Professional Documents
Culture Documents
Safety Management Tracking Matrix
Safety Management Tracking Matrix
X X X
Briefing reports. Track report completion
in the Manager Monthly Briefing tab in
the Safety Matrix
X X X
Employee Violation Report, update the
Safety Violations tab
X X X X X X
X X X X X X
X X X X X X
X X X X X X
X X X X X X
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October November December
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EMPLOYER NAME
Cal-OSHA Policy Development Schedule
Template
Policy name Established
Bloodborne Pathogens
Code of Safe Practices
Drug & Alcohol Policy
Electrical Safety
Fall Protection
Fire Prevention & Response
First Aid / CPR
Fleet Safety
Hazard Communication
Hearing Conservation Program
Heat Illness Prevention
Industrial Truck / Forklift
Injury & Illness Prevention Plan
Lockout Tagout
Material Handling / Lifting
Personal Protective Equipment
Respiratory Protection
Return To Work
Safety & Health Policy
Trenching & Shoring
Warehouse/Housekeeping
Key
Month Assigned for Final Approval
Review Responsible Person (Y/N)
Key
Priority
Secondary
Tertiary
Date Approved Comments
EMPLOYER NAME
Injury Tracking (Frequency & Severity)
2
1 1 1 1
1
0 0 0 0 0 0 0 0 0 0 0
0
January February March April May
Severity Goals
Injury Frequency
ency Goals Total by month First Aid Medical Only Indemnity
0 0 0 0 0 0 0
ril May June July August September October
Injury Severity
Severity Goals Total by month First Aid Medical Only Indemnity
0 0 0
October November December
mnity
Data as of:
# of
Total # # of # of
Policy Year Carrier/TPA Medical
Claims Open Indemnity
Only
2012 1 0 0 1
2013 0 0 0 0
2014 3 0 2 1
2015 0 0 0 0
2016 0 0 0 0
2017 0 0 0 0
Totals 4 0 2 2
$ 2,981 $ 2,981 $ -
$ - $ - $ -
$ 37,041 $ 37,041 $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ 40,022 $ 40,022 $ - $ -
red Total Paid Total Outstanding Claim Frequency Total # Claims # of Open # of
3.5
3
3
2.5
2
2
1.5
1 1 1
1
0.5
0 $0 $0 $0 $0 $0 $0 0 0 0 0 0 0 0 0 0 0 0 0
2016 2017 0
2012 2013 2014 2015
Difference from Prior California Avg.
Average Claim Cost
Quarter Indemnity Costs
0 0 0 0 0 0 0 0 0 0 0 0 0
2014 2015 2016 2017
Safety Training Matrix
EMPLOYER NAME
Training Schedule
January February March April May June July August September October November December
60
EMPLOYER NAME
Manger Monthly Briefing Report
# of Managers 10 10 10 10
# of completed reports 8 8 8 7
Percent Completed 80% 80% 80% 70%
Goal 100% 100% 100% 100%
May June July August September October November
10 10 10 10 10 10 10
0 0 0 0 0 0 0
0% 0% 0% 0% 0% 0% 0%
100% 100% 100% 100% 100% 100% 100%
December
10
0
0%
100%
EMPLOYER NAME
Safety Violations Tracking Matrix
Date Hazard Rating Finding Location Notes Responsible Department Corrected? Photo Date Corrected
EMPLOYER NAME
Forklift Management Matrix
Q1 Eval
Employee Name Department Supervisor Date of Hire Date
2014 Tracking
ACTIVITY Add each Quarter's score into the appropriate cell
Max Possible Score 35 45 65 25 40 45 65 50 370 100% 100% 100% 100% 100% 100%
35 35 55 25 40 40 55 45 330 89% 89% 84% 88% 78% 85%
30 45 65 25 35 40 50 35 325 88% 88% 82% 78% 90% 85%
0 0% #DIV/0!
0 0% #DIV/0!
0 0% #DIV/0! A passing score is 300 ore more. An automatic failure should be imposed for any one of the following
0 0% #DIV/0! reasons: A passing score is 300 ore more. An automatic failure should be imposed for any one of the
0 0%
following reasons:
#DIV/0!
(1) Any unsafe act.
0 0% #DIV/0! (2) Not knowing location and function of gauges and controls.
0 0% #DIV/0! (3) Unsatisfactory performance on “Vehicle Control Test”.
0 0% #DIV/0! (4) Undue nervousness.
0 0% #DIV/0! (5) Failure to achieve a minimum passing score
0 0% #DIV/0! (6) If the individual scores 300 or more, but the examiner feels that the individual needs additional
0 0% #DIV/0! training, the examiner has the right to recommend to the General Manager that the Driver’s license be
0 0%
suspended until further training is completed
#DIV/0!
0 0% #DIV/0! Whether the driver passes or fails any portion of the test, the examiner will review the results of the road
0 0% #DIV/0! test with him or her, and bring to the driver’s attention any weaknesses that require further practice or
0 0% #DIV/0! training. Record the main points of this review in the space below.
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