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AVMA PLIT Safety Questionnaire_Is My Practice Healthy
For additional safety information and resources, please visit AVMAPLIT.com. You can also contact us at info@avmaplit.com or toll free at 1-800-228-7548.
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1.
Practice Name
(Required.)
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2.
Contact Name
(Required.)
*
3.
E-mail Address
(Required.)
*
4.
How many full and part time employees do you have?
(Required.)
0-10
10-20
20-50
50-100
100+
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5.
Please indicate your practice type.
(Required.)
Small Animal
Equine
Mixed Animal
Food/Large Animal
Other
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6.
Who is completing this survey?
(Required.)
Veterinarian
Vet Tech
Practice Manager
Office Employee
Other
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7.
On average, how often do you conduct safety training for your employees?
(Required.)
Never
Bi-monthly
Monthly
Quarterly
Yearly
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8.
On a scale of 1-5, with 5 being the highest value and 1 being the lowest value
(Required.)
1
2
3
4
5
How do you rate your location's safety culture?
1
2
3
4
5
How comfortable do you feel with your state and federal regulatory safety requirements?
1
2
3
4
5
How prepared is your location is to handle a natural disaster or fire?
1
2
3
4
5
How equipped are your employees to address or report safety concerns at your location?
1
2
3
4
5
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9.
Do you provide orientation safety training for new employees?
(Required.)
Yes
No
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10.
Does your location have a safety committee?
(Required.)
Yes
No
*
11.
Does your location currently have a safety manual?
(Required.)
Yes
No
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12.
Do you currently utilize the AVMA PLIT online safety training modules?
(Required.)
Yes
No
*
13.
Do you currently post your OSHA 300A Summary each year from February 1st - April 30th?
(Required.)
Yes
No
*
14.
Do you have a safety inspection form that you utilize for your facility?
(Required.)
Yes
No
*
15.
Do you conduct background checks before hiring your employees?
(Required.)
Yes
No
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16.
Do you have a current Return to Work policy for employees injured on the job?
(Required.)
Yes
No
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17.
On a scale of 0 to 10,
How likely is it that you would recommend AVMA PLIT to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
(Required.)
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
18.
Please enter any additional questions or comments for the AVMA PLIT Risk Services department.
