MIRMA LOSS CONTROL PROGRAM EVALUATION RATING FORM

Transcription

1 MIRMA LOSS CONTROL PROGRAM EVALUATION RATING FORM MEMBER OFFICIAL REPRESENTATIVE TITLE SAFETY COORDINATOR VALUE RATING I. Management Direction II. Safety Committee Development 70 0 III. Loss Control Methodology 80 0 IV. Occupational Illness/Injury Control 20 0 V. Fleet Safety 60 0 VI. Liability Control A. GENERAL B. SELF-INSPECTION PROGRAM 60 0 C. PARKS DEPARTMENT 60 0 D. POLICE DEPARTMENT E. UTILITY DEPARTMENT F. WASTE WATER DEPARTMENT VII. National Standards Compliance 80 0 VIII. Human Resources 10 0 IX. Training X. Recommendation Compliance 0 0 Final Rating Adjustment for a serious injury without an enforced policy 10% Adjustment for failure to establish a police u-turn policy 10% Percentage Score 0% History of Past Evaluations Score - Credit to assessment Year Score 90% or greater Score - Debit to assessment % 10% of annual assessment % 20% of annual assessment < 60% 30% of annual assessment Date: Auditor: Revised September,

2 I. MANAGEMENT DIRECTION A. LOSS CONTROL POLICY Written policy Posted throughout the workplace 10 B SAFETY COORDINATOR FORMALLY APPOINTED Individual assigned responsibilities and formal 10 job description C. DEPARTMENTAL OPERATIONAL SAFETY POLICY/GUIDELINES (RULES) 1 Develops written rules/guidelines for their operations 20 and provides safety manual to employees 2 Job or department safety rules developed and enforced 10 **Moved from section III.B.1 below 3 Utilization of Disciplinary Procedures 10 **Moved from section III.B.2 D. MONTHLY DEPARTMENTAL SAFETY MEETINGS Monthly safety meetings in each department 10 E. TRANSITIONAL DUTY PROGRAM Written program with mandatory employee participation that allows 100 for inter-department assignments F. ATTENDANCE AND PARTICIPATION AT MIRMA MEETINGS/SEMINARS Attendance required at MIRMA meetings and seminars 100 Increased value from 75 to 100. Propose making two seminars worth 25 pts each and the annual meeting worth 50 points. All three 25 pts each previously. TOTAL II. SAFETY COMMITTEE DEVELOPMENT A. SAFETY COMMITTEE 1 Committee established 10 2 Documentation of all safety committee activities 10 3 Goals and objectives set on an annual basis 10 **Deleted 3 Supervisors accident investigation report form used on all work comp, 10 auto accidents, general liability claims that result in bodily injury and sewer backups within 2 working days. **Moved from III.A.1 4 Accident investigations sent to MIRMA Loss Control. 10 **Moved from III.A.2 5 Reports reviewed by Safety Committee for cause & corrective action taken 20 **Moved from III.A.3 TOTAL 70 0 III. LOSS CONTROL METHODOLOGY **Whole section moved or deleted A. ACCIDENT INVESTIGATION PROGRAM **Title deleted 1 Supervisors accident investigation report form used on all work comp, 10 auto accidents, general liability claims that result in bodily injury and sewer backups within 2 working days. **Moved to II.A.3 Revised September,

3 2 Accident investigations sent to MIRMA Loss Control. 10 **Moved to II.A.4 3 Reports reviewed by Safety Committee for cause & corrective action taken 20 **Moved to II.A.5 B. SAFETY RULES ENFORCEMENT 10 **Title deleted 1 Job or department safety rules developed and enforced **Moved to I.C.2 2 Utilization of Disciplinary Procedures 10 **Moved to I.C.3 C. INCENTIVE/AWARD PROGRAM 10 ***deleted 1 Written incentive/award program reviewed Bi-Annually 10 **Deleted TOTAL 80 0 IV. OCCUPATIONAL ILLNESS/INJURY CONTROL **Title deleted A. PRE-PLACEMENT PHYSICAL CONDUCTED 10 **Whole section moved to section VIII Human Resources B. BLOOD PRESSURE/CHOLESTEROL TESTING FOR POLICE, FIRE AND 10 STRENUOUS WORK POSITIONS BIENNIALLY **Whole section moved to section VIII Human Resources V. FLEET SAFETY 1 Physical agility/fitness program for police and non-volunteer fire depts with mandatory performance standards. N/A N/A **This section was never implemented and will be deleted from the evaluation. TOTAL 20 0 A. MOTOR VEHICLE RECORDS (MVR) CHECKED BEFORE HIRING NEW EMPLOYEE Performs pre-employment MVR check 10 **Moved to section VIII Human Resources B. ANNUAL MVR CHECK Performs annual MVR 10 **Moved to section VIII Human Resources C. NEW DRIVER ORIENTATION Performs basic orientation and familiarization on 10 equipment assigned to driver and documents. D. CHECK RIDES CONDUCTED ON AN ANNUAL BASIS BY IMMEDIATE SUPERVISOR Check rides on annual basis 10 E. DRIVERS RESPONSIBLE FOR PRE-USE VEHICLE AND EQUIPMENT INSPECTIONS Pre-use inspections completed 10 F. CITIES WITH GARAGE FACILITIES CERTIFY AS A STATE INSPECTION STATION AND INSPECT VEHICLES ANNUALLY (Applies with FT Mechanic). 10 TOTAL 60 0 VI. LIABILITY CONTROL A. GENERAL Revised September,

4 1 Citizen Complaint follow-up program 10 2 Sidewalk replacement program (maintenance, inspection, documentation) 20 3 Secure Hold Harmless Agreements 20 4 Require Certificates of Insurance 20 5 City named as an additional Insured 20 6 Require an additional insured endorsement 20 Currently an element of coverage packet TOTAL B. SELF-INSPECTION PROGRAM 1 Inspections of all buildings/facilities with public access 10 on a monthly basis 2 Inspections of all buildings/facilities without public access 10 on a quarterly basis 3 Jobsite Inspection checklist completed on a monthly (9 mo's of the year) basis 20 for each department working at remote locations (i.e.. Streets, Water, Sewer, Gas, Electrical & ect) **Added the nine months section of this requirement 4 Playground safety inspection completed weekly- spring, summer & fall, 20 and monthly during winter TOTAL 60 0 C. Parks Department 1 Proper protection provided for swimming pool diving boards, platforms and 20 slides in excess of one meter 2 Minimum dimensions for boards and/or platforms, one meter or less, 10 shall be 10ft in depth, extending to 10 ft to either side of the board and 12ft in front, with the tip of the board extending 4ft over the water. 3 Utilize the services of an Aquatic Risk Management firm for 20 lifeguard training & pool safety audits 4 The water below (fall area) an aquatic climbing wall shall be sectioned off from 10 the rest of the deep end. **New requirement TOTAL 60 0 D. Police Department 1 Overall Procedures/policies manual 7 2 Policies and Procedures Manual containing the following specific policies: 1. Pursuit Driving Emergency Driving Domestic Violence Use of Force Reporting Use of Force Semi Annual Weapons Qualification Communicable Disease Off-Duty Employment New values coincide with previously approved police model policies. The total of this section does not change. 3 Annual re-certification on LVNR 10 Revised September,

5 4 ECW drive stun restriction TOTAL E. Utility Departments to be renamed to "Electric Generation and/or Distribution" 1 Aerial boom truck annual inspection (grounding, structural integrity) 10 2 Annual dielectric fluid testing on continual use transformers 5,000-Kva or larger Every three years; dielectric fluid testing on standby or peaking transformers 20 5,000-Kva or larger. 4 Furan testing on 5,000Kva or larger transformers that are over 15 years old Insulation resistance testing on generators 1,000-KW or larger, every 5 years Circuit breaker maintenance & testing and relay calibrations on 1,000-KW or 20 larger generators, every 5 years. 7 Annual mechanical overspeed trip tests and crankshaft deflection readings for 20 internal combustion engine/generator units 1,000-KW or larger, that operate in excess of 50 hours per year. This test should be performed on all engines/generators that require a large concrete foundation. 8 Every three years; mechanical overspeed trip tests and crankshaft deflection 20 readings for internal combustion engine/generator units 1,000-KW or larger, that operate less than or equal to than 50 hours per year. This test should be performed on all engines/generators that require a large concrete foundation. 9 Annual oil tests for viscosity, acid, fuel dilution, water, additive package and 20 wear metal elemental analysis for internal combustion engine/generator units 1,000-KW or larger, that operate in excess of 50 hours per year 10 Every three years; oil tests for viscosity, acid, fuel dilution, water, additive 20 package and wear metal elemental analysis for internal combustion engine/ generator units 1,000-KW or larger, that operate less than or equal to 50 hours per year. 11 Corrosive Sulfur Testing Generator Step-up (GSU) transformers, utility 20 transmission transformers, and other large power transformer above distribution class containing mineral oil as the dielectric fluid should undergo a one-time corrosive sulfur test (ASTM D-1275B test & CIGRE TF A test) if they were new or had a fluid change between the years 1995 and Corrosive sulfur in transformer oil can lead to the formation of copper sulfide, which weakens the dielectric strength of the paper insulation and eventually leads to winding failure. Test to be performed on 10,000 KVA and larger. **New recommendations per our reinsurer, Travelers. 11 Fall Protection when working from buckets, lifts and elevated work platforms 10 **Moved to VII. National Standards Compliance 12 Fire Retardant Clothing for exposed electrical employees. 10 **An element of the APPA Safety Program. Deleted 13 Electic utilities formally adopt the current American Public Power Association 10 Safety Manual and provide training to employees based upon the manual. **Safety manuals developed by the utility will be analyzed by loss control. **New requirement TOTAL F. Waste Water Collection and Treatment Department Revised September,

