Workers Compensation Program Checklist

This checklist is designed to assist in evaluating an employer's workers' compensation program and related safety and health practices. It covers key areas to ensure compliance and promote a safe working environment.

Instructions: Complete each item by marking the appropriate box. Note any corrective actions needed in the space provided.

I. Program Review

• Written Program: Does the employer have a written safety and health program (WSP) that addresses workers' compensation and related safety issues? [1]
  • Corrective Actions:
• Availability: Is the program made available to employees or their collective bargaining agent upon request? [2]
  • Corrective Actions:
• Regular Updates: Is the policy statement and prevention plan reviewed and revised at least every 3 years or when circumstances change? [3]
  • Corrective Actions:

II. Injury and Illness Recordkeeping

• OSHA 300 Log: Does the employer maintain an OSHA 300 Log to record work-related injuries and illnesses? [4], [5]
  • Corrective Actions:
• Recording Criteria: Does the employer correctly apply the general recording criteria for injuries and illnesses (e.g., death, days away from work, medical treatment beyond first aid)? [4], [5]
  • Corrective Actions:
• Employee Access: Do employees and their representatives have access to the OSHA 300 Log? [6]
  • Corrective Actions:
• Reporting Procedure: Is there a reasonable procedure for employees to report work-related injuries and illnesses promptly and accurately? [6]
  • Corrective Actions:

III. Hazard Assessment and Control

• Hazard Assessment: Does the employer perform hazard assessments to identify potential risks in the workplace? [7]
  • Corrective Actions:
• Hazard Control: Does the employer eliminate or control existing and potential hazards using engineering controls, work practice controls, administrative controls, or PPE? [2]
  • Corrective Actions:
• PPE Program: Is there a comprehensive PPE program, including hazard assessment, selection, fit testing, training, and maintenance of PPE? [2], [8], [9]
  • Corrective Actions:

IV. Training and Communication

• Employee Training: Are employees trained on safe work practices, hazard recognition, and the proper use of equipment and PPE? [2], [9], [10]
  • Corrective Actions:
• MSI Training: Are workers trained in specific measures to eliminate or reduce the possibility of musculoskeletal injuries? [7]
  • Corrective Actions:
• Communication: Are employees informed of their rights and responsibilities regarding workplace safety and workers' compensation? [11], [6]
  • Corrective Actions:

V. Incident Investigation and Prevention

• Incident Investigation: Does the employer have a mechanism to investigate accidents and near-miss incidents to identify root causes and prevent recurrence? [12]
  • Corrective Actions:
• Corrective Actions: Are corrective actions implemented and documented to address hazards identified during incident investigations or inspections? [13]
  • Corrective Actions:
• Trend Analysis: Does the employer review injury and illness trends to identify patterns and implement preventive measures? [12]
  • Corrective Actions:

VI. Workplace Conditions

• Housekeeping: Is the worksite kept clean and free from slip and trip hazards? [14]
  • Corrective Actions:
• Lighting: Is lighting sufficient to enable work to be done safely? [14]
  • Corrective Actions:
• Ergonomics: Are workstations and tasks designed to minimize ergonomic stressors and the risk of musculoskeletal injuries? [15], [16]
  • Corrective Actions:

VII. Program Implementation

• Safety Inspections: Are regular safety and health inspections conducted to identify new or previously missed hazards? [13], [12]
  • Corrective Actions:
• Disciplinary Actions: Are safe work practices enforced through a clearly defined and communicated disciplinary system? [2]
  • Corrective Actions:
• Emergency Preparedness: Does the employer have written plans and procedures to ensure employee safety during emergencies? [12]
  • Corrective Actions:

VIII. Employee Involvement

• Reporting Without Reprisal: Are employees able to report safety and health concerns without fear of reprisal? [12], [6]
  • Corrective Actions:
• Safety Committee: Is there a safety committee with employee representation that meets regularly to address safety and health issues? [13], [16], [17]
  • Corrective Actions:

IX. Specific Hazards (if applicable)

• Manual Handling: Are hazards associated with manual lifting, lowering, pushing, pulling, carrying, handling, or transporting loads assessed and controlled? [15], [7]
  • Corrective Actions:
• Visual Demands: Are tasks involving potentially harmful visual demands identified and addressed? [17]
  • Corrective Actions:
• Shift Work: Are the risks to workers' health and safety assessed and addressed for those working shifts or performing constant effort/exertion tasks? [17]
  • Corrective Actions:

Completed by: ____________________________

Date: ____________________________

Supervisor Review: ____________________________

Date: ____________________________