, or exposure that directly produced or inflicted the previously identified injury or illness (e.g., needlestick, burn, reaching).

Loss Type - Identifies how the injury or illness was inflicted (e.g., uneven surface, prolonged standing/sitting, writing/charting). Person, place, or thing that causes the injury – secondary cause.

Medical Only Claim – A workers’ compensation claim where the injured employee has received medical benefits but there is no lost time from work and no permanent disability or continued future medical care.

Member Area Access Authorization Form (MAAAF) – This BETA form is used to grant and remove secure online access to our member portal where sensitive information is stored to employees at our members/insureds.

Nature of Injury (Diagnosis) - Identifies the principal physical characteristic(s) of the work-related injury or illness (e.g., contusion/bruise, puncture, fracture).

Occupation - Identifies the job or profession (e.g., Registered Nurse, Medical Assistant Patient Access Representative, Pharmacist).

Occupied Bed Equivalent (OBE) – An exposure unit used in underwriting to quantify the relative size of the risk for pricing purposes, particular to hospitals and healthcare facilities.

Total Incurred – Estimated dollars set aside to pay claims which includes total paid and outstanding reserves.

Total Paid – Amounts paid on reported claims.

Total Reserves – The estimated amount to be paid on a claim as established by the claim’s handler.

Work Setting - Identifies the department where the injury or illness happened (e.g., Medical/ Surgical, Emergency Department, Dietary Services, Facility Grounds).

Workers’ Compensation Insurance Rating Bureau (WCIRB) - The WCIRB is the designated statistical agent of the California Insurance Commissioner and is an integral provider of actuarially based information and research to the California workers’ compensation community.

Overview

Data Mapping

Utilizing a taxonomy set consisting of a robust, customizable location and injury cause coding structure can enhance and refine loss cause. A taxonomy that aligns with the California Workers’ Compensation Institute (CWCI) and the Workers’ Compensation Insurance Rating Bureau (WCIRB) allows organizations to benchmark against their peers. Utilizing a standardized taxonomy gives the organization better data quality and a greater ability to map injuries to their work settings and pinpoint the origin of risk. The completion of the Form 5020 (Employer’s Report of Occupational Injury or Illness) in its entirety can help minimize errors in coding and increase an organization’s benchmarking accuracy.

Form 5020: Employer’s Report of Occupational Injury or Illness

The Form 5020 has several critical areas containing data points that allow you to drill down the data in the dashboard reports. The following lines of 5020 provide you with these essential data points:

Line 19 – Nature of Injury: Specific injury/illness and part of body affected, medical diagnosis if available, e.g., Second-degree burns on the right arm, tendonitis on left elbow, lead poisoning.

Line 25 – Injury Cause: Specific activity the employee was performing when event or exposure occurred, e.g., Welding seams of metal forms, loading boxes onto truck.

Line 26 – Loss Type: How injury/illness occurred. Describe sequence of events. Specify object or exposure which directly produced the injury/illness, e.g., Worker stepped back to inspect work and slipped on scrap material. As he fell, he brushed against a fresh weld and burned his right hand.

Line 19 – Body Part: Specific injury/illness and part of body affected, medical diagnosis if available, e.g., Second-degree burns on right arm, tendonitis on the left elbow, lead poisoning.

Line 20 - Property Injury Location: Location where event or exposure occurred (number, street, city, zip code).

Line 22 – Work Setting: Department where event or exposure occurred, e.g., Shipping department, machine shop.

Line 35 – Occupation: Occupation (Regular job title, no initials, abbreviations, or numbers).

Dashboards

Report

A dashboard report informs organizations in real-time of their injury trends and is a data-driven approach to prioritizing and reducing loss in an organization. The enhanced cause code structure focuses on the following data markers: occupation, injury cause, nature of injury, body part, loss type, work setting, and property location. These data markers are collected from the Employer’s Report of Occupational Injury or Illness – Form 5020, so it is vital to complete the form in as much detail as possible.

Dashboard Report Interpretation

The interpretation of a dashboard report starts with the essential elements from the data markers. These basic components are frequency by department, frequency by cause, frequency by occupation, frequency by loss type, frequency by body part, and frequency of litigated claims. Analyzing these markers can reveal that a system needs to be examined, training needs to be conducted, or a gap analysis needs to be performed. We suggest reviewing all components of the dashboard report to understand who, what, where, and how the claim has occurred. The focus on claims frequency is weighted heavier on the experience modification (Ex-Mod) calculation than severity. Mitigating the frequency of injuries will minimize the number of claims, potentially reduce litigation rates, and decrease the Ex-Mod over time.

Data Markers Displayed in the Member Dashboard Include:

Member Status Tab

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Member Status Tab – This tab includes a policy year summary of costs: total paid, total incurred, average total paid and incurred, claims filed per year, claim type – including indemnity, medical only, and future medical, claims that remain open, and claims by department.

Top 10 Tab

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Top 10 Tab – A policy year summary of the ten most expensive claims with frequency/severity percentages by department and cause.

Claim Activity Tab

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Claim Activity Tab – Claim closures vs. new losses in the last 12 months, year over year incurred cost change in the last five contract years, claim closures in the selected activity period, and claims reported in selected activity period.

Frequency and Severity Tab

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Frequency and Severity Tab – This tab illustrates the claim count by type in the last five contract years, and total incurred costs by contract year for the last five years.

Risk and Safety Tab

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Risk and Safety Tab – Contains the following information:

Department – A policy year summary of the department where the employee is assigned (e.g., Medical/Surgical, Surgical Services).

Occupation – A policy year summary of the occupations that sustained injuries.

Injury Cause – A policy year summary of the injury causes or specific activity the employee was performing when the event or exposure occurred, e.g., Welding seams of metal forms, loading boxes onto truck.

Body Part – Identifies body part(s) where the injury or illness happened.

Nature of Injury – Policy year summary of the specific injury/illness, medical diagnosis (if available), e.g., Second-degree burns on the right arm, tendonitis on left elbow, lead poisoning.

Loss Type – How injury/illness occurred. Describe sequence of events. Specify object or exposure which directly produced the injury/illness, e.g., Worker stepped back to inspect work and slipped on scrap material. As he fell, he brushed against a fresh weld and burned his right hand.

Injury Frequency Rate Tab

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Injury Frequency Rate Tab – This tab shows the claims injury frequency rate (IFR) per 100 full time equivalent employees (FTE) for the last five contract years, the claim count vs. FTE count, and the IFR by injury group cause for the last five years.

COVID-19 Claims Tab

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COVID-19 Claims Tab – This tab displays COVID-19 claims counts by contract year, claims by Department, Occupation, and incurred costs by contract year.

Important Dashboard Tabs to Review

Member Status Tab (Summary Data)

The member status tab reviews injuries, including the fiscal year, location description, department description, injury cause group, and claimant type. Manipulating the slicers to filter the data on this page impacts the pivot tables throughout the document. The organization can utilize this tab to get a snapshot of how well they control their injuries during each policy year. Members can also use this tab to forecast the number of injuries they can expect to occur during the policy year if no system refinements, process improvements, or safety controls are implemented.

Top 10

The Top 10 tab provides a review of the top ten claims experienced within the selected policy periods to include claim number, department, injury cause, date of injury, claim status (open, re-opened, or closed), total paid, total reserves, and total incurred. It also includes a review of the policy periods and frequency by department, severity by department, frequency by cause, and severity by cause. Again, when reviewing the Top 10 tab, the focus should be on the frequency of injuries. This tab can help an organization uncover which departments may be trending higher than others and the percentage difference between departments.

Occupation

The occupation tab provides the organization with an accounting of which employees encounter the most substantial number of occupational injuries for the policy periods selected. Members can take the highest number of injuries by occupation and divide them by the total claims experienced. The result is the difference in occupational injury percentages. Identifying which occupations are trending higher in injuries can assist organizations with prioritizing staff training to advance their knowledge and understanding of workplace hazards particular to that occupation and improve their work practices.

Injury Cause

Injury causes are narrowing injuries into groups such as strain or injury by slips, trips, and falls. This tab provides a review of injury causes and can assist an organization in determining what injuries are trending. Members who have implemented a BETA Service Plan may find that specific loss cause trends experienced in the earlier policy years are no longer evident while other trends have surfaced. Analyzing the three most recently completed policy years helps pinpoint what trends remain and which hazards require further preventative measures.

Claim Type

The claimant data analyzes the type of claims experienced, including medical-only, indemnity, and future medical. The data can be used to gauge how well an organization's return to work program is functioning. If indemnity claims outweigh medical-only claims, BETA suggests implementing an effective return to work program and offering modified duty when available.

Litigated

An organization can take a pulse of its culture by evaluating the litigation rate.  Reviewing the claims litigated within the policy years selected indicates the engagement and communication between employees and leadership. Litigation may spike for several reasons but often can be traced back to a change in management or a hostile work environment. An unhealthy work environment can lead to litigation and applicant attorneys’ soliciting business.

Body Part

Evaluating the body part can expose specific injury trends. For example, if you see an uptick in back injuries, it could point to deficiencies in safe patient handling and manual material handling policies and procedures. A high rate of multiple body part injuries may reveal an influx in slips, trips, and falls. Neck and wrist injuries may bring to light repetitive motion or ergonomic issues.

Department

Identifies the department where the employee works or is assigned to work (e.g., Shipping department, machine shop). Employers will find that most injuries occur in the employee's home department. For example, repetitive motion injuries are typically experienced by an employee using their assigned workstation located in their home department. An example of this is a Sterile Processing Technician injured by equipment while cleaning tools in the Sterile Processing department. Analyzing which departments have a sizable number of injuries can help employers focus their training efforts.

Work Setting

Discovering the work setting where the event or exposure occurred, e.g., Shipping department, machine shop, is where an organization wants to conclude its Accident Investigation. As stated above, injuries often arise in an employee's home department; however, they can happen in other locations such as a parking lot, stairwell, or elevator. The correct identification on the Form 5020 (line 22) can uncover the facility’s exact location (work setting) where the injury occurred and is critical in developing strategies to protect additional employees from experiencing a similar injury. The ability to quickly identify the source of the hazard and shore up any weak systems or processes can help mitigate future injuries. If immediate remedies are unavailable or too costly, physical barriers can isolate the risk until funds become available and a permanent solution is applied.

Facility Review 

In-person Hazard and Risk Assessments are another way to gain perspective on how well the organization reduces injuries and controls hazards. It is recommended to review the organization's policies, procedures, and the Injury and Illness Prevention Plan (IIPP) Program before conducting the review.

Cal/OSHA logs are another way to gather data and spot injury trends or near-miss incidents. Safety Data Sheets (SDS) in English and Spanish guide employees on what to do if they are exposed to any chemicals used within the workplace. Safety Data Sheets are required to be available to all employees as noted in the OSHA's Hazard Communication Standard (HCS), 29 CFR (Code of Federal Regulations) 1910.1200.

Direct observation of the work environment helps ensure compliance with the policies and procedures. These observations should be jointly conducted by supervisors and line level staff. If there are any problems with the safety culture, including human error or drift, a worksite investigation is warranted.

It is recommended that a multidisciplinary team perform work-site analyses. The team may include risk managers, health and safety personnel, engineers, human resources, and frontline staff. Employees are often familiar with the nuances of the job and may provide better insight into potential flaws in the system or process. Items to consider in your analysis are the impact of the aging workforce including declining mental acuity, decreased decision-making capacity, and slower response times. With 20% of the aging workforce experiencing deconditioning, employers should have plans to modify the work environment to help counteract repetitive motion injuries to the neck, back, knees, and shoulders. New employees have a higher rate of near misses or injuries due to lack of competency-based training, mentorship, or job knowledge. It is essential to follow up with new employees and monitor their integration into the position.
BETA Data Processes

Member Area Access Authorization Form (MAAAF)

Before access is granted to the Workers’ Compensation Dashboard, the BETA Member Area Access Authorization (MAAAF) Form must be fully executed to grant online access for member/insured employees to this resource. Given the sensitive nature of the materials posted on our Member Area, Member Area accounts must be kept current. If a new employee is hired or a new position is created, the employee will not have immediate access to the Member Area. Permission is granted through submitting a completed MAAAF Form to support@betahg.com. If an employee resigns or is terminated, it is imperative to notify BETA to ensure access is disabled. The MAAAF Form allows for various levels of access from general information to claim reports to risk management and safety reports. It is typically the purchaser of the policy or policies who is authorized to grant access to the member portal. The form is available through the Underwriting department (or can be downloaded from the BETA website) and must be provided to fully execute any additions, deletions or modifications to account access.

Member Area

Our secure Member Area currently provides confidential online access to the following:

• Risk Management publications
• Presentations from recent meetings
• Claim reports
• Workers’ Compensation and Employee Safety Dashboards
• Drill-down analysis of claims data using Business Objects software

Due to the sensitivity of the information, including the claimant's names, the best practice is to limit how many employees will have access to the Member Area resources.

 

BETA’s Claims Intake Portal

The BETA Healthcare Group Claims Intake Portal allows for the reporting of claims, storage of assessments performed, newsletters and the dashboard, to name a few items. Access to the portal is granted on the MAAAF Form, which can assign all areas or specific areas depending on the level decided by the grantor in your organization. Once access is granted, you may then file a claim online and create a 5020 Form. As mentioned above, the 5020 is completed in its entirety and with detail to provide data that is then reflected on the dashboard. Opting in to a data scrub of the reported claims with a BETA Employee Safety team member assigned to the member account will ensure the accuracy of the data. Once the data scrub is complete, it will be up to the Employee Health and Safety personnel in your organization to review and report new changes to the data.

Identified Loss Leaders and BETA’s Employee Safety and Wellness Initiative (ESWI)

Comprehensive data analysis can direct an organization toward a key loss area. Setting risk priority based on both quantitative (data metrics/trends) and qualitative data (through risk and hazard assessments, site visits, and observation) help identify focus areas.

BETA’s Employee Safety and Wellness Initiative provides organizations with a structured approach to reduce injury in high-frequency areas. Our incentive-based program offers best practice strategies and prescribed processes to achieve injury reduction. Fully insured members can participate and undertake a course of work in eight domains that address common safety issues and yield 2% credit per domain. A member may join two domains per policy year. The eight domains are Ergonomics, Safe Patient Handling and Mobility, Slip, Trip and Fall Prevention, Workplace Violence Prevention, Fleet Safety and Mobile Ergonomics, Opioid and Polypharmacy Prescribing, Return to Work and Manual Material Handling. Each domain includes specified criteria based on best practices that are culled from evidence nationwide. There is an opt-in process and an available toolkit to help get you started. Your assigned Risk Management and Employee Safety Manager / Director / Specialist will guide you through the process.

References
Workers’ Compensation Insurance Rating Bureau: https://www.wcirb.com/

California Workers’ Compensation Institute: https://www.cwci.org/

Centers for Disease Control and Prevention: https://www.cdc.gov/workplacehealthpromotion/model/employee-level-assessment/injuries.html

Occupational Safety and Health Administration (OSHA): https://www.osha.gov/laws-regs/standardinterpretations/1992-05-15

 

 

Mitigating Risk and Follow-Up

At BETA Healthcare Group, our goal is to help ensure that every decision our members make drives a positive outcome for employees, patients, and their families. As the demand for qualified, experienced, and engaged healthcare workers continues to rise, employers must do more to create safer working environments and increase levels of employee engagement while improving the patient experience. Recognizing the impact that your employees have on delivering these positive outcomes, BETA Risk Management and Employee Safety programs align your personnel with our team of knowledgeable safety professionals experienced in the healthcare industry. As a member, you have access to comprehensive risk management and employee safety best practices and tools which provide mitigation strategies to minimize injuries, control costs and protect employees. Each member has access to an employee safety expert who will work to build a customized Service Plan focused on your organization’s specific needs. With a targeted employee safety Service Plan focusing on minimizing workplace disruption and work-related injuries, the organization's risk is identified, and mitigation strategies are implemented.

Glossary of Terms

Hazard Risks – Risks that arise from property, liability, or personnel loss exposures and are often covered by specified insurance (i.e., workers’ compensation, liability insurance).

Operational Risks – Arises from people, processes, systems, or controls.

Loss Control Techniques – Include avoidance, loss prevention, loss reduction, separation, duplication, and diversification.

Avoidance – A risk control technique that involves ceasing an activity (or never undertaking it in the first place) so that the possibility of a future loss occurring from that activity is eliminated.

Loss Prevention – The act of taking proactive measures to prevent identified risks and reduce the frequency of identified risks.

Loss Reduction – A risk control technique for reducing the potential impact of an identified risk.

Separation – The isolation of loss exposures from one another to minimize the adverse effect of a single loss.

Duplication – A risk control technique often found with the use of technology, which uses backups, spares, or copies of critical property, information, or capabilities and keeps them in reserve.

Diversification – A risk control technique that spreads loss exposures over numerous projects, products, markets, or regions.

Heinrich’s Domino Theory – Workplace injury accidents are a result of a chain of events that includes an unsafe act or an unsafe mechanical or physical hazard. Therefore, the focus is on the prevention and elimination of unsafe acts or conditions.

Energy Release Theory – An approach to accident causation that views accidents in terms of energy transference – that accidents are caused by energy out of control. The theory purports that a transfer of energy, in large amounts or at rapid rates, can adversely affect living things and nonliving objects, causing injury and damage.

BETA Healthcare Group Risk Management and Employee Safety Services

Data Mapping | Dashboard Opt-In

Metrics help organizations understand where risks reside, set priorities to address trends, and take corrective action to mitigate risk. The data entered and reported through our online workers’ compensation claims portal generates the data to populate an accessible, interactive, easily interpretable real-time member dashboard complete with key performance indicators. The data serves as a checkpoint to assure safety interventions are tied to measures of effectiveness.

Members can opt-in to a two-part effort designed to assure data integrity by reviewing the data entered in a 5-year period of historical claims with the assistance of the Employee Safety representative assigned to their account. In addition to the opt-in and the completion of the Member Area Access Authorization Form (MAAAF), access is granted to BETA Healthcare Group Claims Intake Portal which is the online member portal to report workers’ compensation claims. Once underway, this combined effort results in the delivery of a powerful measurement tool that brings data to life in dashboard format and is aligned with the Workers’ Compensation Insurance Rating Bureau (WCIRB) and California Workers’ Compensation Institute (CWCI) to assure benchmarking capability.

The data mapping exercise provides an opportunity to deploy customized and directed safety interventions to specific areas of need. Identifying where the injuries are most frequent, what occupations in the organization are experiencing the highest injury rate, and how the employees are being injured, including any contributing factors to that injury, are essential to developing effective strategies to mitigate risk. The dashboard provides members with a data map to ensure proper assignment of resources, which will help drive down costs. Illustrating these results helps to quantify the return on investment of proactive workers’ compensation claims intervention and efforts in safety that can positively impact the organization’s Ex-Mod and its overall workers’ compensation premium expenditure.

Specialized Service Planning

Healthcare organizations have complexities and characteristics that are unlike any other industry. Because of the uniqueness of the healthcare environment, BETA takes a customized approach to preventing loss by providing expert consulting services. Employee Safety professionals assigned to your account will work side-by-side with you to build a customized Service Plan. The Service Plan begins with analyzing loss trends identified in your dashboard report and includes the necessary resources and guidance to make your organization a success. Our Employee Safety staff are all experts in their field and will review your most frequent causes of loss, conduct a hazard and risk assessment, and in partnership with the organization, develop a customized Service Plan to meet your needs. The plan includes guidance on addressing and mitigating risk and coupled with ongoing support and consultation with your team, ensures successful implementation.

Hazard Risk Assessment

On-site hazard and risk assessments are available to member participants to identify potential employee safety loss exposures and assist in creating targeted risk mitigation strategies. The hazard and risk assessments include an in-depth review of an organization’s employee safety programs, analysis of high exposure areas, and examination of various factors as part of their assessment, culminating in a confidential report. This report provides a comprehensive view of identified deficiencies and detailed recommendations and best practice resources that an organization can use as a blueprint for developing and implementing improved employee safety programs.

One-on-One Risk Consultation

BETA offers one-on-one risk consultation with the Risk Management and Employee Safety professional dedicated to providing service to your account. The Risk representative can help you anticipate and navigate the risk management and safety-related issues you may face via one-on-one phone consultations and secure email exchanges. As part of our Consulting Services, an Employee Safety professional performs a robust analysis to help your teams identify risk patterns and behaviors backed by training designed to help with risk prevention and mitigation. What sets our team apart is our proactive approach to helping healthcare organizations mitigate risk. BETA’s Risk Management and Safety personnel are seasoned professionals with years of experience. Whether you need to assess a situation or determine the best way forward, your assigned Employee Safety professional can help you and your leadership respond effectively.

BETA Healthcare Group Office Ergonomics

As part of the ergonomics domain in the Employee Safety and Wellness Initiative, a Workstation Self-Assessment Checklist was developed to help employees understand the importance of ergonomics and how to identify potential risks. The Office Ergonomics Sitting Workstation handout accompanies the checklist and includes a pictorial diagram for reference and instructions and tips for making adjustments and assessing for proper alignment and posture. Members also have access to a video that they can use with step-by-step demonstrations. Employees can work through the checklist and video and document any problems on the checklist and once complete, contact their ergonomics representative or supervisor for assistance. The checklist is a handy tool for employees to keep if they change workstations, use a shared workstation or are away from work for a period of time and need to re-assess their workstation ergonomics.

Heat Illness Prevention Plan

Per T8 CCR 3395 the Heat Illness Prevention Plan must include methods for providing ample water, steps for providing access to shade, a high-heat plan, emergency response actions, and adjustment techniques and strategies. Warm summers bring an increased risk for heat-related illness (which can be a medical emergency and life-threatening), and outdoor and indoor workers can be at risk. It is essential to know the risks and symptoms and preventative measures to keep employees safe from the heat and sun during physical activity. The employer’s plan must be drafted in English and the language spoken/understood by the majority of its employees. It must be made accessible to personnel throughout the organization and Cal/OSHA upon request.

Employee Safety and Wellness Initiative (ESWI)

To help reduce employee injuries, BETA created the Employee Safety and Wellness Initiative (ESWI). Our employee safety incentive program addresses common risk areas across all work settings and promotes best practice strategies under eight domains: Ergonomics, Fleet Safety and Mobile Ergonomics, Manual Material Handling, Opioid and Polypharmacy Prescribing, Return to Work, Safe Patient Handling and Mobility, Slip, Trip and Fall Prevention, Workplace Violence Prevention. Best practice strategies, outlined in the ESWI Guideline, serve as the basis for this incentive program designed to keep the workplace safe. BETA members are eligible to participate on an annual basis in improvement work designed to enhance worker safety and health. Members who are fully insured are eligible for a premium credit of 2% per domain for the successful implementation of all program elements, and the credit is applied at policy renewal. All domain requirements will be confirmed during a validation audit by May 1^st of the contract year.

Just Culture

Just Culture is a supportive system of shared accountability designed to balance the assessment of systems, processes, and human behavior when an error occurs, or an event is reported. The program focuses on system design and behavior management and holds organizations accountable for the systems they design, and individuals accountable for the quality of their choices within a framework that considers human capacity and human fallibility. This model drives continuous improvement and better equips an organization to learn about system vulnerabilities and make corrections before employees and patients are affected.

 

 

Principles

Hazard Risks

Once the source of past losses or near-misses have been identified through incident investigation and data trends, loss control techniques must be selected and implemented to prevent subsequent incidents and minimize their effects.

Loss Control Techniques

Avoidance - Avoidance is a loss control technique that involves discontinuing or deciding not to pursue an activity in the first place to mitigate future injuries arising from that activity. Experiencing an injury from a specific loss exposure is reduced when that exposure is avoided and risk management experts and safety personnel assert that phasing out a risk or electing not to participate in a particular activity can bring the risk of loss to zero. While avoidance can be used, prevention and an evaluation of the system process are warranted to mitigate the risk and exposure in most circumstances.

Loss Prevention - Loss prevention differs from avoidance in that loss prevention accepts the risk but does not eradicate all possibilities of loss. Loss prevention is also independent of loss reduction, as loss prevention focuses on reducing the probability of risk. Examples of loss prevention include providing an office worker with a headset to help minimize the possibilities of a neck strain or making sure a vehicle is serviced regularly so that a mechanical failure does not lead to an incident. In practice, safety staff and risk management specialists might blend loss prevention and loss reduction efforts. Loss prevention measures are typically introduced before a mishap occurs to break the chain of events that spark an incident, which can decrease the likelihood of an accident occurring.

Loss Reduction - What loss prevention does for the frequency of losses; loss reduction does for the severity of losses. To value loss reduction opportunities, risk management professionals must assume that an accident has taken place and then contemplate what steps could have been put into effect immediately preceding the incident to diminish the amount or magnitude of the resulting loss.

The two widespread divisions of loss reduction are pre-loss measures (activated before the loss occurs) and post-loss measures (exercised after the loss occurs). Pre-loss measures are utilized to curtail loss severity and can also lessen loss frequency. When pre-loss measures are implemented, they can mitigate property damage or the number of employees suffering from a single episode. Post-loss measures ordinarily target emergency procedures, salvage operations, rehabilitation activities, or legal defense to interrupt the transmission or counter the effects of loss.

The energy release theory developed by Dr. William Haddon Jr. prompts numerous loss reduction measures. His theory of accident causation and control focuses on decreasing the supply of energy distributed. This includes considering pre-loss measures of loss reduction by preventing the buildup or dispersion of the energy’s transfer, reducing the initial amount of energy, preventing the release of energy, carefully controlling the release of energy, and separating the energy being released from the living or nonliving object. For example, utilizing a gel pad to decrease the energy being distributed between a hard desk surface and your wrists or using Safe Patient Handling equipment to carefully control the release of energy from impacting the employee while lifting a heavy patient. Another example is sitting at least ten inches between the center of your breastbone and the cover of a vehicle's airbag, reducing the initial amount of energy. This can help minimize injuries inflicted by the airbag and increase the likelihood of being saved by the airbag. Similarly, the final two energy transfer ideas are based around swiftly uncovering and assessing damage to circumvent its advancement and taking long-term action to reduce further damage are post-loss measures for loss reduction.

Separation - Separation is a loss control technique that disperses critical assets so that events at one location affect the business only at that location. Separation of exposure units can reduce an organization’s dependence on a single asset, activity, or person, making particular losses smaller. Two illustrations are dividing current inventory between two independent warehouses or manufacturing a component in two isolated facilities. Separation is helpful if an organization can function with only a fraction of these separate units intact. If one unit experiences a total loss, the allocation of assets or operations in the other unit must be adequate for operations to continue. Each of the separate units is kept in daily use.

Duplication - Duplication is a loss control technique that uses backups, spares, or copies of vital property, information, or capabilities and keeps them in stock. These duplicates are not used unless the principal asset is ruined or flawed. Like separation, duplication can reduce an organization’s dependence on a single asset, activity, or person, making individual losses smaller. The difference between separation and duplication is how much the organization depends on the asset or activity. Duplication is applicable if an entire asset or activity is so critical that the repercussion of its loss supports the investment and time of maintaining the duplicate. An example of duplication is keeping duplicate accounting records by creating a backup plan if an information system server failure occurs. The information can be created or copied on a backup server if the primary server fails, and business operations can continue. Duplicate files, extra parts, and cross-training employees so that someone is available to perform a job when the person who typically performs that job is unexpectedly unavailable are typical duplication loss control techniques.

Diversification - Diversification of exposure is a loss control technique that spreads exposure over various projects, products, markets, or regions. Diversification prevents a single situation or series of events from destroying a considerable proportion of the organization’s assets. For example, an organization enters into different geographic markets, if one market becomes too competitive, the other markets may still generate sufficient earnings for the organization to survive.

BETA Risk Management and Employee Safety personnel are available to assist our members with their risk mitigation efforts, including:

Loss Trending

• Data Analytics (By Occupation, Work Setting, Cause, Nature of Injury)
• Injury Frequency Trending (By Self, Peer)
• Dashboards and Key Performance Indicators (KPIs)
• Monthly Loss History Reporting

Hazard Risk Assessments

An evaluation includes a review of the following areas:

• Collect and Evaluate Existing Workplace Hazard Information
• Safety Committee Assessment
• Physical Hazards Assessment
• Health Hazards Identification
• Written Program Requirements Assessment

Policy, Plans and Program Development

• Injury and Illness Prevention Plan
• Safe Patient Handling and Mobility Programs
• Just Culture Training
• Safety and Health Program
• Ergonomics and Manual Material Handling
• Exposure Control Plan
• Aerosol Transmissible Disease Program
• Hazardous Communication Program
• Heat-Related Illness Prevention
• Workplace Violence Prevention Program
• Industrial Hygiene and Personal Protective Equipment (PPE)

Technical Assistance

• Compliance with Cal/OSHA Policies
• Job Hazard and System or Environmental Analysis

References
American Institute for Chartered Property Casualty Underwriters, “Introduction to Risk Assessment and Treatment,” October 2012, pp. 1.4, 1.15, 1.18, 1.27-1.33

IRMI. (2021, January). Energy Release Theory. Retrieved from International Risk Management Institute, Inc. Retrieved from https://www.irmi.com/term/insurance-definitions/energy-release-theory

Haddon Jr., M. W. (1970). On the Escape of Tigers. American Journal, 2229-2234.

Petersen, D. (2003). Techniques of safety management: A systems approach (4th ed.).

Des Plaines, Illinois: American Society of Safety Engineers. Risk and Insurance Management Society. (2012), “Exploring Risk Appetite and Risk Tolerance,” RIMS (Risk Management Society) Executive Report, Retrieved from www.rims.org/resources/ERM/Documents/RIMS_Exploring_Risk_Appetitie_Risk_Tolerance_0412.pdf

At BETA Healthcare Group, our goal is to help ensure that every decision our members make drives a positive outcome for employees, patients, and their families. As the demand for qualified, experienced, and engaged healthcare workers continues to rise, employers must do more to create safer working environments and increase levels of employee engagement while improving the patient experience. Recognizing the impact that your employees have on delivering these positive outcomes, BETA Risk Management and Employee Safety programs align your personnel with our team of knowledgeable safety professionals experienced in the healthcare industry. As a member, you have access to comprehensive risk management and employee safety best practices and tools which provide mitigation strategies to minimize injuries, control costs and protect employees. Each member has access to an employee safety expert who will work to build a customized Service Plan focused on your organization’s specific needs. With a targeted employee safety Service Plan focusing on minimizing workplace disruption and work-related injuries, the organization's risk is identified, and mitigation strategies are implemented.

Glossary of Terms

Hazard Risks – Risks that arise from property, liability, or personnel loss exposures and are often covered by specified insurance (i.e., workers’ compensation, liability insurance).

Operational Risks – Arises from people, processes, systems, or controls.

Loss Control Techniques – Include avoidance, loss prevention, loss reduction, separation, duplication, and diversification.

Avoidance – A risk control technique that involves ceasing an activity (or never undertaking it in the first place) so that the possibility of a future loss occurring from that activity is eliminated.

Loss Prevention – The act of taking proactive measures to prevent identified risks and reduce the frequency of identified risks.

Loss Reduction – A risk control technique for reducing the potential impact of an identified risk.

Separation – The isolation of loss exposures from one another to minimize the adverse effect of a single loss.

Duplication – A risk control technique often found with the use of technology, which uses backups, spares, or copies of critical property, information, or capabilities and keeps them in reserve.

Diversification – A risk control technique that spreads loss exposures over numerous projects, products, markets, or regions.

Heinrich’s Domino Theory – Workplace injury accidents are a result of a chain of events that includes an unsafe act or an unsafe mechanical or physical hazard. Therefore, the focus is on the prevention and elimination of unsafe acts or conditions.

Energy Release Theory – An approach to accident causation that views accidents in terms of energy transference – that accidents are caused by energy out of control. The theory purports that a transfer of energy, in large amounts or at rapid rates, can adversely affect living things and nonliving objects, causing injury and damage.

BETA Healthcare Group Risk Management and Employee Safety Services

Data Mapping | Dashboard Opt-In

Metrics help organizations understand where risks reside, set priorities to address trends, and take corrective action to mitigate risk. The data entered and reported through our online workers’ compensation claims portal generates the data to populate an accessible, interactive, easily interpretable real-time member dashboard complete with key performance indicators. The data serves as a checkpoint to assure safety interventions are tied to measures of effectiveness.

Members can opt-in to a two-part effort designed to assure data integrity by reviewing the data entered in a 5-year period of historical claims with the assistance of the Employee Safety representative assigned to their account. In addition to the opt-in and the completion of the Member Area Access Authorization Form (MAAAF), access is granted to BETA Healthcare Group Claims Intake Portal which is the online member portal to report workers’ compensation claims. Once underway, this combined effort results in the delivery of a powerful measurement tool that brings data to life in dashboard format and is aligned with the Workers’ Compensation Insurance Rating Bureau (WCIRB) and California Workers’ Compensation Institute (CWCI) to assure benchmarking capability.

The data mapping exercise provides an opportunity to deploy customized and directed safety interventions to specific areas of need. Identifying where the injuries are most frequent, what occupations in the organization are experiencing the highest injury rate, and how the employees are being injured, including any contributing factors to that injury, are essential to developing effective strategies to mitigate risk. The dashboard provides members with a data map to ensure proper assignment of resources, which will help drive down costs. Illustrating these results helps to quantify the return on investment of proactive workers’ compensation claims intervention and efforts in safety that can positively impact the organization’s Ex-Mod and its overall workers’ compensation premium expenditure.

Specialized Service Planning

Healthcare organizations have complexities and characteristics that are unlike any other industry. Because of the uniqueness of the healthcare environment, BETA takes a customized approach to preventing loss by providing expert consulting services. Employee Safety professionals assigned to your account will work side-by-side with you to build a customized Service Plan. The Service Plan begins with analyzing loss trends identified in your dashboard report and includes the necessary resources and guidance to make your organization a success. Our Employee Safety staff are all experts in their field and will review your most frequent causes of loss, conduct a hazard and risk assessment, and in partnership with the organization, develop a customized Service Plan to meet your needs. The plan includes guidance on addressing and mitigating risk and coupled with ongoing support and consultation with your team, ensures successful implementation.

Hazard Risk Assessment

On-site hazard and risk assessments are available to member participants to identify potential employee safety loss exposures and assist in creating targeted risk mitigation strategies. The hazard and risk assessments include an in-depth review of an organization’s employee safety programs, analysis of high exposure areas, and examination of various factors as part of their assessment, culminating in a confidential report. This report provides a comprehensive view of identified deficiencies and detailed recommendations and best practice resources that an organization can use as a blueprint for developing and implementing improved employee safety programs.

One-on-One Risk Consultation

BETA offers one-on-one risk consultation with the Risk Management and Employee Safety professional dedicated to providing service to your account. The Risk representative can help you anticipate and navigate the risk management and safety-related issues you may face via one-on-one phone consultations and secure email exchanges. As part of our Consulting Services, an Employee Safety professional performs a robust analysis to help your teams identify risk patterns and behaviors backed by training designed to help with risk prevention and mitigation. What sets our team apart is our proactive approach to helping healthcare organizations mitigate risk. BETA’s Risk Management and Safety personnel are seasoned professionals with years of experience. Whether you need to assess a situation or determine the best way forward, your assigned Employee Safety professional can help you and your leadership respond effectively.

BETA Healthcare Group Office Ergonomics

As part of the ergonomics domain in the Employee Safety and Wellness Initiative, a Workstation Self-Assessment Checklist was developed to help employees understand the importance of ergonomics and how to identify potential risks. The Office Ergonomics Sitting Workstation handout accompanies the checklist and includes a pictorial diagram for reference and instructions and tips for making adjustments and assessing for proper alignment and posture. Members also have access to a video that they can use with step-by-step demonstrations. Employees can work through the checklist and video and document any problems on the checklist and once complete, contact their ergonomics representative or supervisor for assistance. The checklist is a handy tool for employees to keep if they change workstations, use a shared workstation or are away from work for a period of time and need to re-assess their workstation ergonomics.

