Heat Exposure Risk Assessment Questionnaire
Please complete this questionnaire to help assess your risk of heat-related illness or injury. Your responses will remain confidential and are used to improve safety measures.
Full Name
*
First Name
Last Name
Job Title or Role
*
Work Location (e.g., site name, building, area)
*
Contact Email
*
example@example.com
Type of Work Environment
*
Indoors
Outdoors
Both
On average, how many hours per day do you spend working in hot conditions?
*
Please Select
Less than 1 hour
1-2 hours
2-4 hours
4-6 hours
More than 6 hours
Please indicate if you have experienced any of the following symptoms during or after working in the heat (select all that apply):
*
Dizziness or fainting
Muscle cramps
Nausea or vomiting
Heavy sweating
Confusion or disorientation
Rapid heartbeat
None of the above
Other
Do you have any pre-existing medical conditions that may increase your risk of heat-related illness?
*
Heart disease
Diabetes
Respiratory conditions
Kidney problems
None of the above
Other
How often do you take breaks and hydrate while working in hot conditions?
*
Every 15-30 minutes
Every hour
Only when I feel thirsty
Rarely/never
Which of the following protective measures do you regularly use during hot work? (Select all that apply)
*
Lightweight clothing
Wide-brimmed hat or head covering
Sunscreen
Access to shade
Cooling towels or devices
None of the above
Other
Have you received training or information on heat exposure prevention and first aid?
*
Yes
No
Have you experienced a heat-related incident (e.g., heat exhaustion, heat stroke) at work in the past 12 months?
*
Yes
No
If yes, please briefly describe the incident and any actions taken:
On a scale of 1 to 5, how would you rate your current risk of heat exposure at work?
*
Very Low
1
2
3
4
Very High
5
1 is Very Low, 5 is Very High
Submit Assessment
Should be Empty: