Occupational Health and Safety Questionnaire
Please answer the following questions regarding occupational health and safety.
What is your full name?
First Name
Last Name
Please provide your email address.
example@example.com
Please provide your phone number.
Please enter a valid phone number.
Format: (000) 000-0000.
Do you feel adequately trained on occupational health and safety procedures?
Yes
No
Not sure
Have you received any safety-related incidents or near misses in the past year?
Yes
No
Please provide details of any safety-related incidents or near misses you have encountered.
Are you aware of the emergency evacuation procedures?
Yes
No
Partially
Is the workplace free from hazards that may affect your health and safety?
Yes
No
Partially
Do you have access to adequate personal protective equipment (PPE)?
Yes
No
Partially
Are safety signs and warnings clearly visible and properly maintained?
Yes
No
Partially
Are the work areas properly illuminated to prevent accidents?
Yes
No
Partially
Do you have any suggestions or concerns regarding occupational health and safety in the workplace?
Submit
Should be Empty: