CHWCA Self Assessment Survey
Page One
1.
Contact Information
Name:
Agency:
2.
Please indicate the number of Safety and/or Risk Management Committee meetings that were held in 2009.
3.
Please indicate the number of documented safety inspections that were conducted at your facilities in 2009.
4.
Has your Agency adopted/implemented CHWCA's Model Injury and Illness Prevention Program (IIPP) or modified its own to include elements of CHWCA's Model IIPP?
Yes
No
5.
Has your Agency provided the CHWCA General Polices and Rules manual to employees as part of the Agency's new hire safety orientation program?
Yes
No
6.
Has your Agency provided the CHWCA Hazard Communication Training Manual to affected employees as part of the Agency's Hazard Communication Program?
Yes
No
7.
Has your Agency adopted/implemented the Assistance and Counseling Program guidelines that have been provided by CHWCA?
Yes
No
8.
Has your Agency adopted/implemented the CHWCA Hazardous Energy Control Program (Lockout/Tagout) and provided training to affected employees?
Yes
No
9.
Has your Agency registered employees to complete the web-based safety training modules being offered by CHWCA?
Yes
No
10.
Please describe other activities, programs, or policies conducted/implemented in 2009 that you feel demonstrate your Agency's efforts to be proactive in area of safety and risk control management.