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RISK ASSESSMENT FORM

 
1. How many people are employed at your company?
25-500 500-2,500 2,500-7,500 7,500-15,000 over 15,000

2. The average employee turnover rate is 14.4 percent annually, according to the Bureau of National Affairs. How does your company compare?
10% 10-15% 15-25% 25-50% Over 50%
3. What are your company's workers compensation claims costing annually?
$250,000-$750,000 $750,000-$2 million $2-4 million $4-8
million		 Over $8 million
 
4. What percentage of injury incidences are strains or sprains?
Under 20% 20-30% 30-40% 40-50% Over 50%
 
5. What is the average annual wage of employees?
Under $20,000 $20-$25,000 $25-$30,000 $30-$40,000 Over $40,000
 
6.What is the percentage of employees that are over 45 years of age?
10% or fewer 10-20% 20-30% 30-40% Over 50%
 
7. Is there a strong need for improvement in your company’s workers compensation programs?
No, not really--- we believe we are the best in our industry
Maybe, but there doesn’t seem to be much interest in the company for new programs in this area
Maybe, but we have already achieved a lot of savings in our program already
Maybe, but we just don’t know how much opportunity is really there
Yes, we should take our program to the next level
 
8. Does your company see workers compensation as a quality problem?
No
No, but we look at several other business issues in this way
Yes, at our company we continually try to improve our processes
Yes, we have a number of quality or Six Sigma processes already underway
 
9. Is senior management committed to solving this need/problem?
No, they don’t seem to be
Maybe
Maybe, we probably need to do something and this may be it
Yes, our company is ready to make a commitment
 
10. Does your company use physical function assessment for job matching the worker to the work?
No
Yes, and we are happy with the results
Yes, but we are not satisfied with the results or we are not sure if the results are successful
Yes, we do for post-offer/pre-work screens, but we’d like to learn about how else to use it to keep workers at work
 
11. Do you think your company would be willing to turn away applicants who do not pass a pre-work physical ability assessment?
No, I can’t imagine that: we need all the workers we can find
Maybe, but I need to know more
Yes, if we know how to perform the right testing
If you provide additional information that will help us determine what your needs might be, please fill out this portion of the test and someone from Employment Cost Solution will contact you via a confidential email.
 
Name:
Company:
Title:
Address:
City: State: Zip:
Email:

 
 

 
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