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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*
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

Δ

IQRM Surveys Available for the Following Risk Issues:

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

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Boise Office

Associated Insurance Services

2676 S Vista Ave
Boise, Idaho 83705

Phone: (208) 336-7733

Toll Free: (800) 678-7733

Fax: (208) 336-1137

Mon-Fri: 8:30am-5:00pm
Sat-Sun: Closed

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Coeur d’Alene Office

Associated Insurance Services

10589 S Highway 95
Coeur d’Alene, Idaho 83814

Phone: (208) 336-7733

Toll Free: (800) 678-7733

Fax: (208) 336-1137

Mon-Fri: 8:30am-4:00pm
Sat-Sun: Closed

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Associated Insurance Services provides Auto, Home, Business, Life & Health Insurance, Workers' Compensation, and Bonds to all of Idaho, including Caldwell, Coeur d'Alene, Eagle, Hailey, Idaho Falls, Lewiston, Meridian, Nampa, Pocatello, Sandpoint, Sun Valley, and Twin Falls.

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