Workplace Health Safety Survey

Workplace Health Safety Survey

The survey is optional.
Name-OPTIONAL

First NameLast Name

Safety Hazards in the Workplace

Rows	Never	Sometimes	Often	Always
How often do you lift or push items weighing above 10 lbs at least 10 times during the day?
How often do you perform new tasks or tasks that are unfamiliar to you?
Do you do repetitive movements with your hands or wrists continuously without a break for at least 3 hours during the day?
Do you interact with chemicals and other hazardous substances such as flammable liquids and gases?
How often do you do work that involves bending or do any twisted or awkward work position?
How often do you stand for more than two hours straight at work?
How often do you work that requires you to be elevated at a height more than 6 above the floor/ground?
How often do you work in an environment where you need to raise your voice when talking to people less than 3 feet away from you?

Policies and Procedures

Rows	Don't Know	Strongly Disagree	Disagree	Agree	Strongly Agree
Employees receive training for health and safety inside the workplace?
Employees and the management meet for conducting updates about safety issues?
Systems are in place to identify, prevent and deal with safety hazards at work
Workplace health and safety is considered to be as important as production and quality
There is at least a health and safety representative or a committee in the company
Incidents and accidents are thoroughly investigated and addressed immediately for better improvement of workplace health and safety in order to prevent of further happening of the same incident or accident
Training sessions and information dissemination on health and safety procedures in a workplace is on in an understandable manner

Occupational Health and Safety Awareness

Rows	Not Applicable	Strongly Disagree	Disagree	Agree	Strongly Agree
I understand my rights and responsibilities with regard to workplace health and safety
I understand my rights and responsibilities in relation to workplace health and safety
I take necessary precautions in my job
In case of any untoward incident that arise involving health and safety, I know where to report it to
I know how to assist and respond to any incident involving health and safety in my workplace.
I understand the risks involved with my job and I take necessary precautions for safety

Participation in Making the Workplace Safer

Rows	Not Applicable	Strongly Disagree	Disagree	Agree	Strongly Agree
I am able to freely express my opinions and discuss with the management my concerns about the safety of my job in my workplace
I can stop my work and report the reason to the management in order for them to address and issue without my action being detrimental against me

Other-Comments

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