Heat Illness Prevention Plan

Per T8 CCR 3395 the Heat Illness Prevention Plan must include methods for providing ample water, steps for providing access to shade, a high-heat plan, emergency response actions, and adjustment techniques and strategies. Warm summers bring an increased risk for heat-related illness (which can be a medical emergency and life-threatening), and outdoor and indoor workers can be at risk. It is essential to know the risks and symptoms and preventative measures to keep employees safe from the heat and sun during physical activity. The employer’s plan must be drafted in English and the language spoken/understood by the majority of its employees. It must be made accessible to personnel throughout the organization and Cal/OSHA upon request.

Employee Safety and Wellness Initiative (ESWI)

To help reduce employee injuries, BETA created the Employee Safety and Wellness Initiative (ESWI). Our employee safety incentive program addresses common risk areas across all work settings and promotes best practice strategies under eight domains: Ergonomics, Fleet Safety and Mobile Ergonomics, Manual Material Handling, Opioid and Polypharmacy Prescribing, Return to Work, Safe Patient Handling and Mobility, Slip, Trip and Fall Prevention, Workplace Violence Prevention. Best practice strategies, outlined in the ESWI Guideline, serve as the basis for this incentive program designed to keep the workplace safe. BETA members are eligible to participate on an annual basis in improvement work designed to enhance worker safety and health. Members who are fully insured are eligible for a premium credit of 2% per domain for the successful implementation of all program elements, and the credit is applied at policy renewal. All domain requirements will be confirmed during a validation audit by May 1^st of the contract year.

Just Culture

Just Culture is a supportive system of shared accountability designed to balance the assessment of systems, processes, and human behavior when an error occurs, or an event is reported. The program focuses on system design and behavior management and holds organizations accountable for the systems they design, and individuals accountable for the quality of their choices within a framework that considers human capacity and human fallibility. This model drives continuous improvement and better equips an organization to learn about system vulnerabilities and make corrections before employees and patients are affected.

 

 

Principles

Hazard Risks

Once the source of past losses or near-misses have been identified through incident investigation and data trends, loss control techniques must be selected and implemented to prevent subsequent incidents and minimize their effects.

Loss Control Techniques

Avoidance - Avoidance is a loss control technique that involves discontinuing or deciding not to pursue an activity in the first place to mitigate future injuries arising from that activity. Experiencing an injury from a specific loss exposure is reduced when that exposure is avoided and risk management experts and safety personnel assert that phasing out a risk or electing not to participate in a particular activity can bring the risk of loss to zero. While avoidance can be used, prevention and an evaluation of the system process are warranted to mitigate the risk and exposure in most circumstances.

Loss Prevention - Loss prevention differs from avoidance in that loss prevention accepts the risk but does not eradicate all possibilities of loss. Loss prevention is also independent of loss reduction, as loss prevention focuses on reducing the probability of risk. Examples of loss prevention include providing an office worker with a headset to help minimize the possibilities of a neck strain or making sure a vehicle is serviced regularly so that a mechanical failure does not lead to an incident. In practice, safety staff and risk management specialists might blend loss prevention and loss reduction efforts. Loss prevention measures are typically introduced before a mishap occurs to break the chain of events that spark an incident, which can decrease the likelihood of an accident occurring.

Loss Reduction - What loss prevention does for the frequency of losses; loss reduction does for the severity of losses. To value loss reduction opportunities, risk management professionals must assume that an accident has taken place and then contemplate what steps could have been put into effect immediately preceding the incident to diminish the amount or magnitude of the resulting loss.

The two widespread divisions of loss reduction are pre-loss measures (activated before the loss occurs) and post-loss measures (exercised after the loss occurs). Pre-loss measures are utilized to curtail loss severity and can also lessen loss frequency. When pre-loss measures are implemented, they can mitigate property damage or the number of employees suffering from a single episode. Post-loss measures ordinarily target emergency procedures, salvage operations, rehabilitation activities, or legal defense to interrupt the transmission or counter the effects of loss.

The energy release theory developed by Dr. William Haddon Jr. prompts numerous loss reduction measures. His theory of accident causation and control focuses on decreasing the supply of energy distributed. This includes considering pre-loss measures of loss reduction by preventing the buildup or dispersion of the energy’s transfer, reducing the initial amount of energy, preventing the release of energy, carefully controlling the release of energy, and separating the energy being released from the living or nonliving object. For example, utilizing a gel pad to decrease the energy being distributed between a hard desk surface and your wrists or using Safe Patient Handling equipment to carefully control the release of energy from impacting the employee while lifting a heavy patient. Another example is sitting at least ten inches between the center of your breastbone and the cover of a vehicle's airbag, reducing the initial amount of energy. This can help minimize injuries inflicted by the airbag and increase the likelihood of being saved by the airbag. Similarly, the final two energy transfer ideas are based around swiftly uncovering and assessing damage to circumvent its advancement and taking long-term action to reduce further damage are post-loss measures for loss reduction.

Separation - Separation is a loss control technique that disperses critical assets so that events at one location affect the business only at that location. Separation of exposure units can reduce an organization’s dependence on a single asset, activity, or person, making particular losses smaller. Two illustrations are dividing current inventory between two independent warehouses or manufacturing a component in two isolated facilities. Separation is helpful if an organization can function with only a fraction of these separate units intact. If one unit experiences a total loss, the allocation of assets or operations in the other unit must be adequate for operations to continue. Each of the separate units is kept in daily use.

Duplication - Duplication is a loss control technique that uses backups, spares, or copies of vital property, information, or capabilities and keeps them in stock. These duplicates are not used unless the principal asset is ruined or flawed. Like separation, duplication can reduce an organization’s dependence on a single asset, activity, or person, making individual losses smaller. The difference between separation and duplication is how much the organization depends on the asset or activity. Duplication is applicable if an entire asset or activity is so critical that the repercussion of its loss supports the investment and time of maintaining the duplicate. An example of duplication is keeping duplicate accounting records by creating a backup plan if an information system server failure occurs. The information can be created or copied on a backup server if the primary server fails, and business operations can continue. Duplicate files, extra parts, and cross-training employees so that someone is available to perform a job when the person who typically performs that job is unexpectedly unavailable are typical duplication loss control techniques.

Diversification - Diversification of exposure is a loss control technique that spreads exposure over various projects, products, markets, or regions. Diversification prevents a single situation or series of events from destroying a considerable proportion of the organization’s assets. For example, an organization enters into different geographic markets, if one market becomes too competitive, the other markets may still generate sufficient earnings for the organization to survive.

BETA Risk Management and Employee Safety personnel are available to assist our members with their risk mitigation efforts, including:

Loss Trending

• Data Analytics (By Occupation, Work Setting, Cause, Nature of Injury)
• Injury Frequency Trending (By Self, Peer)
• Dashboards and Key Performance Indicators (KPIs)
• Monthly Loss History Reporting

Hazard Risk Assessments

An evaluation includes a review of the following areas:

• Collect and Evaluate Existing Workplace Hazard Information
• Safety Committee Assessment
• Physical Hazards Assessment
• Health Hazards Identification
• Written Program Requirements Assessment

Policy, Plans and Program Development

• Injury and Illness Prevention Plan
• Safe Patient Handling and Mobility Programs
• Just Culture Training
• Safety and Health Program
• Ergonomics and Manual Material Handling
• Exposure Control Plan
• Aerosol Transmissible Disease Program
• Hazardous Communication Program
• Heat-Related Illness Prevention
• Workplace Violence Prevention Program
• Industrial Hygiene and Personal Protective Equipment (PPE)

Technical Assistance

• Compliance with Cal/OSHA Policies
• Job Hazard and System or Environmental Analysis

References
American Institute for Chartered Property Casualty Underwriters, “Introduction to Risk Assessment and Treatment,” October 2012, pp. 1.4, 1.15, 1.18, 1.27-1.33

IRMI. (2021, January). Energy Release Theory. Retrieved from International Risk Management Institute, Inc. Retrieved from https://www.irmi.com/term/insurance-definitions/energy-release-theory

Haddon Jr., M. W. (1970). On the Escape of Tigers. American Journal, 2229-2234.

Petersen, D. (2003). Techniques of safety management: A systems approach (4th ed.).

Des Plaines, Illinois: American Society of Safety Engineers. Risk and Insurance Management Society. (2012), “Exploring Risk Appetite and Risk Tolerance,” RIMS (Risk Management Society) Executive Report, Retrieved from www.rims.org/resources/ERM/Documents/RIMS_Exploring_Risk_Appetitie_Risk_Tolerance_0412.pdf

Purposeful rounding is a best practice intended to help ensure a safe, clean, comfortable environment by promoting regular open communication between staff members of all levels and across various departments within the organization. Rounding provides a heightened awareness of the environment and safety measures in place throughout the organization and ensures compliance with proper work practices and safety protocols to help reduce risk. Purposeful rounding is a tool for learning more about system processes, equipment, employees, and the culture of safety within the organization.
 

Definitions

Contracted Staff: An individual who provides services based on short- or long-term contracts negotiated with the organization.

Environment: Environment includes all your surroundings when working. Your physical working environment is the building you work in, your workstation and tools as well as air, noise and light. The environment also includes the psychological aspects of how your work is organized and your wellbeing at work.

Facility: Physical building in which staff carry out daily work functions.

Staff/Employees: All the people employed by the organization.

What is Purposeful Rounding?

In a clinical setting the term “purposeful rounding” has always been associated with rounding or checking on a patient every hour. As an Employee Safety professional, it is recommended to round or “check in” with the employees of the organization every week. In larger organizations you may need to perform rounding with different departments every week.

Purposeful rounding provides great learning opportunities through communication with members of different departments. The items listed are the goals of rounding and the outcomes intended for improving a culture of safety and learning.

• Building relationships encourages trust.
  • Remember details like “Cindy enjoys spending time with her family” then ask about her family.
• Celebrate “Wins” – ask what is working well.
• Identify areas where process or system improvement can be made.
  • Observe
• Ask, “What do you see as a barrier for you to perform your job safely? Regular rounding of facilities helps to build awareness of all aspects of the building.
• Purposeful rounding allows you to proactively address safety issues before they occur.

 

• Ask questions such as:
  • Are you aware of any “near-misses” or events that almost caused you or another coworker harm but did not?
  • Have you reported, or do you know how to report a “near-miss?” If not, what are the barriers that prevented you from reporting or how can the process be improved?
  • What is your biggest safety concern?
  • Do you have access to all the proper equipment necessary to perform your job safely? If not, what would help you perform your job safely?
  • Do you feel you have trained to use the equipment?
  • Do you know who to ask if more training or help is needed?

All these questions are meant to engage the employee in a conversation and for you to gain more information about the day-to-day task taking place in the organization. When rounding the following week or month, engage in a conversation with a different employee asking the same questions. It is best practice to scribe the issues that are collected in a log, then circle back with employees on identified solutions to those issues to promote trust.

When in a department, if you see a task being performed incorrectly, stop the task when safe to do so and provide a teaching moment. The teaching moment is not meant as discipline or a one-sided conversation, but an opportunity to learn from the employee.

An example of a conversation is:

Hi Jane

I noticed that while you were making the bed, the bed was in a low position. Did you feel that it was too low?

No, I did not notice. I was in a hurry to get the bed ready before the patient came back from radiology.

Let us try raising the bed to a level that will make the task easier and safer for you to perform. It is important to stop and plan out the task before starting the task. It may only take a few seconds or a few minutes depending on the task and the preparations involved to complete the task.

I had not thought about stopping to plan, but it makes sense.

Thank you

Safety and Work Environments

• Become familiar with the different areas of the organization and the diverse types of working environments.
• Identify one or more contact(s) within each of the different departments with whom to conduct regular safety-related check-ins.
• Schedule time on a weekly basis to walk at least two different departments and check in with staff members around those departments.
• As you are walking throughout the building, be aware of key safety items that may need attention, such as:
  • Fire hazards, including obstructed or partially obstructed emergency exits and egress pathways
  • Slip, trip, and fall hazards, especially falls from height
  • Cluttered hallways or workstations due to equipment, furniture, boxes, etc.
  • Visibly faulty equipment where lockout/tagout may be necessary
  • Poor lighting or lights that need to be replaced
  • Note employees who may not be exercising proper safety protocols and ergonomic practices and might require guidance or training
• A checklist is a best practice to ensure the accuracy of the rounding. It is important though to not rely solely on the checklist, but also on the interactions with the employees.
• Take note of any feedback received from staff and any observed environmental safety issues.
• Any urgent safety issues should be addressed immediately. Non-urgent matters should be addressed (or an update provided) within three to five business days.
• Devise a plan for resolving any communicated or observed safety concerns and share the method with affected parties. Necessary reporting and resources deployed will vary depending on the safety concern being addressed.

 

Follow Up

After rounding has been completed take the time to review the findings with the manager or supervisor of the work area or department. Remember to provide the “Wins” and the areas that need review. If items need to be repaired, determine who will place the work order with facilities and follow up when completed. When training issues are identified, address those issues as whole, and suggest a teaching opportunity that can be presented at a huddle or monthly staff meeting instead of singling out an individual. In this way, trust and rapport with the individual will be preserved.

If an employee has a concern about the safety of performing their job duties due to a system process or lack of equipment, make sure that you follow up with the employee. The follow-up leads to further open communication, reporting of near-miss incidents and builds trust in the organization.

References
AORN (Association of Perioperative Registered Nurses) (2013) Leadership Rounding Worksheet. Retrieved from: https://www.aorn.org

Hotko, B., (2021) Rounding for Outcomes: How to Increase Employee Retention and Drive Higher Patient Satisfaction. Retrieved from: https://www.huronlearninglab.com/hardwired-results/hardwired-results-01/rounding-for-outcomes

Montgomery, V., Impact of Staff-Led Safety Walk Rounds; Retrieved from: https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Montgomery_42.pdf

A safety committee aims to help reduce the risk of workplace injuries and illnesses and ensure compliance with federal and state health and safety regulations.

Safety committees play a vital role in effectively reducing risk by allowing representatives from all departments across the organization to have a voice and actively participate in managing risk within the organization. The committee guides the safety measures within an organization by providing a clear purpose and identified objectives. To have a successful safety committee, it is important to engage senior leadership who provide ongoing support, communication, adequate tools, and resources. The committee is led by an appointed committee chair and at least one representative from each department, including frontline employees and security personnel, to create a diverse approach to safety. These committees also provide a broader, more comprehensive view of safety-related matters throughout the organization.

Glossary of Terms

Agenda – A list of things to do or a plan to organize time in a meeting.

Committee - A group of people appointed for a specific function, typically consisting of members of a larger group.

Injury and Illness Prevention Plan (IIPP) – An important written document outlining a workplace safety program.

Terms of Service – The length of time that an individual serves on the committee.

Regulations - Communication with Employees about Title 8, of the California Code of Regulations Section 3203(a)(3) The Injury and Illness Prevention Plan (IIPP) outlines the procedures for implementing and managing the safety committee.

Committee Directives

The Committee on Health and Safety (Committee) is charged with the following responsibilities:

• Exercise oversight for all health and safety programs.
• Communicate with the Chief Executive Officer/Administrator on the adequacy of the health and safety programs, policies, and organization.

• Recommend needs, priorities, and strategies to promote good health, safety, and environmental practices to the administrators.
• Establish leading and lagging safety metrics, monitor performance, and adjust safety policy and practice as necessary to meet goals.
• Committee goals should be specific, measurable, achievable, realistic, and time phased (SMART).
• Use a continuous improvement model for safety, such as Plan, Do, Check, Act (PDCA).
• Foster cooperation among those units having operational responsibility for health and safety.
• Recommend the Chief Executive Officer/Administrator issue facility-wide policies with respect to those health and safety matters that are not addressed by the existing administrative policies.
• Periodically perform a management review of the Committee by reporting to the C-suite on key metrics, risks, opportunities, and resources needed to accomplish goals and objectives.
• Review investigations of workplace violence or threats of violence, occupational accidents and causes of incidents resulting in occupational injury, occupational illness, or exposure to hazardous substance and, where appropriate, submits suggestions to management for the prevention of future incidents.
• Review investigations of alleged hazardous conditions brought to the attention of any committee member.
• Review facility periodic, scheduled worksite inspections.

This Committee in no way replaces or supersedes the administration or senior leadership’s responsibility for health and safety.

Each year, at least one meeting of the Committee shall be publicized and open to all employees of the organization. An effective strategy is to schedule this meeting for the first of the year or the end of the year. The first of the year allows the Committee to hear the employees' suggestions and concerns, whereas the end of the year allows the Committee to capture and review the progress. The meeting will provide an opportunity to report on health and safety conditions and provide an opportunity for staff to raise questions or concerns about activities, facilities, or support services as they may affect the health and safety of employees and the public.

Committee on Health and Safety – Term of Service

The Chair of the Committee shall be one of the members and shall be named by the Chief Executive Officer/Administrator. The term of serving on the committee shall be for two years effective January 1st of the year of appointment and ending December 31st of the year in which the term expires. Committee member terms shall be staggered to minimize the impact of turnover on the Committee. As often happens, there may be times when some committee members may not be able to attend a scheduled meeting due to a conflict in scheduling or patient care priorities. To ensure the meeting can continue, the best practice is for each member to identify a back-up representative in the event they are unable to attend a meeting or can no longer serve. The Committee shall establish permanent subcommittees or task forces from among its membership or departments as it shall deem useful in carrying out its charge. The Committee shall seek advice from legal counsel as necessary and appropriate.

Roles and Responsibilities

Senior Leadership

It is important for senior leadership to consistently attend and actively participate in safety committee meetings, as it demonstrates to staff (and the committee) their dedication to providing a safe and healthy environment for the organization. Best practice is for a senior leadership team member to be assigned as the committee sponsor. The sponsor in turn communicates with the CEO regarding key metrics and activities of the committee, any barriers faced, and any resources needed.

 

Committee Chair

The Committee Chair is responsible for:

• Scheduling meetings
• Creating an agenda
• Facilitating the meeting
• Maintaining records and meeting minutes

Committee Members

Ideally, committee members are a diverse group of individuals from varying departments within the organization. Each member serves as a safety representative who will:

• Be assigned a defined role

• Develop safe working practices
• Creating a written safety program
• Lead safety training
• Conduct workplace inspections and safety audits
• Promote employees' health and safety interests
• Provide a forum to discuss health and safety issues
• Collaborate on solutions

An effective committee member is engaged, actively participates in committee meetings, and serves as a safety champion to all staff. It is important to hold regular meetings with an agenda prepared and distributed in advance, and with minutes taken at each meeting. The agenda allows committee members the opportunity to provide input on topics for discussion. The primary focus is on past injuries, accident investigations, reporting, and follow-up/mitigation of injuries.

