Risk Management
Lodge Safety Worksheet

MUST be filled out and sent in
BY March 15, 2012
(Moose Int'l deadline is April 1, 2012)

 Lodge Safety Inspection Form
Failure to submit this form ON-TIME will result in a Compliance Modifier
being added to your Risk Pool General Liability Assessment

 Risk Pool Modifier

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Any potential Claim arising out of any accident or incident in any Moose Facility or at any Association Meeting should be immediately reported.

  • Potential Claims involving general liability or liquor liability should be reported to our Third-Party Administrator, Gallagher-Bassett at 1-877-5MOOSE (1-877-566-6735).
  • Potential Claims involving Directors and Officers Coverage, potential claims alleging discrimination, or potential claims arising out of employment practices should be reported to the Risk Management Department at 1-800-544-4407.
  • If you are uncertain as to whom to make your report of a potential claim, please contact the Risk Management Department at 1-800-544-4407 for assistance.
  • If you have a question regarding the Risk Pool coverage or regarding the insurance coverages you need to purchase, please contact Risk Management at 1-800-544-4407.


REFERENCE MATERIALS

 Annual Lodge Insurance Report
 Lockton Risk - Lodge Property
Insurance Program

 Requirements When Renting
Your Hall or Property

 Hall Rental Insurance Availability
 How to Remit Payment for
Hall Rental Insurance

 FAQ on Hall and Property Rentals
 Insurance for Lodges/Service
Centers/Chapters/Moose Legions &
Associations: Programs & Procedures

 Sample Participant Release Form
 Sample Sexual Harassment Policy
LOSS CONTROL

 CAP (Continuous Accident
Prevention) Booklet - A Program Guide
for Moose Centers, Staff and Volunteers

 Choosing a designated Safety
Coordinator

 Facility Questionnaire
 Lodge Accident Report form
 Lodge Safety Inspection Form

NOTICE: The Loyal Order of Moose is a private organization. All activities and events referred to on this web site are available to members in good standing. This Web site is for informational purposes with proprietary information intended for members only. General information is available to the public at large, but should not be construed to be a solicitation for membership. This web site is an initiative of the Pennsylvania Moose Association, Inc, and is not sanctioned by the Loyal Order of Moose, Moose International, the Supreme Lodge or any subsidiary thereof. All logos, trademarks and servicemarks pertaining to the Loyal Order of Moose and/or its programs or degrees are copyrighted © by Moose International, Inc., Mooseheart, Illinois. The information contained herein is both confidential and privileged and shall only be available to and used by good-standing members of the Loyal Order of Moose for fraternal purposes. Any use of the information (Section 45.3 of the General Laws) contained herein for private gain or for any commercial, political or business purpose is strictly prohibited.