Management Commitment and Awareness
1. When was the last time you attended a Workers' Compensation Conference?
Choose One Within the last 12 months More than 12 months Never, but I am scheduled to attend one within the next 6 months Never

Insurance Company and Claims Administration
2. When did you (or your broker) last physically review your claim files?
Choose One Within the last 30 days Within the last 1-6 months More than 6 months ago We do not routinely physically review our files

Performance Goals
3. Monthly lost day statistics are sent to all management personnel?
Choose One Yes No

Post Injury Response
4. Is there a written procedure of steps to take when one of your employees is injured at work?
Choose One Yes No

Communication
5. Is there a brochure for employees about returning to work after an injury?
Choose One Yes No

Return to Work and Transitional Duty
6. Does your company have a written return-to-work program which mandates that all employees return to work as soon as they are medically able?
Choose One Yes No

Medical Care Coordination
7. Has a representative of your company visited your preferred medical clinic in the last 12 months?
Choose One Yes No

Medical Cost Containment
8. Does your claims administrator have all medical bills reviewed for fee schedule compliance?
Choose One Yes No Don't know

Fraud, Abuse and Malingering
9. Is there a toll-free number employees can call to report workers' compensation fraud or abuse?
Choose One Yes No

Training Initiatives
10. Do you have a presentation to make management more aware of the cost and importance of workers' compensation?
Choose One Yes No