The committee then creates a method for preventing future injuries or adverse workplace events with policy and procedure updates. The committee shall set short- and long-term goals that are attainable and are reviewed for effectiveness. As a member, each will keep apprised of current safety issues and hazards on campus and bring forth those items to the committee. Committee members may receive training on various safety topics during meetings such as Active Shooter.

Agenda

Creating an agenda for a meeting helps drive the conversation, keeps things on task and allows for updates on the committee's goals. A sample agenda may look like the following:

• Date
• Time
• Attendees
• Review of minutes from the last meeting

Reports on key safety, security, hazardous materials, emergency management, medical equipment, and facilities metrics reports from Safety Rounds:

• Review of accident and incident investigations, as well as corrective and protective actions taken, update on campus security issues and items reported to committee members.

 

A sample Safety Committee Agenda can be found in the Appendix.

Reporting Requirements

The Chairperson for the Committee shall meet with the Chief Executive Officer/Administrator at least quarterly and report on the adequacy of the health and safety programs, policies, and organization from the perspective of the Health and Safety Committee. No later than December 31^st of each year, the Chair of the Committee shall provide an annual report to the Chief Executive Officer, Human Resources Director and Risk/Compliance Director summarizing key issues and new policies addressed by the Committee during the committee year. Copies of these reports shall be available to all employees. The Committee or its members may also submit confidential reports to the Chief Executive Officer, Human Resources Director or Risk/Compliance Director as deemed necessary.

References

California Department of Industrial Relations. (2019, August). The Worker Occupational Safety and Health Training and Education Program. Retrieved from State of California Department of Industrial Relations: https://www.dir.ca.gov/chswc/woshtep/iipp/

Maurer, R. (2013, August 8). Making Workplace Safety Committee Work. Retrieved from Society of Human Resources Management: https://www.shrm.org/resourcesandtools/hr-topics/risk-management/pages/workplace-safety-committees.aspx

BETA Healthcare Group recognizes healthcare organizations have complexities and characteristics that are unlike any other industry. Because of this uniqueness your BETA Risk Management and Employee Safety Manager will work side-by-side with you to build a customized Service Plan.

The Service Plan is a guiding document that is used to identify key risk exposures based on the organization's loss history, including a review of existing data sets and an evaluation of safety hazards in the organization. The collaboration between the ESM and the organization’s leaders will lead to a Service Plan designed to maximize the effectiveness of your safety program. The Service Plan will aid both the organization and the ESM with tracking the progress on performance of the safety efforts in the organization.

Glossary of Terms

Form 5020 – Form for the employer’s report of occupational injury or illness which must be completed within 5 days of reported injury or illness.

Coding – the process of assigning a code to something for classification or identification.

California Workers’ Compensation Institute (CWCI) – Its primary functions are to collect and analyze claims data to improve benefit delivery to injured workers, identify system-wide trends, and address key issues of interest to the membership, the workers’ compensation community, and public policy makers.

Loss History – a record of insurance losses.

Workers’ Compensation Insurance Rating Bureau (WCIRB) – objective provider of actuarially-based, research integral to a healthy workers’ compensation system.

Coding

BETA follows the coding guidelines of the California Workers’ Compensation Institute (CWCI) and the Workers’ Compensation Insurance Rating Bureau (WCIRB). The coding enables BETA to provide an overview of the data and benchmarking capabilities available to the organization. Benchmarking can then be done in comparison with self, peers, BETA members and the industry.

Below is an example of coding by frequency. The frequency is identified in the coding by the injury description and the injury cause entered on the Form 5020 when reporting the claim.

Injury Description	Injury Cause
Burn or Scald	Exposure (Contact)
Burn or Scald	Exposure (Disease)
Cut, Puncture, Scrape	Cut, Puncture, Scrape, NOC
Cut, Puncture, Scrape	Hand Tool, Utensils, Not Powered
Cut, Puncture, Scrape	Needlestick
Cut, Puncture, Scrape	Needlestick (Injection Related)
Cut, Puncture, Scrape	Needlestick (IV Related)
Cut, Puncture, Scrape	Object Lifted or Handled
Cut, Puncture, Scrape	Powered Hand Tool, Appliance
Rubbed or Abraded	Repetitive Motion
Strain or Injury	Repetitive Motion (Data Entry)
Strain or Injury	Reaching
Strain or Injury	Twisting
Strain or Injury	Using Cutting Tools
Strain or Injury	Using Machinery/Tools

 

Service Plan Development

The development of the Service Plan is based on data sets which are found in a dashboard. The dashboard data sets are developed based on the coding of claims as provided by the member in their 5020 forms. Claims information collected consist of frequency, loss type, nature of injury, body part, occupation, location, department and work setting. This data is the basis for the formation of Service Plan objectives and goals.

Example of data sets:

Frequency By Cause
Cause	Claim Count
Strain or Injury	14
Burn or Scald (Heat or Cold Exposures – Contact With	10
Miscellaneous Causes	3
Rubbed or Abraded	3
Cut, Puncture, Scrape	3
Fall, Slip or Trip Injury	2

 

Understanding the unique challenges that occur on a day-to-day basis and the trends identified in the loss history create the goals of the Service Plan. An example is an increase in patient handling injuries specifically related to repositioning the patient in bed by the Certified Nursing Assistants (CNAs). This type of data will inform the objectives and goals set by the organization in collaboration with their Risk Management and Employee Safety Manager. These will be implemented and sustained by the organization. The ESM will guide the implementation and provide resources such as the Employee Safety and Wellness Initiative to help maintain sustainability. Below is an example of a Safe Patient Handling Service Plan.

 

Objective

Safe Patient Handling Example:

• As the patient's mobility assessment indicates, employees will use mechanical lifts with every patient every time.
• Reduce back injuries by ten percent

Goals

Safe Patient Handling Example:

1. Review Policy and Procedures for patient mobility, transfers, and repositioning.
2. Identify equipment available and the location where it is stored.
3. Ensure that all patients are assessed by using a BMAT (Banner Mobility and Assessment Test), SRA (Safety Risk Assessment), CPAx, or algorithm, and the assessment is documented in the patient’s electronic medical record.
4. CNAs are to review the record at the beginning of the shift and notify the RN if the patient is unable to be transferred as indicated.
5. Training and education are done at the time of hire (and annually thereafter).
6. Rounding weekly to uncover any challenges and system process issues that may be a barrier to the usage of equipment.
7. Safe Patient Handling Committee to meet quarterly.

A framework for the development of an Employee Safety Service Plan is in the Appendix.

 

 

Implementation

Once the Service Plan is agreed upon implementation begins. The goals are communicated to those within the organization who would have the most influence to provide capital, reinforce the training and communication with staff, and provide peer support. Forming a committee is often a best practice to mitigate the challenges of implementing and completing a goal. Peer support is done with the help of champions who attend the committee meetings. The pace at which the goals are completed is based on the organization’s timeline and are subject to change due to updates or competing priorities.

The member dashboard is analyzed to identify the most frequent causes of employee injuries. In collaboration with the Risk Management and Employee Safety Manager assigned to the account, a Service Plan is created. The Service Plan is a guiding document that will help direct the use of your allotted CARE funds. The CARE funds are intended to support achieving the goals outlined in the Service Plan and may be applied to professional development in employee safety practices.

Definitions

Contract Year - The contract year starts on July 1^st and ends on June 30^th

Purchaser - The primary contact within an organization in control of purchasing workers’ compensation, liability, and other lines of insurance.

Service Plan - The guiding document that is utilized to identify key risk exposures based on the loss history in your organization.

 

Guidelines

Qualifications

Reimbursement using these funds is limited to educational activities, materials, programs, or services that augment our joint endeavor to manage workers’ compensation risk.

Examples of the types of programs that are eligible for reimbursement include:

• Growth and development of key leaders and staff in employee safety concepts
• Promote and/or achieve specialty certification in ergonomics, human resources practice or safety
• Cover the cost of additional staff to participate in our BETA-hosted education events
• Attendance at professional meetings and/or membership in professional organizations
• Employee safety focused manuals, publications or periodicals to include in your resource library
• Speaker honoraria to deliver topics to address employee injury trends where BETA does not provide similar content
• Equipment to safeguard employees including PPE, SPH equipment and/or lifts, safety signage or patient lifts

Exclusions

• Gift Cards greater than $25.00 in value.
• College Tuition
• Regulatory survey or accreditation preparation activities or education
• License renewal
• Costs incurred, or attendance at education or training outside of contract year

Travel

BETA will reimburse event attendees:

Mileage – At the IRS-approved rate round-trip (minus regular work commute miles), or round-trip airline coach fare. If you qualify for airfare reimbursement, mileage to the airport (minus regular work commute miles), shuttle or taxi fare to/from the airport and venue will also be reimbursed.

Onsite Parking

Hotel Accommodations - At the single occupancy rate if the commute to the event location is greater than 40 miles or more than one hour or longer from an individual’s residence.

Meals – Up to $60.00 per day.

Note: Expenses that will not be reimbursed include: wages/salaries, laundry, valet, telephone, internet, in-room movie, health club and spousal/companion expenses.

For approved events, reimbursements will be processed once the event has concluded. Checks will be processed within fifteen (15) business days following receipt of your request.

Required Documents

The reimbursement process requires that the CEO, CFO, or insurance buyer sign the BETA form in DocuSign.

Itemized receipts are required for all expenses submitted for reimbursement, including the detailed hotel bill and mileage report if driving distance is greater than 175 miles, and must accompany the completed reimbursement form. Receipts for purchases or certificates of completion for education or certification must be attached to the form when submitting for reimbursement.

Reimbursement Checks

Checks are payable to the member or insured organization only. BETA cannot reimburse individuals directly for member-related expenses. Checks will be processed within fifteen business days following receipt of your completed and required documents.

Deadline for Submission

Costs incurred and requests for reimbursement must be submitted within the contract coverage period or by June 30th. Requests submitted after the contract coverage period has ended will not be processed and remaining funds will be forfeited.

The CARE Fund Form and information on filling it out for reimbursement are located on the Member Area of the BETA website. Your Risk Management and Employee Safety Manager can supply you with the CARE Fund Resource List with ideas and options for the use of CARE Funds.

BETA Healthcare Group (BETA) Employee Safety is focused on minimizing injuries, controlling costs, and protecting all employees within the healthcare environment. As your partner in employee safety, BETA provides its members with the opportunity to participate in an incentive-based program designed to embed best practices in your healthcare environment and enhance worker safety and health. The Employee Safety and Wellness Initiative (ESWI) provides a structured and supportive approach to reduce injury. Once all criteria are met through a validation survey, members receive incentive credits applicable to the following year's contribution.

BETA’s Employee Safety and Wellness Initiative focus on eight key loss prevention areas, or domains: Ergonomics, Fleet Safety and Mobile Ergonomics, Manual Materials Handling, Opioid, and Polypharmacy Prescribing, Return to Work, Safe Patient Handling and Mobility, Slip, Trip and Fall Prevention, and Workplace Violence Prevention. Best practice strategies, outlined in the Employee Safety and Wellness Initiative Guideline, serve as the basis of BETA’s incentive program designed to keep the workforce safe. In addition to promoting safe and responsible behavior, the initiative offers a significant return on investment which can impact your experience modification (Ex-Mod) factor.

Definitions

Domain Lead - BETA Employee Safety personnel who have specific expertise in various aspects of a particular domain of the Employee Safety and Wellness Initiative. The Domain Lead is responsible for assessing and conducting the components of the domain and is often different from the Employee Safety Manager assigned to the account.

Employee Safety Manager (ESM) - The BETA account manager assigned to the account and whom you are in contact with regularly assists in service planning, answering questions, providing resources, and keeping you apprised of new regulations and changes to existing ones.

Experience Modification Factor (Ex-Mod) - A factor that aligns manual rates to an insured's experience based on the insured's payroll and loss record for specific prior years.

Exposure - Any condition that presents a possibility of gain or loss, whether or not an actual loss occurs.

Hazard - A condition that increases the frequency or severity of a loss.

Loss Prevention - A risk control technique that reduces the frequency of a particular loss.

Regulations - The U.S. national standards developed to ensure workplace health and safety for all employees. Regulations are specific to each domain and will be identified by the domain lead.

Roles of Individuals

Chief Executive Officer
Provide support through leadership, financial and staff resources to support safety initiatives, and high-level employee safety communication to all staff underscoring the value and prominence of this function to the organization.

Chief Financial Officer
Reviews capital finances and agrees to budget for items related to the safety and wellbeing of all staff.

Chief Nursing Officer
Facilitates conversations with clinical staff and ensures that all clinical staff are competent in the proper procedures and policy. Actively participates in safety initiatives impacting nursing such as safe patient handling and workplace violence prevention and response.

Employee Safety Officer
Responsible for creating a team to establish and implement the program. Develops and maintains the Safety Management System. Promotes management involvement and employee participation in employee safety. Develops and distributes ongoing safety training, and communication to the organization on key safety metric performance. Oversees the Injury and Illness Prevention Program, coordinating with Human Resources, Employee Health, and Occupational Health Services on preventative and injury management programs. Participates in incident investigation and the implementation of post-incident corrective actions. Oversees ongoing organizational hazard assessments and hazard correction. Serves as a safety related regulatory compliance subject matter expert. Provides internal consultation on best practices and promotes organizational adherence to best practices when they exceed regulations.

Compliance Manager
Ensures that all aspects of safety meet or exceed codes, regulations, and regulatory agency requirements.

Human Resources
Creates and implements a policy that meets the requirements of regulations. Promotes annual employee safety performance evaluation metrics for all employees from the CEO down to line level staff.

Risk Manager
Oversees the identification of the risk of injury or exposure, aids in the creation and implementation of the plan, and provides resources and best practices to the team.

Environmental Services
Offers guidance on procedures, reviews the policies, and trains the staff.

Facilities
Actively participates in periodic safety rounding and works directly with the safety officer to ensure that any identified hazard is addressed on a timely basis and by qualified tradespeople/technicians. Provides documentation in the form of work orders to show completion of assigned corrective actions.

Security
Reviews policies, procedures, identifies risk on campus; establishes rapport with community services (fire department, local police, or sheriffs); security training of staff including proper protocols of de-escalation and when to activate a call for help.

 

Employee Safety and Wellness Initiative Domains

https://betahg.com/risk-management-and-safety/employee-safety/incentive-programs/employee-safety-wellness-initiative/

https://betahg.com/eswi-resources/

Ergonomics

California’s Ergonomics Standard (CCR Title 8, Section 5110 – Repetitive Motion Injuries) requires employers to perform worksite evaluations of each job, process, or operation if there are one or more injuries from the same repetitive motion job task. Computer work has become commonplace in healthcare since the introduction of electronic medical records. Repetitive keyboarding can be a risk factor for upper extremity injuries. Having a good plan in place for handling worksite assessments, policies, procedures, and staff education can help mitigate the harm to employees and cost to employers. BETA’s ergonomics toolkit can assist you in developing your own internal program.

Fleet Safety and Mobile Ergonomics

According to the National Safety Council (NSC), motor vehicle collisions continue to generate the most significant amount of major occupational injuries and remains the world's leading cause of death for people ages 15 to 29. Every 12 minutes someone dies; every 10 seconds an injury occurs and every 5 seconds a crash happens. These incidents have lasting financial and psychological effects on employees, co-workers, families, and employers. They not only impact an employer's workers’ compensation premiums, but cost employers $60 billion annually in medical care, legal expenses, property damage and lost time. A typical motor vehicle accident costs an employer $16,500. If an injury is sustained, the cost to the employer, on average, is $74,000 to upwards of $500,000 when a life is lost. A Fleet Safety and Mobile Ergonomics (FSME) program can help protect employees from experiencing life changing injuries or even death.

Manual Material Handling

Manual material handling (MMH) occurs in every type of health organization where employees must push, pull, lift, lower, carry, and hold equipment, materials, and objects (excludes patient handling). Material handlers, laborers, freight handlers, stock handlers, janitors, and cleaners are among the occupations with the highest injuries. In 2020, MMH injuries causing overexertion and bodily reaction accounted for 22% of all injuries in the U.S. MMH injuries impacted the education and health services industries even more at 25%, with back injuries being the most frequent and costly. (2020, Bureau of Labor Statistics, U.S. Department of Labor)

In looking at our BETA membership, we have found that hospices often run thrift stores and donation centers which require handling of large and awkward donation items, including furniture. Hospitals have material supply departments, sterile processing, maintenance engineers, and staff who clean, cook, stock, and manage materials. Clinics also employ staff who are required to maintain the buildings inside and out. Solutions are included in the toolkit to assist in understanding the ergonomic risks, evaluating hazards through ergonomic assessment, and using a hierarchy of controls to find the most economical and efficient solutions for keeping staff safe and healthy at work.

Opioid and Polypharmacy Prescribing

According to the National Center for Drug Abuse Statistics (NCDAS), drug overdose deaths in the United States are up 30% year-over-year. Over 96,700 people die from drug overdoses every year. Seven out of ten overdose deaths involve Opioids. Drug overdoses have killed almost a million people since 1999.

Recent data obtained from the California Workers’ Compensation Institute (CWCI) indicates that from 2017 to 2021, the workers’ compensation system has seen a reduction in opioid usage and improved prescribing practices, noting an opioid prescribing rate in 2017 of 19.6% to 9.4% in 2021 representing a 10.2% decrease of this top therapeutic drug. The decline in opioid usage is excellent news, as while opioids can help with severe, acute pain, a study from the WCIRB states chronic opioid usage can take up to 24 months to wean. In contrast, some workers are never able to wean.

Improving the ways that opioids and prescription stimulants are prescribed through instituting sound clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment and reduce the misuse or overuse of these prescription medications.

