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Home > Workers’ Compensation: Risk Check Survey

Workers’ Compensation: Risk Check Survey

The Risk Check Survey encompasses the degree to which your firm provides comprehensive policies, programs, and training focused on protecting your organization.
Date*
Date Format: MM slash DD slash YYYY
Organization Name*
Person Completing Survey*
Title*
Phone*
Email*
Rate the effectiveness or success of the organization’s actions:
1. How effective is your organization at purchasing workers’ compensation insurance in accordance with state law?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
2. How effective is the designated individual who has responsibility for oversight of the workers’ compensation program at understanding the state workers’ compensation system(s), and streamlining the process inside of your business?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
3. How would you rate the specific metrics utilized by the organization for evaluating workers’ compensation performance?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
4. How effective is your organization at maintaining a formal written workers’ compensation procedure?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
5. How effective is the organization’s safety and accident prevention program?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
6. To what extent does your organization have a formal return to work and injury management program and associated employee training on the program?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
7. How effective is the organization in maintaining an antifraud policy?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
8. How effective is the organization in providing an environment where managers, supervisors and employees communication freely on safety issues?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
9. How effective is your employee orientation training at focusing on equipment use procedures, accident reporting requirements, and workplace safety?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
10. To what extent are employees provided training at least annually on workplace safety procedures?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
11. How willing and effective is management at providing necessary resources to achieve a safe performance from employees?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
12. How effective are the organization's formal policies at addressing how the Family Medical Leave Act (FMLA) will be administered for a workers’ compensation injury?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
13. How effective is the organization at requiring pre-placement physicals and has American Disability Act (ADA) compliant job descriptions?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
14. How would you rate the organization’s drug-free workplace policy?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
15. How would you rate the organization's formal health and wellness program?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
16. How effective is your organization at having a joint labor and management workplace safety committee?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
17. How effective is senior management at meeting regularly with its insurance and risk management advisor to discuss strategies for controlling workers’ compensation costs?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
18. Do you know the minimum experience mod for your business and have a plan that effectively gets your organization there if you have not reached it?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
19. To what extent do you have a relationship with a workers’ compensation medical provider who understands your business and who can help get injured employees back to work within a reasonable amount of time, in a safe manner?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE
20. How effective is your agent or broker in educating you on which classifications apply to your business?*
- N/A
- INEFFECTIVE
- MARGINALLY EFFECTIVE
- MODERATELY EFFECTIVE
- EFFECTIVE
- HIGHLY EFFECTIVE

IQRM Surveys Available for the Following Risk Issues:

Business Continuity: Risk Check Survey
Employment Practices Liability: Risk Check Survey
Discipline and Termination: Risk Check Survey
Cyber Liability: Risk Check Survey
Workers’ Compensation: Risk Check Survey
Products Liability: Risk Check Survey
Professional Liability: Risk Check Survey
Recruitment, Selection & Hiring: Risk Check Survey
Substance Abuse: Risk Check Survey
Wage and Hour: Risk Check Survey
Workplace Discrimination: Risk Check Survey
Workplace Safety: Risk Check Survey
Workplace Sexual Harassment: Risk Check Survey
Claims Management: Risk Check Survey
Directors & Officers Liability: Risk Check Survey
Environmental Liability: Risk Check Survey
Fleet Safety: Risk Check Survey
General Liability: Risk Check Survey
Medical Malpractice: Risk Check Survey
Pre-Employment Screening: Risk Check Survey
Product Contamination & Recall: Risk Check Survey

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3380 Elder Street
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