Health and Safety Expertise Assessment Form
Evaluate your health and safety knowledge, experience, and practices. Please answer all sections accurately to facilitate a thorough assessment.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Job Title/Role
*
Organization/Company Name
How many years of experience do you have in health and safety roles?
*
Please Select
Less than 1 year
1-3 years
4-6 years
7-10 years
More than 10 years
Which of the following health and safety certifications do you currently hold? (Select all that apply)
NEBOSH
IOSH
OSHA
First Aid Certification
None
Other (please specify)
Rate your expertise in the following areas of health and safety.
*
Rows
Beginner
Intermediate
Advanced
Risk Assessment
1
2
3
Incident Investigation
4
5
6
Emergency Response Planning
7
8
9
Workplace Inspections
10
11
12
Hazard Communication
13
14
15
How often do you conduct safety training sessions in your organization?
*
Monthly
Quarterly
Annually
Rarely/Never
Please describe a recent health and safety challenge you encountered and how you addressed it.
*
Rate the following statements based on your agreement.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
Please upload any relevant health and safety certificates (optional)
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