Return to Work

Work-related and non-work-related injuries and illness can have significant negative impacts on the organization, the employee, and their co-workers. Organizations must navigate through complex disability rights and workers’ compensation laws as the employee negotiates through medical care, rehabilitation, and potential loss of income that can lead to stress and job dissatisfaction. Co-workers are left with the possible loss of their colleagues which may add to their workload and can negatively impact organizational culture. Eliminating barriers and implementing strategies that support an employee’s early return-to-work (RTW) through a well-established program can have a far-reaching positive impact on the organization, and those they serve.

There is strong evidence that a well-established RTW program provides a myriad of benefits for the employer and employees that can strengthen the overall health and work environment of the organization. Employee benefits include an ability to maintain some or all their earnings, preserve physical conditioning, stay mentally active, return to pre-injury status quicker, where they can maintain their skillset and feel a sense of self-satisfaction for their contribution. Additionally, employees can maintain social work connections and daily structure.

Employers can avoid high costs related to fines or penalties, reduce costs associated with workers’ compensation claims, overtime, or temporary help, as well as improve employee morale, increase productivity, limit absenteeism/days away from work, retain experienced workers, and ensure equal opportunity for persons with disabilities.

Safe Patient Handling and Mobility

Regulations from OSHA and Cal/OSHA §5120 Health Care Worker Back and Musculoskeletal Injury Prevention and California Labor Code 6403.5 Hospital Patient and Health Care Worker Injury Protection Act require all general acute care hospitals to comply. Direct patient care requires the handling, lifting, and mobilization of patients daily, increasing the risk of musculoskeletal injuries. According to statistics from the National Safety Council, in 2020, 26.2 per 10,000 full-time workers reported injuries related to overexertion and bodily reaction. The Bureau of Labor Statistics (BLS) reported that the number of sprains, strains, and tears in 2018 was 38.4 per 10,000 workers. Safe patient handling programs can reduce injuries related to musculoskeletal disorders (MSDs). Providing a program to reduce patient handling injuries not only helps employees but also will improve patient care and the bottom line.

Slip, Trip, and Fall Prevention

Slips, trips, and falls (STF) are the second leading cause of injury in healthcare workers and the social assistance industry, costing employers $1.35 billion and representing 25.1% in frequency (2023, Liberty Mutual Insurance). Environmental hazards, as well as human factors, can cause an STF. These same hazards can also lead to patient and visitor injury. The outcome can be severe physical harm to the individual and monetary loss to the organization. As of October 2018, STF is the second-leading loss leader in terms of injury severity among BETA members.

Workplace Violence Prevention

Today more than 5 million U.S. hospital workers from many occupations perform a wide variety of duties and are exposed to many safety and health hazards, including violence. This violence can range from offensive or threatening language to homicide. According to estimates of the BLS in 2018, healthcare workers sustain workplace violence (WPV) injuries at a rate of over 10 assaults per 10,000 workers, a rate over four times higher than full-time employees in the private sector. Psychiatric hospitals had WPV injury rates 64 times higher than private industry, while nursing and residential care facilities had rates 11 times higher than private industry. Seventy-nine percent of violent injuries were caused by interactions with patients. Although most events are non-fatal, there were 14 fatal events due to homicide in the sector. Healthcare workers (HCWs) who provide direct care have a high risk for WPV due to the populations they serve, including those who may have altered mental status related to the influence of drugs and alcohol, psychiatric disorders, pain, multiple psychosocial stressors, or grief.

Incentive Structure

Our fully insured members* that formally opt-in to the Employee Safety and Wellness Initiative and commit to implementing and successfully completing all criterion within the selected domain through an annual validation survey, qualify for a 2% renewal premium credit, with a maximum of 4% annually. A one-time credit will be applied to the following year’s policy renewal, after the successful completion of each domain’s subcomponents as described in the BETA ESWI Guideline and as validated by a BETA Employee Safety Manager. Once a domain has been validated and the criteria met, the domain may not be repeated for an incentive.

*Fully insured accounts do not include members/insured with excess coverage over a self-insured retention

Domain	Incentive/Renewal Credit
Ergonomics	2%
Fleet Safety and Mobile Ergonomics	2%
Manual Material Handling	2%
Opioid and Polypharmacy Prescribing	2%
Return to Work	2%
Safe Patient Handling and Mobility	2%
Slip, Trip, and Fall Prevention	2%
Workplace Violence Prevention	2%

 

Get Started

Each domain is supported with tools and resources that represent best practice models.

Validation Process

• BETA will complete onsite validation assessments measuring the extent to which the member/insured has successfully achieved individual domain criteria.
• Validation assessments must be completed by April 30th of each year to earn the incentive/renewal credit for the following contract/policy renewal.
• The results of the validation assessment and findings will be provided to the member with the determination of the incentive/renewal credit the member will receive.

Engagement

For a program to be successful, leadership is encouraged to engage in the possible financial commitment of capital funds to purchase suggested equipment, training programs or other items that would reduce risks. The CEO will communicate to all staff the organization's commitment and dedication of time and resources in supporting efforts to make the workplace safe and healthy. Communication is sent through email, the intranet, or as an announcement to all staff that encourages employees to offer suggestions on how day-to-day successes and challenges affect the operations and will help lead in establishing prevention efforts.

Policies and Procedures (Plan)

The Injury Illness Prevention Plan (IIPP) Program along with policy and procedure documents are the foundation of an organization's safety program. The first step upon opting-in is the review of the organization's IIPP with your designated Employee Safety Manager (ESM). The ESM will be reviewing the IIPP with human resources, employee safety, and security to ensure that all are aware of the program. The BETA ESWI Domain Lead will manage the review of the domain specific policy and procedures. It is essential to have a lead or a committee that can meet with the ESWI Domain Lead to discuss changes to the policy and procedure documents.

Training

Each domain requires that employees are trained upon hire and annually. A new employee will be trained in regulations, policy, related risk exposures, and the reporting of near-misses and injuries. The training may be specific to their area of work and the type of work performed by clinical and non-clinical staff. Upon completion of the new hire employee training, the employee will be able to identify the hazards, prevention strategies and injury reporting procedures. Annual training is conducted to review all the components of the new hire training and the implementation of any new regulations or standards. If equipment is used by staff, training is performed upon hire annually and if a new piece of equipment is purchased. The annual training on equipment will consist of a demonstration on how to use the equipment and in turn, the employee must show that they can operate the equipment as demonstrated.

Documentation

Documentation requirements vary in each domain and should be discussed with the domain lead. It is important to document all training through sign-in sheets, tests, and signatures from the review of policies or employee handbooks. The best practice is to keep the documentation for three to five years depending on the regulations and standards.

References
Department of Industrial Relations; Article 2. Employer Records of Occupational Injury or Illness; Retrieved from https://www.dir.ca.gov/t8/ch7sb1a2.html

Department of Industrial Relations; (2013) Personnel Files and Records; Retrieved from https://www.dir.ca.gov/dlse/faq_righttoinspectpersonnelfiles.htm

Department of Industrial Relations; (1986) Recordkeeping Requirements; Retrieved from https://www.dir.ca.gov/title8/6058.html

Educational Opportunities

Training and protecting employees should be a priority in the workplace. Safety training and education ensures employees have the skills and knowledge to perform their jobs properly and safely. Providing educational opportunities to employees can often increase staff morale and confidence and foster a growth mindset within the organization. Training employees to do their jobs well and safely is an investment that can potentially result in fewer injuries and illnesses, reduce the organization’s claims experience, lower insurance premiums and more.

Regulatory Agencies

Regulatory agencies establish standards for healthcare organizations and can provide insight into the expectations and regulations that apply to your organization. These agencies and other organizations perform accreditation for organizations through a process that reviews their operations to ensure adherence to standards in specific areas of the healthcare delivery system.

Cal/OSHA (California Occupational Safety and Health Administration) – The Division of Occupational Safety and Health (DOSH), better known as Cal/OSHA, protects and improves the health and safety of employees in California and the safety of passengers riding on elevators, amusement rides and tramways through the following activities:

• Setting and enforcing standards
• Providing outreach, education, and assistance
• Issuing permits, licenses, certifications,
  registrations, and approvals

Cal/OSHA requires employers to provide training to workers who face hazards on the job. The Injury and Illness Prevention Plan (IIPP) Program is a guiding document, which outlines safety training of employees within the organization.

CARF (Commission on Accreditation of Rehabilitation Facilities) – CARF is a nonprofit organization which assists service providers in improving the quality of their services, demonstrating value, and meeting internationally recognized organizational and program standards.

OSHA (Occupational Safety and Health Administration) – Is the federal regulating agency under the Department of Industrial Relations for the U.S. However, in California, the Department of Industrial Relations (DIR) administers the California State Plan through Cal/OSHA. It is important to reference California-specific Cal/OSHA standards for two reasons. The first reason is for our members to be able to review regulations specific to the State of California. The second reason is that when there is a difference between Federal OSHA and Cal/OSHA, by regulation, Cal/OSHA must be more stringent than Federal OSHA and would apply.

The Joint Commission (TJC) – The mission of The Joint Commission is to continuously improve healthcare for the public. To achieve the Gold Seal of Approval, organizations must submit to onsite evaluations to verify compliance with standards and regulations. TJC also offers resources in the following areas:

• Cybersecurity
• Patient Safety
• Nursing
• Physicians
• Consumers
• Educational Events

Training and protecting employees should be a priority in the workplace. Safety training and education ensures employees have the skills and knowledge to perform their jobs properly and safely. Providing educational opportunities to employees can often increase staff morale and confidence and foster a growth mindset within the organization. Training employees to do their jobs well and safely is an investment that can potentially result in fewer injuries and illnesses, reduce the organization’s claims experience, lower insurance premiums and more.

Regulatory Agencies

Regulatory agencies establish standards for healthcare organizations and can provide insight into the expectations and regulations that apply to your organization. These agencies and other organizations perform accreditation for organizations through a process that reviews their operations to ensure adherence to standards in specific areas of the healthcare delivery system.

Cal/OSHA (California Occupational Safety and Health Administration) – The Division of Occupational Safety and Health (DOSH), better known as Cal/OSHA, protects and improves the health and safety of employees in California and the safety of passengers riding on elevators, amusement rides and tramways through the following activities:

• Setting and enforcing standards
• Providing outreach, education, and assistance
• Issuing permits, licenses, certifications,
  registrations, and approvals

Cal/OSHA requires employers to provide training to workers who face hazards on the job. The Injury and Illness Prevention Plan (IIPP) Program is a guiding document, which outlines safety training of employees within the organization.

CARF (Commission on Accreditation of Rehabilitation Facilities) – CARF is a nonprofit organization which assists service providers in improving the quality of their services, demonstrating value, and meeting internationally recognized organizational and program standards.

OSHA (Occupational Safety and Health Administration) – Is the federal regulating agency under the Department of Industrial Relations for the U.S. However, in California, the Department of Industrial Relations (DIR) administers the California State Plan through Cal/OSHA. It is important to reference California-specific Cal/OSHA standards for two reasons. The first reason is for our members to be able to review regulations specific to the State of California. The second reason is that when there is a difference between Federal OSHA and Cal/OSHA, by regulation, Cal/OSHA must be more stringent than Federal OSHA and would apply.

The Joint Commission (TJC) – The mission of The Joint Commission is to continuously improve healthcare for the public. To achieve the Gold Seal of Approval, organizations must submit to onsite evaluations to verify compliance with standards and regulations. TJC also offers resources in the following areas:

• Cybersecurity
• Patient Safety
• Nursing
• Physicians
• Consumers
• Educational Events

Professional Associations Offering Educational Opportunities

AAOHN (American Association of Occupational Health Nurses) - An association for licensed nurses who practice occupation and environmental health in nursing. AAOHN promotes the health and safety of work through the development of standards and the Code of Ethics. Education is offered in the form of webinars, onsite courses, and online. http://aaohn.org/

AOHP (Association of Occupational Health Professionals) - AOHP is dedicated to the health, safety and well-being of healthcare personnel. The value of incorporating the Total Worker Health^® (TWH) program is part of the AOHP and the National Institute for Occupational Safety and Health (NIOSH) philosophy. AOHP offers credential education for certified occupational health nurses and certified occupational health nurse specialists. Learn more at https://www.aohp.org

ASHRM (American Society for Healthcare Risk Management) - Offers many live and on-demand educational opportunities for new and experienced risk management professionals. They also offer certification programs such as ERM (Enterprise Risk Management) and CPHRM (Certified Professional in Healthcare Risk Management). For more information: https://www.ashrm.orghttps://www.ashrm.org

ASSP (American Society of Safety Professionals) - The ASSP is a global association for occupational safety and health professionals. Membership will offer the following to aid in education for safety professionals. Go to https://www.assp.org/

• Certificate Programs
  • Safety Management Certificate
  • Leadership in Safety Management Certificate
• Certification Preparation
• Conferences

Basic Ergonomic Classes: The Back School
https://thebackschool.net/

Cal/OSHA - Offers several resources for required or recommended safety training, including free publications and videos for a variety of topics in several sectors. More information can be found at https://www.dir.ca.gov/

• OSHA 10- and 30-Hour Information – provides workers with basic and more advanced training about common safety and health hazards on the job. Students receive an OSHA 10-hour or 30-hour course completion card at the end of training.
• Other OSHA Training Opportunities include but are not limited to:
  • Fall Protection
  • Heat and Illness Protection
  • Cal/OSHA 101
  • Machine Guarding
  • LOTO Lockout/Tagout

NSC (National Safety Council) - Provides training which includes workplace safety, defensive driving and first aid. Their training courses include global best practices to prevent injuries and death. More information can be found at https://www.nsc.org/safety-training

RIMS (The Risk Management Society) - A global nonprofit organization committed to bringing networking, professional development, certification, and education opportunities. Education resources include:

• Online Learning
• In-Person Learning
• Professional Designations
• Continuing Education

To inquire more about education, go to https://www.rims.org/home

SHRM (Society for Human Resource Management) - Specializes in workplace training for individuals in Human Resources and offers a certification program for a SHRM-CP or SHRM-SCP credential which identifies an individual as an expert in the HR field. SHRM information can be found at https://www.shrm.org/

The Institutes - Provides educational courses and resources to assist those in risk management and insurance roles and industries. Their offerings include leading research, free online mini-courses and several designations and certificate programs such as the ARM, CPCU, AIC, AU and AINS go to https://web.theinstitutes.org/ for more information.

UCLA UCI Southern California NIOSH Education and Research Center - See link for schedule (Examples of topics included: Ergonomics, COVID-19 Pandemic Response, Industrial Hygiene, Safety Management, Risk Management, Fleet and Vehicle Safety, Workers’ Compensation) https://erc.ucla.edu/

 

 

 

Conferences and Webinars

Applied Ergonomics Conference (Las Vegas) http://www.iise.org/AEC/details.aspx?id=7016

Association of SPH Professionals https://asphp.org/webinars-education- events/

BETA Healthcare Group hosts complimentary educational webinars designed to provide healthcare personnel with valuable learning opportunities. Nationally renowned experts deliver relevant topics to enhance enterprise-wide organizational safety efforts for both employees and patients in healthcare organizations. Continuing Education credit is available. More information can be found at https://betahg.com/ and click on the Webinar Series icon.

California Hospital Association | Employee Safety and Workers’ Compensation Seminar https://www.calhospital.org/upcoming-programs

Center for Health Care Design https://www.healthdesign.org/events

Ergonomics and HF Annual Meeting https://www.hfes.org/Events

Ergo Expo http://www.ergoexpo.com/

Training Reimbursement – BETA CARE Program

Approval for any training should be obtained by the department lead or executive prior to enrolling and available funding options should also be discussed and approved.

If approved to attend a training or certification course, CARE Funds may be used to reimburse the organization for many training courses. To utilize CARE Funds for reimbursement the course must be an approved course, and the certification or final transcript of grade must be provided with the CARE Fund submission. If you are currently enrolled in a course and will not have a certificate or final grade by June 30, the course will not be eligible for reimbursement.

Your BETA Healthcare Group Employee Safety manager can assist you with identifying training opportunities that may be of value to certain roles or departments within your organization and can also provide guidance on the reimbursement process when using CARE Funds.

Records of attendance should be kept for a minimum of three years for any training courses for individuals or group training provided in-house.

Helpful Links
https://betahg.com/risk-management-and-safety/annual-webinar-safety-series/
https://www.osha.gov/training

https://www.oshatrain.org/pages/professional-training-courses.html

https://www.nsc.org/safety-training

https://www.shrm.org/about-shrm/Pages/default.aspx

https://web.theinstitutes.org/
https://www.ashrm.org/education-ashrm

Data Marker Displayed in the Member Dashboard

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Image – COVID-19 Claims Tab

Hazard Assessment Checklist

GENERAL WORK ENVIRONMENT

• Are work surfaces kept dry or appropriate means taken to assure the surfaces are slip-resistant?
• Are all worksites clean and orderly?
• Are work surfaces kept dry or appropriate means taken to assure the surfaces are slip-resistant?
• Are all spilled materials or liquids cleaned up immediately?
• Is combustible scrap, debris and waste stored safely and removed from the worksite promptly?
• Is accumulated combustible dust routinely removed from elevated surfaces, including the overhead structure of buildings?
• Is combustible dust cleaned up with a vacuum system to prevent the dust going into suspension?
• Is metallic or conductive dust prevented from entering or accumulation on or around electrical enclosures or equipment?
• Are covered metal waste cans used for oily and paint- soaked waste?
• Are all oil and gas fired devices equipped with flame failure controls that will prevent flow of fuel if pilots or main burners are not working?
• Are paint spray booths, dip tanks and the like cleaned regularly?
• Are the minimum number of toilets and washing facilities provided?
• Are all toilets and washing facilities clean and sanitary?
• Are all work areas adequately illuminated?
• Are pits and floor openings covered or otherwise guarded?

