Self-Assessment Tool Survey

	Yes	No
1. Does your staffing firm have a commitment to the safety of temporary workers from top management down?	1. Does your staffing firm have a commitment to the safety of temporary workers from top management down? Yes	1. Does your staffing firm have a commitment to the safety of temporary workers from top management down? No
2. Does your staffing firm have an internal safety manager or someone dedicated to temporary worker safety?	2. Does your staffing firm have an internal safety manager or someone dedicated to temporary worker safety? Yes	2. Does your staffing firm have an internal safety manager or someone dedicated to temporary worker safety? No
3. Does your staffing firm’s contract language address safety responsibilities of both the staffing firm and host employer?	3. Does your staffing firm’s contract language address safety responsibilities of both the staffing firm and host employer? Yes	3. Does your staffing firm’s contract language address safety responsibilities of both the staffing firm and host employer? No
4. Does your staffing firm train internal staff to recognize hazards at a host employer site?	4. Does your staffing firm train internal staff to recognize hazards at a host employer site? Yes	4. Does your staffing firm train internal staff to recognize hazards at a host employer site? No
5. Does your staffing firm have a system in place to evaluate possible hazards facing your temporary workers at host employer work sites?	5. Does your staffing firm have a system in place to evaluate possible hazards facing your temporary workers at host employer work sites? Yes	5. Does your staffing firm have a system in place to evaluate possible hazards facing your temporary workers at host employer work sites? No
6. Does your staffing firm evaluate host employer work sites on an annual basis and as worker job changes occur?	6. Does your staffing firm evaluate host employer work sites on an annual basis and as worker job changes occur? Yes	6. Does your staffing firm evaluate host employer work sites on an annual basis and as worker job changes occur? No
7. Does your staffing firm have a system in place to advise host employers of possible hazards?	7. Does your staffing firm have a system in place to advise host employers of possible hazards? Yes	7. Does your staffing firm have a system in place to advise host employers of possible hazards? No
8. Does your staffing firm have a system in place to verify that host employer-required site-specific orientation and training has been completed?	8. Does your staffing firm have a system in place to verify that host employer-required site-specific orientation and training has been completed? Yes	8. Does your staffing firm have a system in place to verify that host employer-required site-specific orientation and training has been completed? No
9. Does your staffing firm provide general awareness safety training to all temporary workers in their primary language?	9. Does your staffing firm provide general awareness safety training to all temporary workers in their primary language? Yes	9. Does your staffing firm provide general awareness safety training to all temporary workers in their primary language? No
10. Does your staffing firm provide and document general awareness safety training to all temporary workers prior to dispatch to a host employer work site?	10. Does your staffing firm provide and document general awareness safety training to all temporary workers prior to dispatch to a host employer work site? Yes	10. Does your staffing firm provide and document general awareness safety training to all temporary workers prior to dispatch to a host employer work site? No
11. Does your staffing firm have a system in place for temporary workers to report work-related injuries and illnesses that includes how to report the incident and when to report it?	11. Does your staffing firm have a system in place for temporary workers to report work-related injuries and illnesses that includes how to report the incident and when to report it? Yes	11. Does your staffing firm have a system in place for temporary workers to report work-related injuries and illnesses that includes how to report the incident and when to report it? No
12. Does your staffing firm have a system in place to track temporary worker injuries and illnesses by host employer?	12. Does your staffing firm have a system in place to track temporary worker injuries and illnesses by host employer? Yes	12. Does your staffing firm have a system in place to track temporary worker injuries and illnesses by host employer? No
13. Does your staffing firm communicate information about temporary worker injuries and illnesses to your clients so they can complete their OSHA 300 logs?	13. Does your staffing firm communicate information about temporary worker injuries and illnesses to your clients so they can complete their OSHA 300 logs? Yes	13. Does your staffing firm communicate information about temporary worker injuries and illnesses to your clients so they can complete their OSHA 300 logs? No
14. Does your staffing firm have a system in place to receive feedback from temporary workers regarding safety conditions at the work site?	14. Does your staffing firm have a system in place to receive feedback from temporary workers regarding safety conditions at the work site? Yes	14. Does your staffing firm have a system in place to receive feedback from temporary workers regarding safety conditions at the work site? No

Yes

1. Does your staffing firm have a commitment to the safety of temporary workers from top management down?

1. Does your staffing firm have a commitment to the safety of temporary workers from top management down? Yes

1. Does your staffing firm have a commitment to the safety of temporary workers from top management down? No

2. Does your staffing firm have an internal safety manager or someone dedicated to temporary worker safety?

2. Does your staffing firm have an internal safety manager or someone dedicated to temporary worker safety? Yes

2. Does your staffing firm have an internal safety manager or someone dedicated to temporary worker safety? No

3. Does your staffing firm’s contract language address safety responsibilities of both the staffing firm and host employer?

3. Does your staffing firm’s contract language address safety responsibilities of both the staffing firm and host employer? Yes

3. Does your staffing firm’s contract language address safety responsibilities of both the staffing firm and host employer? No

4. Does your staffing firm train internal staff to recognize hazards at a host employer site?

4. Does your staffing firm train internal staff to recognize hazards at a host employer site? Yes

4. Does your staffing firm train internal staff to recognize hazards at a host employer site? No

5. Does your staffing firm have a system in place to evaluate possible hazards facing your temporary workers at host employer work sites?

5. Does your staffing firm have a system in place to evaluate possible hazards facing your temporary workers at host employer work sites? Yes

5. Does your staffing firm have a system in place to evaluate possible hazards facing your temporary workers at host employer work sites? No

6. Does your staffing firm evaluate host employer work sites on an annual basis and as worker job changes occur?

6. Does your staffing firm evaluate host employer work sites on an annual basis and as worker job changes occur? Yes

6. Does your staffing firm evaluate host employer work sites on an annual basis and as worker job changes occur? No

7. Does your staffing firm have a system in place to advise host employers of possible hazards?

7. Does your staffing firm have a system in place to advise host employers of possible hazards? Yes

7. Does your staffing firm have a system in place to advise host employers of possible hazards? No

8. Does your staffing firm have a system in place to verify that host employer-required site-specific orientation and training has been completed?

8. Does your staffing firm have a system in place to verify that host employer-required site-specific orientation and training has been completed? Yes

8. Does your staffing firm have a system in place to verify that host employer-required site-specific orientation and training has been completed? No

9. Does your staffing firm provide general awareness safety training to all temporary workers in their primary language?

9. Does your staffing firm provide general awareness safety training to all temporary workers in their primary language? Yes

9. Does your staffing firm provide general awareness safety training to all temporary workers in their primary language? No

10. Does your staffing firm provide and document general awareness safety training to all temporary workers prior to dispatch to a host employer work site?

10. Does your staffing firm provide and document general awareness safety training to all temporary workers prior to dispatch to a host employer work site? Yes

10. Does your staffing firm provide and document general awareness safety training to all temporary workers prior to dispatch to a host employer work site? No

11. Does your staffing firm have a system in place for temporary workers to report work-related injuries and illnesses that includes how to report the incident and when to report it?

11. Does your staffing firm have a system in place for temporary workers to report work-related injuries and illnesses that includes how to report the incident and when to report it? Yes

11. Does your staffing firm have a system in place for temporary workers to report work-related injuries and illnesses that includes how to report the incident and when to report it? No

12. Does your staffing firm have a system in place to track temporary worker injuries and illnesses by host employer?

12. Does your staffing firm have a system in place to track temporary worker injuries and illnesses by host employer? Yes

12. Does your staffing firm have a system in place to track temporary worker injuries and illnesses by host employer? No

13. Does your staffing firm communicate information about temporary worker injuries and illnesses to your clients so they can complete their OSHA 300 logs?

13. Does your staffing firm communicate information about temporary worker injuries and illnesses to your clients so they can complete their OSHA 300 logs? Yes

13. Does your staffing firm communicate information about temporary worker injuries and illnesses to your clients so they can complete their OSHA 300 logs? No

14. Does your staffing firm have a system in place to receive feedback from temporary workers regarding safety conditions at the work site?

14. Does your staffing firm have a system in place to receive feedback from temporary workers regarding safety conditions at the work site? Yes

14. Does your staffing firm have a system in place to receive feedback from temporary workers regarding safety conditions at the work site? No

Question Title

Please select or enter the total number of times you chose "Yes" in response to the questions above, then click "Done" below to see your assessment results.

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i We adjusted the number you entered based on the slider’s scale.