SB 553 Pre-Assessment Form
Discovery Survey
Organization
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Company Name
Your Name &Title
Name
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Email address
Phone #
What industry best describes your business?
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Small Company? To confirm - all three must be in place for you to be exempt from Cal/OSHA SB 553: 1)You are compliant with the Injury & Illness Prevention Plan (IIPP) and file annual reports. 2)Your business is not accessible to the public. 3)You have less than 10 employees at the worksite at any given time.
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Yes, I meet all three requirements which means I am exempt
No, I do not meet all three requirements and must comply
I am interested in additional information
Have you started drafting or implementing your SB 553 Workplace Violence Prevention Plan? (WVPP)
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YES
NO
Have you informed personnel about SB 553 being a Workplace Violence Prevention Plan (WVPP) their involvement is needed, and training required?
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YES
NO
How many employees do you have?
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0 - 10
10 - 25
25 - 100
100 - 500
+500
Does your company have a lobby where people 'check-in'?
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YES
NO
Do you have any current policies or programs that already cover Domestic Violence at the workplace?
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YES
NO
Prevention of Domestic Violence spillover is a part of the WVPP plan, and it's a sensitive topic, 1:3 women and 1:7 men are the statistics, have you considered how to approach this topic and training to your staff?
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YES
NO
Are you aware of anyone in the past or currently experiencing domestic violence?
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YES
NO
Other
Do you have any inhouse departments that are responsible for human safety?
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YES
NO
Selected Personnel
Outsourced Security Company
Do you conduct periodic hazard inspections?
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YES
NO
How many active members are on your emergency response team?
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When was the last time you tested the integrity of your access control program?
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Do you know how many hard keys are distributed?
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YES
NO
It is recommended the Workplace Violence Prevention Plan be a stand alone document opposed to embedded in the Injury & Illness Prevention Plan (IIPP), what are looking to do?
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Have the WVPP as a stand alone document
Embed the mandates within our current IIPP
Unsure, I would like to discuss the differences in more detail
Avoid fines ($18k-$100k+) Use this space to provide more information about where you are with having your plan finalized, what you want help with and when you would like to have your staff fully trained. (Responsible persons listed in your plan receive an additional layer of training)
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Avoid fines ($18k-$100k+) Use this space to provide more information about where you are with having your plan finalized, what help you are seeking and when you would like to have your staff fully trained. (Responsible persons listed in your plan receive an additional layer of training)
Have you booked a Discovery call?
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