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

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* 2. Contact Name

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* 3. E-mail Address

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* 4. How many full and part time employees do you have?

0-10

10-20

20-50

50-100

100+

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* 5. Please indicate your practice type.

Small Animal

Equine

Mixed Animal

Food/Large Animal

Other

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* 6. Who is completing this survey?

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?

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

	1	2	3	4	5
How do you rate your location's safety culture?	How do you rate your location's safety culture? 1	How do you rate your location's safety culture? 2	How do you rate your location's safety culture? 3	How do you rate your location's safety culture? 4	How do you rate your location's safety culture? 5
How comfortable do you feel with your state and federal regulatory safety requirements?	How comfortable do you feel with your state and federal regulatory safety requirements? 1	How comfortable do you feel with your state and federal regulatory safety requirements? 2	How comfortable do you feel with your state and federal regulatory safety requirements? 3	How comfortable do you feel with your state and federal regulatory safety requirements? 4	How comfortable do you feel with your state and federal regulatory safety requirements? 5
How prepared is your location is to handle a natural disaster or fire?	How prepared is your location is to handle a natural disaster or fire? 1	How prepared is your location is to handle a natural disaster or fire? 2	How prepared is your location is to handle a natural disaster or fire? 3	How prepared is your location is to handle a natural disaster or fire? 4	How prepared is your location is to handle a natural disaster or fire? 5
How equipped are your employees to address or report safety concerns at your location?	How equipped are your employees to address or report safety concerns at your location? 1	How equipped are your employees to address or report safety concerns at your location? 2	How equipped are your employees to address or report safety concerns at your location? 3	How equipped are your employees to address or report safety concerns at your location? 4	How equipped are your employees to address or report safety concerns at your location? 5

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* 9. Do you provide orientation safety training for new employees?

Yes

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* 10. Does your location have a safety committee?

Yes

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* 11. Does your location currently have a safety manual?

Yes

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* 12. Do you currently utilize the AVMA PLIT online safety training modules?

Yes

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* 13. Do you currently post your OSHA 300A Summary each year from February 1st - April 30th?

Yes

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* 14. Do you have a safety inspection form that you utilize for your facility?

Yes

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* 15. Do you conduct background checks before hiring your employees?

Yes

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* 16. Do you have a current Return to Work policy for employees injured on the job?

Yes

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* 17. How likely is it that you would recommend AVMA PLIT to a friend or colleague?

Not at all likely

Extremely likely

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* 1. Practice Name

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* 2. Contact Name

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* 3. E-mail Address

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* 4. How many full and part time employees do you have?

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* 5. Please indicate your practice type.

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* 6. Who is completing this survey?

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* 7. On average, how often do you conduct safety training for your employees?

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* 8. On a scale of 1-5, with 5 being the highest value and 1 being the lowest value

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* 9. Do you provide orientation safety training for new employees?

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* 10. Does your location have a safety committee?

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* 11. Does your location currently have a safety manual?

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* 12. Do you currently utilize the AVMA PLIT online safety training modules?

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* 13. Do you currently post your OSHA 300A Summary each year from February 1st - April 30th?

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* 14. Do you have a safety inspection form that you utilize for your facility?

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* 15. Do you conduct background checks before hiring your employees?

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* 16. Do you have a current Return to Work policy for employees injured on the job?

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* 17. How likely is it that you would recommend AVMA PLIT to a friend or colleague?

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* 18. Please enter any additional questions or comments for the AVMA PLIT Risk Services department.