Updated: Safety Culture Assessment Form

Safety Culture

Assessment Form
Date*

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Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Number of Employees*
What's Your Emod Score?
Tick N/A below if unkown
Emod Score is unknown
Safety Culture Assessment

Using a scale from 0 (No/Never) to 10 (Always) score the following statements that indicate your perception of the company’s safety culture.
1. Supervisors are engaged in your Safety Culture.*

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0 is No/Never, 10 is Always
2. Employees are engaged in your Safety Culture. *

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0 is No/Never, 10 is Always
3. Safety activities or goals are established for each location. *

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4. Employees are given the tools, training and resources to achieve their activities or goals. *

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0 is No/Never, 10 is Always
5. When goals or activities are met, the effort is recognized. *

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6. Employee safety activities are measured.*

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0 is No/Never, 10 is Always
7. Supervisor safety activities are measured.*

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0 is No/Never, 10 is Always
8. Employees can identify at-risk behaviors and unsafe conditions.*

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0 is No/Never, 10 is Always
9. Employees understand the personal benefits of reducing incidents.*

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0 is No/Never, 10 is Always
10. Employees understand the impact incidents have on production, quality, schedule, and resources. *

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0 is No/Never, 10 is Always
Your Result
Here's your culture rating: An impressive average of 10! Congratulations on embodying an engaged and vibrant safety culture! Your organization exemplifies excellence and a commitment to outstanding safety cultural standards. Your engaging culture sounds amazing. We would so appreciate learning from you, so we can help others empower people. Are you willing to drop us a note or have a brief call to share one of your proven methods.
Here's your culture rating: An impressive average of 9! Congratulations on embodying an engaged and vibrant safety culture! Your organization exemplifies excellence and a commitment to outstanding safety cultural standards. If you want to become a 10 and would like to brainstorm some ideas around the non-10 ratings, we would welcome a conversation.
Here's your culture rating: Your average score is 8. This indicates you have a commendable culture, coupled with opportunities for improvement. It's a solid foundation with potential for even greater achievements in nurturing your organization's safety culture.
Here's your culture rating: Your average score of 7 signifies a respectable culture, with room for improvement. It's an opportunity to pinpoint and leverage areas where your organization's safety culture can be fortified. Our RMA team would welcome the opportunity to discuss our SRS (Safety Risk Score) with you and how it will set a path for continuous improvement and an engaging safety culture. Please contact us.
Here's your culture rating: Scores of 6 or below suggest a critical need for an in-depth evaluation and proactive steps towards improvement. It's a call to action for implementing comprehensive strategies and actionable steps to improve your organization's safety culture. Our RMA team would welcome the opportunity to discuss our SRS (Safety Risk Score) with you and how it will set a path for continuous improvement and an engaging safety culture. Please contact us.
Thank you for answering our assessment form!

If you’d like to stay informed with the latest updates from us, receive cutting-edge industry reports, or gain access to exclusive, personalized assessment tools for enhancing your safety culture and training, we invite you to leave your contact details below. This is entirely optional, but it’s a great way to ensure you don’t miss out on valuable resources tailored to your interests and needs.

Alternatively, you may also reach us at

Local: 602.753.4250
Toll Free: 1.855.378.5819
Email: info@resecoadvisors.com

www.ResecoAdvisors.com
Name

First NameLast Name
Email
example@example.com
Company Name
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