 

PERSONAL PROTECTIVE EQUIPMENT & CLOTHING

• Are protective goggles or face shields provided and worn where there is any danger of flying particles or corrosive materials?
• Are approved safety glasses required to be worn at all times in areas where there is a risk of eye injuries such as punctures, abrasions, contusions or burns?
• Are employees who need corrective lenses (glasses or contact lenses) in working environments with harmful exposures, required to wear only approved safety glasses, protective goggles, or use other medically approved precautionary procedures?
• Are protective gloves, aprons, shields, or other means provided against cuts, corrosive liquids and chemicals?
• Are hard hats provided and worn where danger of falling objects exists?
• Are hard hats inspected periodically for damage to the shell and suspension system?
• Is appropriate foot protection required where there is the risk of foot injuries from hot, corrosive, poisonous substances, falling objects, crushing or penetrating actions?
• Are approved respirators provided for regular or emergency use where needed?
• Is all protective equipment maintained in a sanitary condition and ready for use?
• Do you have eye wash facilities and a quick drench shower within the work area where employees are exposed to injurious corrosive materials?
• Where special equipment is needed for electrical workers, is it available?
• When lunches are eaten on the premises, are they eaten in areas where there is no exposure to toxic materials or other health hazards?
• Is protection against the effects of occupational noise exposure provided when sound levels exceed those of the Cal/OSHA noise standard?

 

WALKWAYS

• Are aisles and passageways kept clear?
• Are aisles and walkways marked as appropriate?
• Are wet surfaces covered with non-slip materials?
• Are holes in the floor, sidewalk or other walking surface repaired properly, covered or otherwise made safe?
• Is there safe clearance for walking in aisles where motorized or mechanical handling equipment is operating?
• Are spilled materials cleaned up immediately?
• Are materials or equipment stored in such a way that sharp projectiles will not interfere with the walkway?
• Are changes of direction or elevations readily identifiable?
• Are aisles or walkways that pass near moving or operating machinery, welding operations or similar operations arranged so employees will not be subjected to potential hazards?
• Is adequate headroom provided for the entire length of any aisle or walkway?
• Are standard guardrails provided wherever aisle or walkway surfaces are elevated more than 30 inches above any adjacent floor or the ground?
• Are bridges provided over conveyors and similar hazards?

 

FLOOR & WALL OPENINGS

• Are floor openings guarded by a cover, guardrail, or equivalent on all sides (except at entrance to stairways or ladders)?
• Are toeboards installed around the edges of a permanent floor opening (where people may pass below the opening)?
• Are skylight screens of such construction and mounting that they will withstand a load of at least 200 pounds?
• Is the glass in windows, doors, glass walls that are subject to human impact, of sufficient thickness and type for the condition of use?
• Are grates or similar type covers over floor openings such as floor drains, of such design that foot traffic or rolling equipment will not be affected by the grate spacing?
• Are unused portions of service pits and pits not actually in use either covered or protected by guardrails or equivalent?
• Are manhole covers, trench covers and similar covers, plus their supports, designed to carry a truck rear axle load of at least 20,000 pounds when located in roadways and subject to vehicle traffic?
• Are floor or wall openings in fire resistive construction provided with doors or covers compatible with the fire rating of the structure and provided with self-closing feature when appropriate?

 

STAIRS & STAIRWAYS

• Do standard stair rails or handrails on all stairways having four or more risers?
• Are all stairways at least 22 inches wide?
• Do stairs have at least a 6'6" overhead clearance?
• Do stairs angle no more than 50 and no less than 30 degrees?
• Are stairs of hollow-pan type treads and landings filled to nosing level with solid material?
• Are step risers on stairs uniform from top to bottom, with no riser spacing greater than 7-1/2 inches?

• Are steps on stairs and stairways designed or provided with a surface that renders them slip resistant?
• Are stairway handrails located between 30 and 34 inches above the leading edge of stair treads?
• Do stairway handrails have at least 1-1/2 inches of clearance between the handrails and the wall or surface they are mounted on?
• Are stairway handrails capable of withstanding a load of 200 pounds, applied in any direction?
• Where stairs or stairways exit directly into any area where vehicles may be operated, are adequate barriers and warnings provided to prevent employees stepping into the path of traffic?
• Do stairway landings have a dimension measured in the direction of travel, at least equal to width of the stairway?
• Is the vertical distance between stairway landings limited to 12 feet or less?

 

ELEVATED SURFACES

• Are signs posted, when appropriate, showing the elevated surface load capacity?
• Are surfaces elevated more than 30 inches above the floor or ground provided with standard guardrails?
• Are all elevated surfaces (beneath which people or machinery could be exposed to falling objects) provided with standard 4-inch toeboards?
• Is a permanent means of access and egress provided to elevated storage and work surfaces?
• Is required headroom provided where necessary?
• Is material on elevated surfaces piled, stacked or racked in a manner to prevent it from tipping, falling, collapsing, rolling or spreading?
• Are dock boards or bridge plates used when transferring materials between docks and trucks or rail cars?

 

EXITING OR EGRESS

• Are all exits marked with an exit sign and illuminated by a reliable light source?
• Are the directions to exits, when not immediately apparent, marked with visible signs?
• Are doors, passageways or stairways, which are neither exits nor access to exits and which could be mistaken for exits, appropriately marked "NOT AN EXIT," "TO BASEMENT," "STOREROOM" and the like?
• Are exit signs provided with the word "EXIT" in lettering at least 5 inches high and the stroke of the lettering at least 1/2 inch wide?
  • Are exit doors side-hinged?
  • Are all exits kept free of obstructions?
  • Are at least two means of egress provided from elevated platforms, pits or rooms where the absence of a second exit would increase the risk of injury from hot, poisonous, corrosive, suffocating, flammable, or explosive substances?
  • Are there sufficient exits to permit prompt escape in case of emergency?
  • Are special precautions taken to protect employees during construction and repair operations?
  • Is the number of exits from each floor of a building, and the number of exits from the building itself, appropriate for the building occupancy load?
  • Are exit stairways which are required to be separated from other parts of a building enclosed by at least two-hour fire- resistive construction in buildings more than four stories in height, and not less than one-hour fire resistive construction elsewhere?
  • When ramps are used as part of required exiting from a building, is the ramp slope limited to 1- foot vertical and 12 feet horizontal?
  • Where exiting will be through frameless glass doors, glass exit doors, storm doors, and such are the doors fully tempered and meet the safety requirements for human impact?

 

EXIT DOORS

• Are doors that are required to serve as exits designed and constructed so that the way of exit travel is obvious and direct?
• Are windows that could be mistaken for exit doors, made inaccessible by means of barriers or railings?
• Are exit doors openable from the direction of exit travel without the use of a key or any special knowledge or effort when the building is occupied?
• Is a revolving, sliding or overhead door prohibited from serving as a required exit door?
• Where panic hardware is installed on a required exit door, will it allow the door to open by applying a force of 15 pounds or less in the direction of the exit traffic?
• Are doors for cold storage rooms provided with an inside release mechanism that will release the latch and open the door even if it's padlocked or locked on the outside?
• Where exit doors open directly onto any street, alley or other area where vehicles may be operated, are adequate barriers and warnings provided to prevent employees stepping into the path of traffic?
• Are doors that swing in both directions and are located between rooms where there is frequent traffic, provided with viewing panels in each door?

 

PORTABLE LADDERS

• Are all ladders maintained in good condition, joints between steps and side rails tight, all hardware and fittings securely attached, and moveable parts operating freely without binding or undue play?
• Are non-slip safety feet provided on each ladder?
• Are non-slip safety feet provided on each metal or rung ladder?
• Are ladder rungs and steps free of grease and oil?
• Is it prohibited to place a ladder in front of doors opening toward the ladder except when the door is blocked open, locked or guarded?
• Is it prohibited to place ladders on boxes, barrels, or other unstable bases to obtain additional height?
• Are employees instructed to face the ladder when ascending or descending?
• Are employees prohibited from using ladders that are broken, missing steps, rungs, or cleats, broken side rails or other faulty equipment?
• Are employees instructed not to use the top 2 steps of ordinary stepladders as a step?
• When portable rung ladders are used to gain access to elevated platforms, roofs, and the like does the ladder always extend at least 3 feet above the elevated surface?
• Is it required that when portable rung or cleat type ladders are used the base is so placed that slipping will not occur, or it is lashed or otherwise held in place?
• Are portable metal ladders legibly marked with signs reading "CAUTION," "Do Not Use Around Electrical Equipment" or equivalent wording?
• Are employees prohibited from using ladders as guys, braces, skids, gin poles, or for other than their intended purposes?
• Are employees instructed to only adjust extension ladders while standing at a base (not while standing on the ladder or from a position above the ladder)?
• Are metal ladders inspected for damage?
• Are the rungs of ladders uniformly spaced at 12 inches, center to center?

 

HAND TOOLS & EQUIPMENT

• Are all tools and equipment (both company and employee-owned) used by employees at their workplace in good condition?
• Are hand tools such as chisels, punches, which develop mushroomed heads during use, reconditioned or replaced as necessary?
• Are broken or fractured handles on hammers, axes and similar equipment replaced promptly?
• Are worn or bent wrenches replaced regularly?
• Are appropriate handles used on files and similar tools?
• Are employees made aware of the hazards caused by faulty or improperly used hand tools?
• Are appropriate safety glasses, face shields, and similar equipment used while using hand tools or equipment that might produce flying materials or be subject to breakage?
• Are jacks checked periodically to assure they are in good operating condition?
• Are tool handles wedged tightly in the head of all tools?
• Are tool cutting edges kept sharp so the tool will move smoothly without binding or skipping?
• Are tools stored in dry, secure locations where they won't be tampered with?
• Is eye and face protection used when driving hardened or tempered spuds or nails?

 

PORTABLE (POWER OPERATED) TOOLS & EQUIPMENT

• Are grinders, saws, and similar equipment provided with appropriate safety guards?
• Are power tools used with the correct shield, guard or attachment recommended by the manufacturer?
• Are portable circular saws equipped with guards above and below the base shoe?
• Are circular saw guards checked to assure they are not wedged up, thus leaving the lower portion of the blade unguarded?
• Are rotating or moving parts of equipment guarded to prevent physical contact?
• Are all cord-connected, electrically operated tools and equipment effectively grounded or of the approved double insulated type?
• Are effective guards in place over belts, pulleys, chains, and sprockets, on equipment such as concrete mixers, air compressors, and the like?
• Are portable fans provided with full guards or screens having openings 1/2 inch or less?
• Is hoisting equipment available and used for lifting heavy objects, and are hoist ratings and characteristics appropriate for the task?
• Are ground-fault circuit interrupters provided on all temporary electrical 15 and 20 ampere circuits, used during periods of construction?
• Are pneumatic and hydraulic hoses on power-operated tools checked regularly for deterioration or damage?

 

ABRASIVE WHEEL EQUIPMENT GRINDERS

• Is the work rest used and kept adjusted to within 1/8 inch of the wheel?
• Is the adjustable tongue on the top side of the grinder used and kept adjusted to within 1/4 inch of the wheel?
• Do side guards cover the spindle, nut, and flange and 75 percent of the wheel diameter?
• Are bench and pedestal grinders permanently mounted?
• Are goggles or face shields always worn when grinding?
• Is the maximum RPM rating of each abrasive wheel compatible with the RPM rating of the grinder motor?
• Are fixed or permanently mounted grinders connected to their electrical supply system with metallic conduit or other permanent wiring method?
• Does each grinder have an individual on and off control switch?
• Is each electrically operated grinder effectively grounded?
• Before new abrasive wheels are mounted, are they visually inspected and ring tested?
• Are dust collectors and powered exhausts provided on grinders used in operations that produce large amounts of dust?
• Are splashguards mounted on grinders that use coolant, to prevent the coolant reaching employees?
• Is cleanliness maintained around grinder?

 

POWDER ACTUATED TOOLS

• Are employees who operate powder-actuated tools trained in their use and carry a valid operator's card?
• Do the powder-actuated tools being used have written approval of the Division of Occupational Safety and Health?
• Is each powder-actuated tool stored in its own locked container when not being used?
• Is a sign at least 7" by 10" with bold type reading "POWDER- ACTUATED TOOL IN USE" conspicuously posted when the tool is being used?
• Are powder-actuated tools left unloaded until they are ready to be used?
• Are powder-actuated tools inspected for obstructions or defects each day before use?
• Do powder-actuated tools operators have and use appropriate personal protective equipment such as hard hats, safety goggles, safety shoes and ear protectors?

 

MACHINE GUARDING

• Is there a training program to instruct employees on safe methods of machine operation?
• Is there adequate supervision to ensure that employees are following safe machine operating procedures?
• Is there a regular program of safety inspection of machinery and equipment?
• Is all machinery and equipment kept clean and properly maintained?
• Is sufficient clearance provided around and between machines to allow for safe operations, set up and servicing, material handling and waste removal?
• Is equipment and machinery securely placed and anchored, when necessary to prevent tipping (or other movement) that could result in personal injury?
• Is there a power shut-off switch within reach of the operator's position at each machine?
• Can electric power to each machine be locked out for maintenance, repair, or security?
• Are the noncurrent-carrying metal parts of electrically operated machines bonded and grounded?
• Are foot-operated switches guarded or arranged to prevent accidental actuation by personnel or falling objects?
• Are manually operated valves and switches controlling the operation of equipment and machines clearly identified and readily accessible?
• Are all emergency stop buttons colored red?
• Are all pulleys and belts that are within 7 feet of the floor or working level properly guarded?
• Are all moving chains and gears properly guarded?
• Are splashguards mounted on machines that use coolant, to prevent the coolant from reaching employees?
• Are methods provided to protect the operator and other employees in the machine area from hazards created at the point of operation, ingoing nip points, rotating parts, flying chips, and sparks?
• Are machinery guards secure and so arranged that they do not offer a hazard in their use?
• If special hand tools are used for placing and removing material, do they protect the operator's hands?
• Are revolving drums, barrels, and containers required to be guarded by an enclosure that is interlocked with the drive mechanism, so that revolution cannot occur unless the guard enclosure is in place, so guarded?
• Do arbors and mandrels have firm and secure bearings and are they free from play?
• Are provisions made to prevent machines from automatically starting when power is restored after a power failure or shutdown?
• Are machines constructed to be free from excessive vibration when the largest size tool is mounted and run at full speed?
• If machinery is cleaned with compressed air, is air pressure controlled, and personal protective equipment or other safeguards used to protect operators and other workers from eye and body injury?
• Are fan blades protected with a guard having openings no larger than 1/2 inch, when operating within 7 feet of the floor?
• Are saws used for ripping, equipped with anti-kickback devices and spreaders?
• Are radial arm saws so arranged that the cutting head will gently return to the back of the table when released?

 

LOCKOUT BLOCKOUT PROCEDURES

• Is all machinery or equipment capable of movement, required to be de-energized or disengaged and blocked or locked out during cleaning, servicing, adjusting or setting up operations, whenever required?
• Is the locking-out of control circuits in lieu of locking-out main power disconnects prohibited?
• Are all equipment control valve handles provided with a means for locking-out?
• Does the lockout procedure require that stored energy (i.e., mechanical, hydraulic, air,) be released or blocked before equipment is locked-out for repairs?
• Are appropriate employees provided with individually keyed personal safety locks?
• Are employees required to keep personal control of their key(s) while they have safety locks in use?
• Is it required that employees check the safety of the lock out by attempting a start up after making sure no one is exposed?
• Where the power disconnecting means for equipment does not also disconnect the electrical control circuit:
• Are the appropriate electrical enclosures identified?
• Is the means provided to ensure that the control circuit can also be disconnected and locked out?

 

WELDING, CUTTING & BRAZING

• Are only authorized and trained personnel permitted to use welding, cutting or brazing equipment?
• Do all operators have a copy of the appropriate operating instructions and are they directed to follow them?
• Are compressed gas cylinders regularly examined for obvious signs of defects, deep rusting, or leakage?
• Is care used in handling and storage of cylinders, safety valves, relief valves, and the like, to prevent damage?
• Are precautions taken to prevent the mixture of air or oxygen with flammable gases, except at a burner or in a standard torch?
• Is only approved apparatus (torches, regulators, pressure- reducing valves, acetylene generators, manifolds) used?
• Are cylinders kept away from sources of heat?
• Is it prohibited to use cylinders as rollers or supports?
• Are empty cylinders appropriately marked, their valves closed and valve-protection caps on?
• Are signs reading: DANGER NO-SMOKING, MATCHES, OPEN LIGHTS (or the equivalent) posted?
• Are cylinders, cylinder valves, couplings, regulators, hoses, and apparatus kept free of oily or greasy substances?
• Is care taken not to drop or strike cylinders?
• Unless secured on special trucks, are regulators removed and valve-protection caps put in place before moving cylinders?
• Do cylinders without fixed hand wheels have keys, handles, or non-adjustable wrenches on stem valves when in service?
• Are liquefied gases stored and shipped valve-end up with valve covers in place?
• Are employees instructed to never crack a fuel-gas cylinder valve near sources of ignition?
• Before a regulator is removed, is the valve closed and gas released from the regulator?
• Is red used to identify the acetylene (and other fuel-gas) hose, green for oxygen hose, and black for inert gas and air hose?
• Are pressure-reducing regulators used only for the gas and pressures for which they are intended?
• Is the open circuit (No Load) voltage of arc welding and cutting machines as low as possible and not more than the recommended limits?
• Under wet conditions, are automatic controls for reducing no-load voltage used?
• Is grounding of the machine frame and safety ground connections of portable machines checked periodically?
• Are electrodes removed from the holders when not in use?
• Is it required that electric power to the welder be shut off when no one is in attendance?
• Is suitable fire extinguishing equipment available for immediate use?
• Is the welder forbidden to coil or loop welding electrode cable around his body?
• Are wet machines thoroughly dried and tested before being used?
• Are work and electrode lead cables frequently inspected for wear and damage, and replaced when needed?
• Do means for connecting cables' lengths have adequate insulation?
• When the object to be welded cannot be moved and fire hazards cannot be removed, are shields used to confine heat, sparks, and slag?
• Are firewatchers assigned when welding or cutting is performed, in locations where a serious fire might develop?
• Are combustible floors kept wet, covered by damp sand, or protected by fire-resistant shields?
• When floors are wet down, are personnel protected from possible electrical shock?
• When welding is done on metal walls, are precautions taken to protect combustibles on the other side?
• Before hot work is begun, are used drums, barrels, tanks, and other containers so thoroughly cleaned that no substances remain that could explode, ignite, or produce toxic vapors?
• Is it required that eye protection helmets, hand shields and goggles meet appropriate standards?
• Are employees exposed to the hazards created by welding, cutting, or bracing operations protected with personal protective equipment and clothing?
• Is adequate ventilation checked for in and where welding or cutting is performed?
• When working in confined places are environmental monitoring tests taken and means provided for quick removal of welders in case of an emergency?

