Chemical Safety Survey
Help us assess and improve chemical safety practices in your workplace.
Full Name
*
First Name
Last Name
Department/Work Area
*
What is your primary role in the workplace?
*
Please Select
Laboratory Staff
Maintenance
Supervisor/Manager
Researcher
Other
Which types of chemicals do you regularly handle? (Select all that apply)
*
Acids/Bases
Solvents
Toxins
Compressed Gases
Oxidizers
Other
Have you received chemical safety training in the past 12 months?
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Yes
No
Which personal protective equipment (PPE) do you use when handling chemicals? (Select all that apply)
*
Gloves
Safety Goggles
Lab Coat/Apron
Respirator/Mask
Face Shield
Other
Have you experienced or witnessed a chemical spill or accident in the past year?
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Yes
No
If yes, please briefly describe the incident and how it was handled.
Do you have any suggestions to improve chemical safety in your workplace?
Submit Survey
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