Prepared By:	Rep:	Date:
Prepared For:	Company:
*Revenue: $	*ROR:  %
*Benefit Rate:    %	*# Employees:
Number of Injuries:	*# Low: *# Medium: *# High:

Average Hourly Rates Hourly Rate Constr Mfg *Workers:   $ $17.88 $17.26 *Managers: $ $28.92 $35.47

Total Hours       *Per Month:   *Per Year:

The losstimator is an attempt to model the Accident Iceberg Theory. This theory essentially states that only a small portion of lost costs are direct and "visible" while a much greater protion are indirect or hidden costs and are not exceedingly obvious. The model identifies some of these hidden costs and provides a general range for each based on research and/or prior loss control experiences.
The model is driven by a few simple variables that will need to be input by the Loss Control representative. These include the following: Revenue, Number of Employees, Return on Revenue, and Insurance Deductible. Industry averages have been entered for labor rates and benefit rates, but these may be overridden. The model also allows the representative to adjust any or all of the line item costs as he/she deems appropriate.
Based on the input, the model calculates ranges of possible lost costs and shoule serve as a guide only. Actual costs will vary.
Prepared For:
Prepared By:  ,	Date Prepared:
Worker Manager   Inputs: Revenue: $ Hrly Rate: $ $ Employees: Benefits: $ $ ROR: % Total: $ $ Revenue/Hour*: $ Rev/Emply/Hour: $ Actual Events # Low: Monthly Hours: # Medium: Yearly Hours: # High: Note: Revenue/Hour based on 2,080 hours per year.
Action/Event Low Cost    Medium      High   Direct Costs Estimate   Lost Employee Time $ $ $   Reduction in productivity after return to work $ $ $   Medical Costs $ $ $ Direct Costs Per Event: $ $ $   Indirect Costs Estimate   Injured worker lost profit $ $ $   Co-worker time $ $ $   Management Time $ $ $   General Losses $ $ $   Property Losses $ $ $ Indirect Costs Per Event: $ $ $       Number of ActualEvents:      Total Direct Costs All Events: $ $ $ Total Indirect Costs All Events: $ $ $ $ $ $     Total Cost All Events: $

	Detail Analysis
Report For:
Action/Event		Low	Cost    Medium	High
Direct Costs Estimate (Per Event)
	Cost of time lost by employee on day of accident	$	$	$
	Cost of employee lost time beyond day of accident	$	$	$
	Cost of reduction in productivity after return to work	$	$	$
	Medical Costs as a result of the accident	$	$	$
	Total Direct Costs:	$	$	$
Indirect Costs Estimate (Per Event)
	Lost profit from injured worker - day of accident	$	$	$
	Co-worker lost time day of accident	$	$	$
	Co-worker reduction in productivity	$	$	$
	Co-worker overtime hours to compensate for lost time	$	$	$
	Co-worker Incidental time for cleanup, meetings, etc	$	$	$
	Co-worker Training time as a result of accident - Dept	$	$	$
	Co-worker Training time as a result of accident - Entire Plant	$	$	$
	Mgmt time assisting injured	$	$	$
	Mgmt time investigating causes of accident	$	$	$
	Mgmt time arranging for work continuance	$	$	$
	Mgmt time on Federal reporting requirements	$	$	$
	Mgmt time spent working with insurance company	$	$	$
	Mgmt time spent recruiting, training new/temp employee	$	$	$
	Safety manager additional time	$	$	$
	Lost profit from site closure	$	$	$
	Lost business goodwill from negative publicity	$	$	$
	Uncovered first-aid, emergency costs	$	$	$
	Inventory costs, uncovered	$	$	$
	Temporary employee costs	$	$	$
	Legal - Attorney	$	$	$
	Legal - Mgmt time spent working with attorney	$	$	$
	Administrative Expenses	$	$	$
	Penalties, fines, etc.	$	$	$
	Uncovered property	$	$	$
	Incidental costs	$	$	$
	Total Indirect Costs (Per Event):	$	$	$

The "Losstimator" is merely an additional tool to help better understand how losses can impact overall business operations. The results may not be reflective of all businesses.