 

COMPRESSORS & COMPRESSED AIR

• Are compressors equipped with pressure relief valves, and pressure gauges?
• Are compressor air intakes installed and equipped to ensure that only clean uncontaminated air enters the compressor?
• Are air filters installed on the compressor intake?
• Are compressors operated and lubricated in accordance with the manufacturer's recommendations?
• Are safety devices on compressed air systems checked frequently?
• Before any repair work is done on the pressure system of a compressor, is the pressure bled off and the system locked-out?
• Are signs posted to warn of the automatic starting feature of the compressors?
• Is the belt drive system totally enclosed to provide protection for the front, back, top and sides?
• Is it strictly prohibited to direct compressed air towards a person?
• Are employees prohibited from using highly compressed air for cleaning purposes?
• If compressed air is used for cleaning off clothing, is the pressure reduced to less than 10 psi?
• When using compressed air for cleaning, do employees use personal protective equipment?
• Are safety chains or other suitable locking devices used at couplings of high-pressure hose lines where a connection failure would create a hazard?
• Before compressed air is used to empty containers of liquid, is the safe working pressure of the container checked?
• When compressed air is used with abrasive blast cleaning equipment, is the operating valve a type that must be held open manually?
• When compressed air is used to inflate auto tires, is a clip-on chuck and an inline regulator preset to 40 psi required?
• Is it prohibited to use compressed air to clean up or move combustible dust if such action could cause the dust to be suspended in the air and cause a fire or explosion hazard?

 

COMPRESSED AIR RECEIVERS

• Is every receiver equipped with a pressure gauge and with one or more automatic, spring-loaded safety valves?
• Is the total relieving capacity of the safety valve capable of preventing pressure in the receiver from exceeding the maximum allowable working pressure of the receiver by more than 10 percent?
• Is every air receiver provided with a drainpipe and valve at the lowest point for the removal of accumulated oil and water?
• Are compressed air receivers periodically drained of moisture and oil?
• Are all safety valves tested frequently and at regular intervals to determine whether they are in good operating condition?
• Is there a current operating permit issued by the Division of Occupational Safety and Health?
• Is the inlet of air receivers and piping systems kept free of accumulated oil and carbonaceous materials?

 

COMPRESSED GAS & CYLINDERS

• Are cylinders with a water weight capacity over 30 pounds equipped with means for connecting a valve protector device, or with a collar or recess to protect the valve?
• Are cylinders legibly marked to clearly identify the gas contained?
• Are compressed gas cylinders stored in areas which are protected from external heat sources such as flame impingement, intense radiant heat, electric arcs, or high temperature lines?
• Are cylinders located or stored in areas where they will not be damaged by passing or falling objects, or subject to tampering by unauthorized persons?
• Are cylinders stored or transported in a manner to prevent them creating a hazard by tipping, falling or rolling?
• Are cylinders containing liquefied fuel gas stored or transported in a position so that the safety relief device is always in direct contact with the vapor space in the cylinder?
• Are valve protectors always placed on cylinders when the cylinders are not in use or connected for use?
• Are all valves closed off before a cylinder is moved, when the cylinder is empty, and at the completion of each job?
• Are low pressure fuel-gas cylinders checked periodically for corrosion, general distortion, cracks, or any other defect that might indicate a weakness or render it unfit for service?
• Does the periodic check of low-pressure fuel-gas cylinders include a close inspection of the cylinders' bottom?

 

HOIST & AUXILIARY EQUIPMENT

• Is each overhead electric hoist equipped with a limit device to stop the hook travel at its highest and lowest point of safe travel?
• Will each hoist automatically stop and hold any load up to 125 percent of its rated load, if its actuating force is removed?
• Is the rated load of each hoist legibly marked and visible to the operator?
• Are stops provided at the safe limits of travel for trolley hoist?
• Are the controls of hoists plainly marked to indicate the direction of travel or motion?
• Is each cage-controlled hoist equipped with an effective warning device?
• Are close-fitting guards or other suitable devices installed on hoist to assure hoist ropes will be maintained in the sheave groves?
• Are all hoist chains or ropes of sufficient length to handle the full range of movement for the application while still maintaining two full wraps on the drum at all times?
• Are nip points or contact points between hoist ropes and sheaves which are permanently located within 7 feet of the floor, ground or working platform, guarded?
• Is it prohibited to use chains or rope slings that are kinked or twisted?
• Is it prohibited to use the hoist rope or chain wrapped around the load as a substitute for a sling?
• Is the operator instructed to avoid carrying loads over people?
• Are only employees who have been trained in the proper use of hoists allowed to operate them?

 

INDUSTRIAL TRUCKS - FORKLIFTS

• Are only trained personnel allowed to operate industrial trucks?
• Is substantial overhead protective equipment provided on high lift rider equipment?
• Are the required lift truck operating rules posted and enforced?
• Is directional lighting provided on each industrial truck that operates in an area with less than 2-foot candles per square foot of general lighting?
• Does each industrial truck have a warning horn, whistle, gong or other device which can be clearly heard above the normal noise in the areas where operated?
• Are the brakes on each industrial truck capable of bringing the vehicle to a complete and safe stop when fully loaded?
• Will the industrial truck's parking brake effectively prevent the vehicle from moving when unattended?
• Are industrial trucks operating in areas where flammable gases or vapors, or combustible dust or ignitable fibers may be present in the atmosphere, approved for such locations?
• Are motorized hand and hand/rider trucks so designed that the brakes are applied, and power to the drive motor shuts off when the operator releases his/her grip on the device that controls the travel?
• Are industrial trucks with internal combustion engines operated in buildings (or enclosed areas) carefully checked to ensure such operations do not cause harmful concentration of dangerous gases or fumes?

 

SPRAYING OPERATIONS

• Is adequate ventilation assured before spray operations are started?
• Is mechanical ventilation provided when spraying operation is done in enclosed areas?
• When mechanical ventilation is provided during spraying operations, is it so arranged that it will not circulate the contaminated air?
• Is the spray area free of hot surfaces?
• Is the spray area at least 20 feet from flames, sparks, operating electrical motors and other ignition sources?
• Are portable lamps used to illuminate spray areas suitable for use in a hazardous location?
• Is approved respiratory equipment provided and used when appropriate during spraying operations?
• Do solvents used for cleaning have a flash point of 100"W F or more?
• Are fire control sprinkler heads kept clean?
• Are "NO SMOKING" signs posted in spray areas, paint rooms, paint booths, and paint storage areas?
• Is the spray area kept clean of combustible residue?
• Are spray booths constructed of metal, masonry, or other substantial noncombustible material?
• Are spray booth floors and baffles noncombustible and easily cleaned?
• Is infrared drying apparatus kept out of the spray area during spraying operations?
• Is the spray booth completely ventilated before using the drying apparatus?
• Is the electric drying apparatus properly grounded?
• Are lighting fixtures for spray booths located outside of the booth and the interior lighted through sealed clear panels?
• Are the electric motors for exhaust fans placed outside booths or ducts?
• Are belts and pulleys inside the booth fully enclosed?
• Do ducts have access doors to allow cleaning?
• Do all drying spaces have adequate ventilation?

 

ENTERING CONFINED SPACES

• Are confined spaces thoroughly emptied of any corrosive or hazardous substances, such as acids or caustics, before entry?
• Before entry, are all lines to a confined space, containing inert, toxic, flammable, or corrosive materials valved off and blanked or disconnected and separated?
• Is it required that all impellers, agitators, or other moving equipment inside confined spaces be locked-out if they present a hazard?
• Is either natural or mechanical ventilation provided prior to confined space entry?
• Before entry, are appropriate atmospheric tests performed to check for oxygen deficiency, toxic substance and explosive concentrations in the confined space before entry?
• Is adequate illumination provided for the work to be performed in the confined space?
• Is the atmosphere inside the confined space frequently tested/continuously monitored?
• Is there an assigned safety standby employee outside of the confined space, whose sole responsibility is to watch the work in progress, sound an alarm if necessary, and render assistance?
• Is the standby employee or other employees prohibited from entering the confined space without lifelines and respiratory equipment if there are any questions as to the cause of an emergency?
• In addition to the standby employee, is there at least one other trained rescuer in the vicinity?
• Are all rescuers appropriately trained and using approved, recently inspected equipment?
• Does all rescue equipment allow for lifting employees vertically from a top opening?
• Are there trained personnel in First Aid and CPR immediately available?
• Is there an effective communication system in place whenever respiratory equipment is used and the employee in the confined space is out of sight of the standby person?
• Is approved respiratory equipment required if the atmosphere inside the confined space cannot be made acceptable?
• Is all portable electrical equipment used inside confined spaces either grounded and insulated, or equipped with ground fault protection?
• Before gas welding or burning is started in a confined space, are hoses checked for leaks, compressed gas bottles forbidden inside of the confined space, torches lighted only outside of the confined area and the confined area tested for an explosive atmosphere each time before a lighted torch is to be taken into the confined space?
• If employees will be using oxygen-consuming equipment such as salamanders, torches, furnaces, in a confined space, is sufficient air provided to assure combustion without reducing the oxygen concentration of the atmosphere below 19.5 percent by volume?
• Whenever combustion-type equipment is used in confined space, are provisions made to ensure the exhaust gases are vented outside of the enclosure?
• Is each confined space checked for decaying vegetation or animal matter, which may produce methane?
• Is the confined space checked for possible industrial waste, which could contain toxic properties?
• If the confined space is below the ground and near areas where motor vehicles will be operating, is it possible for vehicle exhaust or carbon monoxide to enter the space?

 

ENVIRONMENTAL CONTROLS

• Are all work areas properly illuminated?
• Are employees instructed in proper first aid and other emergency procedures?
• Are hazardous substances identified which may cause harm by inhalation, ingestion, skin absorption or contact?
• Are employees aware of the hazards involved with the various chemicals they may be exposed to in their work environment (ammonia, chlorine, epoxies, and caustics)?
• Is employee exposure to chemicals in the workplace kept within acceptable levels?
• Can a less harmful method or product be used?
• Is the work area's ventilation system appropriate for the work being performed?
• Are spray painting operations done in spray rooms or booths equipped with an appropriate exhaust system?
• Is employee exposure to welding fumes controlled by ventilation, use of respirators, exposure time, or other means?
• Are welders and other workers nearby provided with flash shields during welding operations?
• If forklifts and other vehicles are used in buildings or other enclosed areas, are the carbon monoxide levels kept below maximum acceptable concentration?
• Has there been a determination that noise levels in the facilities are within acceptable levels?
• Are steps being taken to use engineering controls to reduce excessive noise levels?
• Are proper precautions being taken when handling asbestos and other fibrous materials?
• Are caution labels and signs used to warn of asbestos?
• Are wet methods used, when practicable, to prevent the emission of airborne asbestos fibers, silica dust and similar hazardous materials?
• Is vacuuming with appropriate equipment used whenever possible rather than blowing or sweeping dust?
• Are grinders, saws, and other machines that produce respirable dusts vented to an industrial collector or central exhaust system?
• Are all local exhaust ventilation systems designed and operating properly such as airflow and volume necessary for the application? Are the ducts free of obstructions or the belts slipping?
• Is personal protective equipment provided, used and maintained wherever required?
• Are there written standard operating procedures for the selection and use of respirators where needed?
• Are restrooms and washrooms kept clean and sanitary?
• Is all water provided for drinking, washing, and cooking potable?
• Are all outlets for water not suitable for drinking clearly identified?
• Are employees' physical capacities assessed before being assigned to jobs requiring heavy work?
• Are employees instructed in the proper manner of lifting heavy objects?
• Where heat is a problem, have all fixed work areas been provided with spot cooling or air conditioning?
• Are employees screened before assignment to areas of high heat to determine if their health condition might make them more susceptible to having an adverse reaction?
• Are employees working on streets and roadways where they are exposed to the hazards of traffic, required to wear bright colored (traffic orange) warning vests?
• Are exhaust stacks and air intakes located so that contaminated air will not be recirculated within a building or other enclosed area?
• Is equipment producing ultra-violet radiation properly shielded?

 

FLAMMABLE & COMBUSTIBLE MATERIALS

• Are combustible scrap, debris and waste materials (i.e., oily rags) stored in covered metal receptacles and removed from the worksite promptly?
• Is proper storage practiced minimizing the risk of fire including spontaneous combustion?
• Are approved containers and tanks used for the storage and handling of flammable and combustible liquids?
• Are all connections on drums and combustible liquid piping, vapor and liquid tight?
• Are all flammable liquids kept in closed containers when not in use (e.g., parts cleaning tanks, pans)?
• Are bulk drums of flammable liquids grounded and bonded to containers during dispensing?
• Do storage rooms for flammable and combustible liquids have explosion-proof lights?
• Do storage rooms for flammable and combustible liquids have mechanical or gravity ventilation?
• Is liquefied petroleum gas stored, handled, and used in accordance with safe practices and standards?
• Are liquefied petroleum storage tanks guarded to prevent damage from vehicles?
• Are all solvent wastes and flammable liquids kept in fire- resistant covered containers until they are removed from the worksite?
• Is vacuuming used whenever possible rather than blowing or sweeping combustible dust?
• Are fire separators placed between containers of combustibles or flammables, when stacked one upon another, to assure their support and stability?
• Are fuel gas cylinders and oxygen cylinders separated by distance, fire resistant barriers or other means while in storage?
• Are fire extinguishers selected and provided for the types of materials in areas where they are to be used? Class A: Ordinary combustible material fires. Class B: Flammable liquid, gas or grease fires. Class C: Energized-electrical equipment fires.
• If a Halon 1301 fire extinguisher is used, can employees evacuate within the specified time for that extinguisher?
• Are appropriate fire extinguishers mounted within 75 feet of outside areas containing flammable liquids, and within 10 feet of any inside storage area for such materials?
• Is the transfer/withdrawal of flammable or combustible liquids performed by trained personnel?
• Are fire extinguishers mounted so that employees do not have to travel more than 75 feet for a class "A" fire or 50 feet for a class "B" fire?
• Are employees trained in the use of fire extinguishers?
• Are extinguishers free from obstructions or blockage?
• Are all extinguishers serviced, maintained and tagged at intervals not to exceed one year?
• Are all extinguishers fully charged and in their designated places?
• Is a record maintained of required monthly checks of extinguishers?
• Where sprinkler systems are permanently installed, are the nozzle heads directed or arranged so that water will not be sprayed into operating electrical switchboards and equipment?
• Are "NO SMOKING" signs posted where appropriate in areas where flammable or combustible materials are used or stored?
• Are "NO SMOKING" signs posted on liquefied petroleum gas tanks?
• Are "NO SMOKING" rules enforced in areas involving storage and use of flammable materials?
• Are safety cans used for dispensing flammable or combustible liquids at the point of use?
• Are all spills of flammable or combustible liquids cleaned up promptly?
• Are storage tanks adequately vented to prevent the development of excessive vacuum or pressure as a result of filling, emptying, or atmosphere temperature changes?
• Are storage tanks equipped with emergency venting that will relieve excessive internal pressure caused by fire exposure?
• Are spare portable or butane tanks, which are sued by industrial trucks stored in accord with regulations?

 

FIRE PROTECTION

• Do you have a fire prevention plan?
• Does your plan describe the type of fire protection equipment and/or systems?
• Have you established practices and procedures to control potential fire hazards and ignition sources?
• Are employees aware of the fire hazards of the material and processes to which they are exposed?
• Is your local fire department well acquainted with your facilities, location and specific hazards?
• If you have a fire alarm system, is it tested at least annually?
• If you have a fire alarm system, is it certified as required?
• If you have interior standpipes and valves, are they inspected regularly?
• If you have outside private fire hydrants, are they flushed at least once a year and on a routine preventive maintenance schedule?
• Are fire doors and shutters in good operating condition?
• Are fire doors and shutters unobstructed and protected against obstructions, including their counterweights?
• Are fire door and shutter fusible links in place?
• Are automatic sprinkler system water control valves, air and water pressures checked weekly/periodically as required?
• Is maintenance of automatic sprinkler system assigned to responsible persons or to a sprinkler contractor?
• Are sprinkler heads protected by metal guards, when exposed to physical damage?
• Is proper clearance maintained below sprinkler heads?
• Are portable fire extinguishers provided in adequate number and type?
• Are fire extinguishers mounted in readily accessible locations?
• Are fire extinguishers recharged regularly and noted on the inspection tag?
• Are employees periodically instructed in the use of extinguishers and fire protection procedures?

 

HAZARDOUS CHEMICAL EXPOSURES

• Are employees trained in the safe handling practices of hazardous chemicals such as acids, caustics, and the like?
• Are employees aware of the potential hazards involving various chemicals stored or used in the workplace--such as acids, bases, caustics, epoxies, and phenols?
• Is employee exposure to chemicals kept within acceptable levels?
• Are eye wash fountains and safety showers provided in areas where corrosive chemicals are handled?
• Are all containers, such as vats and storage tanks labeled as to their contents--e.g., "CAUSTICS?”
• Are all employees required to use personal protective clothing and equipment when handling chemicals (i.e., gloves, eye protection, and respirators)?
• Are flammable or toxic chemicals kept in closed containers when not in use?
• Are chemical piping systems clearly marked as to their content?
• Where corrosive liquids are frequently handled in open containers or drawn from storage vessels or pipelines, is adequate means readily available for neutralizing or disposing of spills or overflows properly and safely?
• Have standard operating procedures been established and are they being followed when cleaning up chemical spills?
• Where needed for emergency use, are respirators stored in a convenient, clean and sanitary location?
• Are respirators intended for emergency use adequate for the various uses for which they may be needed?
• Are employees prohibited from eating in areas where hazardous chemicals are present?
• Is personal protective equipment provided, used and maintained whenever necessary?
• Are there written standard operating procedures for the selection and use of respirators where needed?
• If you have a respirator protection program, are your employees instructed on the correct usage and limitations of the respirators?
• Are the respirators NIOSH-approved for this application?
• Are they regularly inspected and cleaned, sanitized and maintained?
• If hazardous substances are used in your processes, do you have a medical or biological monitoring system in operation?
• Are you familiar with the Threshold Limit Values or Permissible Exposure Limits of airborne contaminants and physical agents used in your workplace?
• Have control procedures been instituted for hazardous materials, where appropriate, such as respirators, ventilation systems, handling practices, and the like?
• Whenever possible, are hazardous substances handled in properly designed and exhausted booths or similar locations?
• Do you use general dilution or local exhaust ventilation systems to control dusts, vapors, gases, fumes, smoke, solvents or mists which may be generated in your workplace?
• Is ventilation equipment provided for removal of contaminants from such operations as production grinding, buffing, spray painting, and/or vapor decreasing, and is it operating properly?
• Do employees complain about dizziness, headaches, nausea, irritation, or other factors of discomfort when they use solvents or other chemicals?
• Is there a dermatitis problem? Do employees complain about skin dryness, irritation, or sensitization?
• Have you considered the use of an industrial hygienist or environmental health specialist to evaluate your operation?
• If internal combustion engines are used, is carbon monoxide kept within acceptable levels?
• Is vacuuming used (rather than blowing or sweeping dust) for most cleaning?
• Are materials, which give off toxic, asphyxiant, suffocating or anesthetic fumes, stored in remote or isolated locations when not in use?

