Dealership:
Date:
Your Name:
Telephone:
Email:
Rank each item on a scale of
1-5:
1=Agree Strongly
2=Somewhat agree 3=Neutral / Not sure
4=Somewhat
disagree 5=Strongly disagree
1.
Our safety program covers all the primary
hazards.
2. We have an
effective program to prevent slips, trips and
falls.
3. Our Service area is
clean and attractive.
4. We carefully
monitor conditions of lots and walkways during storms.
5. We know how to respond to
customer reports of injury.
6. Every employee
consistently performs his or her job safely.
7. There is no
"horseplay" at our dealership.
8. There are no drugs
or alcohol problems among our employees.
9. Our employment
handbook is up-to-date.
10. There is no
discrimination in our hiring or employment practices.
11. There
is no sexual harassment in our
dealership.
12.
Our hiring process consistently brings good people into our
company
13.
We check references on all
hires.
14.
Employees know what to do when confronted with
hazards.
15.
Employees know what to do if injured on the
job.
16.
Supervisors have been trained in sexual harassment with the past
year.
17.
Supervisors know how to respond to injured
employees.
18.
Supervisors support temporary modified duty to speed recovery of
workers.
19.
Our turnover rate among mechanics is
low.
20.
We have explicit policies on safe driving for all employees who
drive.
21.
We stay in frequent contact with any employees out of work on
disability.
22.
We use temporary modified duty to speed the recovery of injured
employees.
23.
We require certificates of insurance from subcontractors (towing,
waste removal...)
24.
We get the most out of our insurance
carriers.
25.
All Claims are reported to insurance carriers within 5
days.
26.
We understand how our workers' comp insurance premiums are
calculated.
27.
We track all open claims to
closure.
28.
We communicate regularly with doctors who are treating our
employees.
List any additional issues or
concerns:
