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Workplace Health and Safety Survey | (DSG-ProF001)

Workplace Health and Safety Survey | (DSG-ProF001)

Thank you for participating in our survey! Depending on the arrangements made, a summary of your workplace's responses may be shared with your Employer or Workplace. We will not share your individual submission; the data collected is for educational / consulting purposes only and is not to be considered a worker's report of accident or illness to their employer.
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    (Optional)
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    (Optional)
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    If you are attending a DSG-Training Session, we'll be able to capture your responses and review them during the session.
    -
    Pick a Date
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    Choose your industry-sector, from the list below.
    Please choose ...
    • Please choose ...
    • Industrial (includes manufacturing and retail)
    • Construction (includes project-related services, i.e. architects and engineers)
    • Health care (includes hospitals, long-term and retirement care homes, and medical-type services)
    • Mining
    • Diving
    • Farming - Agriculture
    • Service (examples might include restaurants and hair-dressers)
    • Professional Services (includes education, lawyers and agents)
    • Other
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    Please choose ...
    • Please choose ...
    • Less than 5
    • 5 to 19
    • 20 to 99
    • 100 to 299
    • 300 to 499
    • 500 to 999
    • more than 1000
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    Please choose ...
    • Please choose ...
    • Worker
    • Supervisor/Manager
    • Owner
    • OTHER
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    Job Title or Job Description
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    (Optional); 5-part question
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    Unsafe
    Safe
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    (REQUIRED); 5-part question
    1 of 5
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    SELECT the category that best fits your previously identified hazard
    Please choose ...
    • Please choose ...
    • Struck / Caught (i.e. "line of fire" or "pinch point")
    • Fall (from one level to another)
    • Slip / Trip ('fall' on the same level)
    • Overexertion (use of a one-time excessive force)
    • Repetition (use of frequent movements under in a short-duration)
    • Harmful Substances/Environmental (exposure to a chemical or biological agent)
    • Motor Vehicle (while in operation)
    • Assault (result of physical/violent altercation)
    • Fire/Explosion
    • Other
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    There is no wrong answer here. Describe an additional control measure to REDUCE the risk of injury.
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    Your answer to this question WILL NOT be shared with your Employer or Supervisor. Your privacy is important to us!
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    Please choose ...
    • Please choose ...
    • Head / Face
    • Torso / Back
    • Upper Arm
    • Lower Arm
    • Hand / Fingers
    • Upper Leg
    • Lower Leg
    • Foot Toes
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    ANTICIPATE
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    SELECT the category that best fits your ANTICIPATED hazard.
    Please choose ...
    • Please choose ...
    • Struck / Caught (i.e. "line of fire" or "pinch point")
    • Fall (from one level to another)
    • Slip / Trip ('fall' on the same level)
    • Overexertion (use of a one-time excessive force)
    • Repetition (use of frequent movements under in a short-duration)
    • Harmful Substances/Environmental (exposure to a chemical or biological agent)
    • Motor Vehicle (while in operation)
    • Assault (result of physical/violent altercation)
    • Fire/Explosion
    • Other
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    Please choose ...
    • Please choose ...
    • Head / Face
    • Torso / Back
    • Upper Arm
    • Lower Arm
    • Hand / Fingers
    • Upper Leg
    • Lower Leg
    • Foot Toes
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    You are assessing one-risk component here ...
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    No injury
    A fatal injury
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    You are assessing the 2nd component of risk here ...
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    Unlikely
    Very likely
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    You've assessed that CONSEQUENCE x LIKELIHOOD result in a ranked hazard (see below).
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    Given the RISK-RANKING (previously assessed).
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    What could be done fo reduce the RISK; either reduce that CONSEQUENCES or the LIKELIHOOD.
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    DISAGREE
    AGREE
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    NEVER
    On MULTIPLE occasions
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    If you found this survey helpful, let us know ... We'd love to here from you.
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