 

HAZARDOUS SUBSTANCES COMMUNICATION

• Is there a list of hazardous substances used in your workplace?
• Is there a written hazard communication program dealing with Safety Data Sheets (SDS) labeling, and employee training?
• Who is responsible for SDSs, container labeling, employee training?
• Is each container for a hazardous substance (i.e., vats, bottles, storage tanks,) labeled with product identity and a hazard warning (communication of the specific health hazards and physical hazards)?
• Is there a Safety Data Sheet readily available for each hazardous substance used?
• How will you inform other employers whose employees share the same work area where the hazardous substances are used?
• Is there an employee training program for hazardous substances?
• Does this program include:
• An explanation of what an SDS is and how to use and obtain one?
• SDS contents for each hazardous substance or class of substances?
• Explanation of "Right to Know"?
• Identification of where employees can see the employer's written hazard communication program and where hazardous substances are present in their work area?
• The physical and health hazards of substances in the work area, how to detect their presence, and specific protective measures to be used?
• Details of the hazard communication program, including how to use the labeling system and SDSs?
• How employees will be informed of hazards of non-routine tasks, and hazards of unlabeled pipes?

 

ELECTRICAL

• Are your workplace electricians familiar with the Cal/OSHA Electrical Safety Orders?
• Do you specify compliance with Cal/OSHA for all contract electrical work?
• Are all employees required to report as soon as practicable any obvious hazard to life or property observed in connection with electrical equipment or lines?
• Are employees instructed to make preliminary inspections and/or appropriate tests to determine what conditions exist before starting work on electrical equipment or lines?
• When electrical equipment or lines are to be serviced, maintained or adjusted, are necessary switches opened, locked-out and tagged whenever possible?
• Are portable electrical tools and equipment grounded or of the double insulated type?
• Are electrical appliances such as vacuum cleaners, polishers, vending machines grounded?
• Do extension cords in use have a grounding conductor?
• Are multiple plug adapters prohibited?
• Are ground-fault circuit interrupters installed on each temporary 15 or 20 amperes, 120-volt AC circuit at locations where construction, demolition, modifications, alterations or excavations are being performed?
• Are all temporary circuits protected by suitable disconnecting switches or plug connectors at the junction with permanent wiring?
• Is exposed wiring and cords with frayed or deteriorated insulation repaired or replaced promptly?
• Are flexible cords and cables free of splices or taps?

 

• Are clamps or other securing means provided on flexible cords or cables at plugs, receptacles, tools, and equipment and is the cord jacket securely held in place?
• Are all cord, cable and raceway connections intact and secure?
• In wet or damp locations, are electrical tools and equipment appropriate for the use or location or otherwise protected?
• Is the location of electrical power lines and cables (overhead, underground, underfloor, other side of walls) determined before digging, drilling or similar work is begun?
• Are metal measuring tapes, ropes, handlines or similar devices with metallic thread woven into the fabric prohibited where they could come in contact with energized parts of equipment or circuit conductors?
• Is the use of metal ladders prohibited in areas where the ladder or the person using the ladder could come in contact with energized parts of equipment, fixtures or circuit conductors?
• Are all disconnecting switches and circuit breakers labeled to indicate their use or equipment served?
• Are disconnecting means always opened before fuses are replaced?
• Do all interior wiring systems include provisions for grounding metal parts of electrical raceways, equipment and enclosures?
• Are all electrical raceways and enclosures securely fastened in place?
• Are all energized parts of electrical circuits and equipment guarded against accidental contact by approved cabinets or enclosures?
• Is sufficient access and working space provided and maintained for all electrical equipment to permit ready and safe operations and maintenance?
• Are all unused openings (including conduit knockouts) in electrical enclosures and fittings closed with appropriate covers, plugs or plates?
• Are electrical enclosures such as switches, receptacles, junction boxes, etc., provided with tight-fitting covers or plates?
• Are disconnecting switches for electrical motors in excess of two horsepower, capable of opening the circuit when the motor is in a stalled condition, without exploding? (Switches must be horsepower rated equal to or in excess of the motor hp rating).
• Is low voltage protection provided in the control device of motors driving machines or equipment, which could cause probably injury from inadvertent starting?
• Is each motor disconnecting switch or circuit breaker located within sight of the motor control device?
• Is each motor located within sight of its controller or is the controller disconnecting means capable of being locked in the open position or is a separate disconnecting means installed in the circuit within sight of the motor?
• Is the controller for each motor in excess of two horsepower, rated in horsepower equal to or in excess of the rating of the motor is serves?
• Are employees who regularly work on or around energized electrical equipment or lines instructed in the cardiopulmonary resuscitation (CPR) methods?
• Are employees prohibited from working alone on energized lines or equipment over 600 volts?

 

NOISE

• Are there areas in the workplace where continuous noise levels exceed 85 dBA? (To determine maximum allowable levels for intermittent or impact noise, see Title 8, Section 5097.)
• Are noise levels being measured using a sound level meter or an octave band analyzer and records being kept?
• Have you tried isolating noisy machinery from the rest of your operation?
• Have engineering controls been used to reduce excessive noise levels?
• Where engineering controls are determined not feasible, are administrative controls (i.e., worker rotation) being used to minimize individual employee exposure to noise?
• Is there an ongoing preventive health program to educate employees about safe levels of noise and exposure, effects of noise on their health, and use of personal protection?
• Is the training repeated annually for employees exposed to continuous noise above 85 dBA?
• Have work areas where noise levels make voice communication between employees difficult been identified and posted?
• Is approved hearing protective equipment (noise attenuating devices) available to every employee working in areas where continuous noise levels exceed 85 dBA?
• If you use ear protectors, are employees properly fitted and instructed in their use and care?
• Are employees exposed to continuous noise above 85 dBA given periodic audiometric testing to ensure that you have an effective hearing protection system?

 

FUELING

• Is it prohibited to fuel an internal combustion engine with a flammable liquid while the engine is running?
• Are fueling operations done in such a manner that the likelihood of spillage will be minimal?
• When spillage occurs during fueling operations, is the spilled fuel cleaned up completely, evaporated, or other measures taken to control vapors before restarting the engine?
• Are fuel tank caps replaced and secured before starting the engine?
• In fueling operations is there always metal contact between the container and fuel tank?
• Are fueling hoses of a type designed to handle the specific type of fuel?
• Is it prohibited to handle or transfer gasoline in open containers?
• Are open lights, open flames, or sparking or arcing equipment prohibited near fueling or transfer of fuel operations?
• Is smoking prohibited in the vicinity of fueling operations?
• Are fueling operations prohibited in buildings or other enclosed areas that are not specifically ventilated for this purpose?
• Where fueling or transfer of fuel is done through a gravity flow system, are the nozzles of the self-closing type?

 

IDENTIFICATION OF PIPING SYSTEMS

• When non potable water is piped through a facility, are outlets or taps posted to alert employees that it is unsafe and not to be used for drinking, washing or other personal use?
• When hazardous substances are transported through above ground piping, is each pipeline identified at points where confusion could introduce hazards to employees?
• When pipelines are identified by color painting, are all visible parts of the line so identified?
• When pipelines are identified by color painted bands or tapes, are the bands or tapes located at reasonable intervals and at each outlet, valve or connection?
• When pipelines are identified by color, is the color code posted at all locations where confusion could introduce hazards to employees?
• When the contents of pipelines are identified by name or name abbreviation, is the information readily visible on the pipe near each valve or outlet?
• When pipelines carrying hazardous substances are identified by tags, are the tags constructed of durable materials, the message carried clearly and permanently distinguishable and are tags installed at each valve or outlet?
• When pipelines are heated by electricity, steam or other external sources, are suitable warning signs or tags placed at unions, valves, or other serviceable parts of the system?

 

MATERIAL HANDLING

• Is there safe clearance for equipment through aisles and doorways?
• Are aisleways designated, permanently marked, and kept clear to allow unhindered passage?
• Are motorized vehicles and mechanized equipment inspected daily or prior to use?
• Are vehicles shut off and brakes set prior to loading or unloading?
• Are containers or combustibles or flammables, when stacked while being moved, always separated by dunnage sufficient to provide stability?
• Are dock boards (bridge plates) used when loading or unloading operations are taking place between vehicles and docks?
• Are trucks and trailers secured from movement during loading and unloading operations?
• Are dock plates and loading ramps constructed and maintained with sufficient strength to support imposed loading?
• Are hand trucks maintained in safe operating condition?
• Are chutes equipped with sideboards of sufficient height to prevent the materials being handled from falling off?
• Are chutes and gravity roller sections firmly placed or secured to prevent displacement?
• At the delivery end of rollers or chutes, are provisions made to stop the movement of the handled materials?
• Are pallets usually inspected before being loaded or moved?
• Are hooks with safety latches or other arrangements used when hoisting materials so that slings or load attachments won't accidentally slip off the hoist hooks?
• Are securing chains, ropes, chockers or slings adequate for the job to be performed?
• When hoisting material or equipment, are provisions made to assure no one will be passing under the suspended loads?
• Are Safety Data Sheets available to employees handling hazardous substances?

 

TRANSPORTING EMPLOYEES & MATERIALS

• Do employees who operate vehicles on public thoroughfares have valid operator's licenses?
• When seven or more employees are regularly transported in a van, bus or truck, is the operator's license appropriate for the class of vehicle being driven?
• Is each van, bus or truck used regularly to transport employees equipped with an adequate number of seats?
• When employees are transported by truck, is provision provided to prevent their falling from the vehicle?
• Are vehicles used to transport employees equipped with lamps, brakes, horns, mirrors, windshields and turn signals in good repair?
• Are transport vehicles provided with handrails, steps, stirrups or similar devices, so placed and arranged that employees can safely mount or dismount?
• Are employee transport vehicles always equipped with at least two reflective type flares?
• Is a fully charged fire extinguisher, in good condition, with at least 4 B:C rating maintained in each employee transport vehicle?
• When cutting tools with sharp edges are carried in passenger compartments of employee transport vehicles, are they placed in closed boxes or containers which are secured in place?
• Are employees prohibited from riding on top of any load, which can shift, topple, or otherwise become unstable?

 

CONTROL OF HARMFUL SUBSTANCES BY VENTILATION

• Is the volume and velocity of air in each exhaust system sufficient to gather dusts, fumes, mists, vapors or gases to convey them to a suitable point of disposal?
• Are exhaust inlets, ducts and plenums designed, constructed, and supported to prevent collapse or failure of any part of the system?
• Are clean-out ports or doors provided at intervals not to exceed 12 feet in all horizontal runs of exhaust ducts?
• Where two or more different types of operations are being controlled through the same exhaust system, will the combination of substances being controlled, constitute a fire, explosion or chemical reaction hazard in the duct?
• Is adequate makeup air provided to areas where exhaust systems are operating?
• Is the intake for makeup air located so that only clean, fresh air, which is free of contaminates, will enter the work environment?
• Where two or more ventilation systems are serving a work area, is their operation such that one will not offset the functions of the other?

 

SANITIZING EQUIPMENT & CLOTHING

• Is personal protective clothing or equipment that employees are required to wear or use, of a type capable of being easily cleaned and disinfected?
• Are employees prohibited from interchanging personal protective clothing or equipment unless it has been properly cleaned?
• Are machines and equipment, which processes, handle or apply materials that could be injurious to employees, cleaned and/or decontaminated before being overhauled or placed in storage?
• Are employees prohibited from smoking or eating in any area where contaminates are present that could be injurious if ingested?
• When employees are required to change from street clothing into protective clothing, is a clean changeroom with separate storage facility for street and protective clothing provided?
• Are employees required to shower and wash their hair as soon as possible after a known contact has occurred with a carcinogen?
• When equipment, materials, or other items are taken into or removed from a carcinogen regulated area, is it done in a manner that will not contaminate non-regulated areas or the external environment?

 

TIRE INFLATION

• Where tires are mounted and/or inflated on drop center wheels is a safe practice procedure posted and enforced?
• Where tires are mounted and/or inflated on wheels with split rims and/or retainer rings is a safe practice procedure posted and enforced?
• Does each tire inflation hose have a clip-on chuck with at least 24 inches of hose between the chuck and an in-line hand valve and gauge?
• Does the tire inflation control valve automatically shut off the airflow when the valve is released?
• Is a tire restraining device such as a cage, rack or other effective means used while inflating tires mounted on split rims, or rims using retainer rings?
• Are employees strictly forbidden from taking a position directly over or in front of a tire while it's being inflated?

 

EMERGENCY ACTION PLAN

• Are you required to have an emergency action plan?
• Does the emergency action plan comply with the requirements of T8CCR 3220(a)?
• Have emergency escape procedures and routes been developed and communicated to all employers?
• Do employees who remain operating critical plant operations before evacuation know the proper procedures?
• Is the employee alarm system that provides a warning for emergency action recognizable and perceptible above ambient conditions?
• Are alarm systems properly maintained and tested regularly?
• Is the emergency action plan reviewed and revised periodically?
• Do employees know their responsibilities:
• For reporting emergencies?
• During an emergency?
• For conducting rescue and medical duties?

INFECTION CONTROL

• Are employees potentially exposed to infectious agents in body fluids?
• Have occasions of potential occupational exposure been identified and documented?
• Has a training and information program been provided for employees exposed to or potentially exposed to blood and/or body fluids?
• Have infection control procedures been instituted where appropriate, such as ventilation, universal precautions, workplace practices, and personal protective equipment?
• Are employees aware of specific workplace practices to follow when appropriate? (Hand washing, handling sharp instruments, handling of laundry, disposal of contaminated materials, reusable )
• Is personal protective equipment provided to employees, and in all appropriate locations?
• Is the necessary equipment (i.e., mouthpieces, resuscitation bags, and other ventilation devices) provided for administering mouth-to-mouth resuscitation on potentially infected patients?
• Are facilities/equipment to comply with workplace practices available, such as hand-washing sinks, biohazard tags and labels, needle containers, detergents/disinfectants to clean up spills?
• Are all equipment and environmental and working surfaces cleaned and disinfected after contact with blood or potentially infectious materials?
• Is infectious waste placed in closable, leak proof containers, bags or puncture-resistant holders with proper labels?
• Has medical surveillance including HBV evaluation, antibody testing, and vaccination been made available to potentially exposed employees?
• Training on universal precautions?
• Training on personal protective equipment?
• Training in workplace practices, which should include blood drawing, room cleaning, laundry handling, cleanup of blood spills?
• Training on needlestick exposure/management?
• Hepatitis B vaccinations?

 

ERGONOMICS

• Can the work be performed without eyestrain or glare impacting the employees?
• Does the task require prolonged raising of the arms?
• Do the neck and shoulders have to be stooped to view the task?
• Are there pressure points on any parts of the body (wrists, forearms, back of thighs)?
• Can the work be done using the larger muscles of the body?
• Can the work be done without twisting or overly bending the lower back?
• Are there sufficient rest breaks, in addition to the regular rest breaks, to relieve stress from repetitive-motion tasks?
• Are tools, instruments and machinery shaped, positioned and handled so that tasks can be performed comfortably?
• Are all pieces of furniture adjusted, positioned and arranged to minimize strain on all parts of the body?

 

VENTILATION FOR INDOOR AIR QUALITY

• Does your HVAC system supply at least the quantity of outdoor air required by the State Building Standards Code, Title 24, Part 2 at the time the building was constructed?
• Is the HVAC system inspected at least annually, and problems corrected?
• Are inspection records retained for at least 5 years?

 

CRANE CHECKLIST

• Are the cranes visually inspected for defective components?
• prior to the beginning of any work shift?
• Are all electrically operated cranes effectively grounded?
• Is a crane preventive maintenance program established?
• Is the load chart clearly visible to the operator?
• Are operating controls clearly identified?
• Is a fire extinguisher provided at the operator's station?
• Is the rated capacity visibly marked on each crane?
• Is an audible warning device mounted on each crane?
• Is sufficient illumination provided for the operator to perform the work safely?
• Are cranes of such design, that the boom could fall over backward, equipped with boom stops

 

Worker Training and Instruction Record

WORKER TRAINING AND INSTRUCTION RECORD

 

EMPLOYEE NAME	TRAINING DATES	TYPE OF TRAINING	TRAINERS
[Enter name]	[Enter date]	[Enter type]	[Enter name]

Cal/OSHA Hazard Assessment and Correction Record

HAZARD ASSESSMENT AND CORRECTION RECORD

 

 

 

Cal/OSHA Accident/Exposure Investigation Report

ACCIDENT/EXPOSURE INVESTIGATION REPORT

 

Safety Committee Agenda Items

Agenda	Topics	Open Items	Trends	Action/Follow-Up= Evaluation, Implementation, Training	Solution	Communication
1. Environmental
2. Safety Rounds
3. Accident Investigation
4. Patient Safety
5. Employee Safety
6. Security
7.Reported Risk/Incidents
8. Outpatient
9. Other

 

Employee Safety Service Plan