Worksite Assessment Guide (continued) Describe the focus, frequency, and outcomes of industrial hygiene and safety inspections and indicate the OHN’s involvement. _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Describe the record system in the health unit (including logs, records, reports). What is the policy regarding confidentiality of health records and is this observed? _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Health/Disability Insurance What type of employee health insurance does the company have (e.g., third party, self-insured)? _______________________________________________________________________________________________________ What are average annual company expenditures for health insurance claims? $ ______________ Percentage hospital claims ____________________ Percentage ambulatory care claims ____________________ What are the major categories of expenditures for these claims? (Indicate specific illnesses, injury, etc.) _______________________________________________________________________________________________________ What are the average annual company expenditures for worker’s compensation claims? $_________________ What are the major categories of expenditure for worker’s compensation claims? (Specify the illness/injury.) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 347 Guideline continues on next page