6 1 Elimination of private mains 10 2 Inspection of connections/repairs 10 3 Routine inspection of entire system 20 4 Sewer line backup log 20 5 Routine maintenance of problem areas 20 6 Infiltration correction program 20 TOTAL VII. NATIONAL STANDARDS COMPLIANCE A. PERSONAL PROTECTIVE EQUIPMENT Written policy and use of equipment enforced 10 B. HAZARD COMMUNICATION PROGRAM Secure Material Safety Data Sheets (MSDS) for hazardous 10 chemicals and complete annual inventory C. LOCK OUT/TAG OUT Written procedures developed and locks, tags, 10 and/or locking devices are provided D. TRENCHING/SHORING PROGRAM Written procedures developed and equipment used when 10 in excess of 5' in depth E. CONFINED SPACE ENTRY PROGRAM Written procedures developed and air monitoring 10 devices used prior to and during entry utilized F. BLOOD BORNE PATHOGENS Written program developed and Hepatis A & B vaccine 10 offered to Police, Fire, EMS, Waste Water, Refuse, Custodial and other exposed employees. (Points are prorated) G. DRUG & ALCOHOL TESTING PROGRAM Written procedures developed and pre-hire, post accident and reasonable 10 suspicion testing conducted for all employees, must also comply with DOT requirements for those effected positions. H FALL PROTECTION PROGRAM Written procedures for working from buckets, lifts and elevated work platforms 10 **Taken from section VI.E.11 and added the policy element. TOTAL 80 0 VIII. HUMAN RESOURCES EMPLOYMENT PRACTICES A. Employment application that complies with ADA, Title VII 10 and Missouri State Law completed for all employees. B. Utilize job descriptions for all positions 10 C. Written personnel policies/handbook distributed to all employees 10 with a signed acknowledgment statement D. Policy addresses all forms of discrimination 10 E. Written policy and procedures developed for all forms of harassment posted 10 Revised September,

7 F. Have procedures in place so that prior to an employee being terminated, 10 Human Resources, City Administrator or Mayor insures that employment policies have been followed and applied consistently A. Pre-placement physical conducted. 10 **Moved from IV.A B. BLOOD PRESSURE/CHOLESTEROL TESTING FOR POLICE, FIRE AND 10 STRENUOUS WORK POSITIONS BIENNIALLY **Moved from IV.B A. MOTOR VEHICLE RECORDS (MVR) CHECKED BEFORE HIRING NEW EMPLOYEE Performs pre-employment MVR check 10 **Moved from Fleet Safety section V.A B. ANNUAL MVR CHECK Performs annual MVR 10 **Moved from Fleet Safety section V.A TOTAL IX. SAFETY TRAINING ANNUAL TRAINING PROVIDED ON EACH OF THE FOLLOWING TOPICS: X. A. Hazardous Material Communication / MSDS 10 B. Harassment 10 C. Bloodborne Pathogens 10 D. Confined Space Entry 10 E. Trenching & Shoring 10 F. LockOut/TagOut 10 G. Fall Protection 10 H. Drug & Alcohol awareness 10 I. First aid training 10 (Certification of at least two individuals from each work area and crew) J. CPR training 10 (Certification of at least two individuals from each work area and crew) K. Defensive Driving 10 L. Classroom Emergency Driving (Police, Fire & EMS) 10 M Hands-on Emergency Driving (Police, Fire & EMS) 10 Each driver should complete a course every five years N Personal Protective Equipment 10 **have always required a policy, but have never had a training requirement. TOTAL RECOMMENDATION COMPLIANCE (MIRMA) Based on percentage of recommendations completed To ensure the member has reviewed and understands the assigned ratings please sign below. This signature does not indicate the member agrees or waives their right to appeal the ratings recorded, but simply indicates the member has reviewed the evaluation form prior to the auditors departure. Date Signature Revised September,