Workplace Safety Solution Survey
Help us improve safety in your workplace by sharing your experiences and feedback.
Your Name
*
First Name
Last Name
Department
*
Please Select
Production
Logistics
Administration
Sales
Maintenance
Other
What is your role in the organization?
*
Manager/Supervisor
Employee/Worker
Contractor
Visitor
Other
How would you rate the overall safety in your workplace?
*
1
2
3
4
5
Safety Practices Assessment
*
Rows
Very Poor
Poor
Average
Good
Excellent
Use of personal protective equipment
1
2
3
4
5
Cleanliness and orderliness
6
7
8
9
10
Availability of safety signage
11
12
13
14
15
Machine/equipment safety
16
17
18
19
20
Emergency procedures
21
22
23
24
25
Have you witnessed or experienced any safety incidents or near-misses in the past 12 months?
*
Yes
No
If yes, please briefly describe the incident(s) or near-miss(es).
How effective do you find the current safety training provided?
*
Not Effective
1
2
3
4
Very Effective
5
1 is Not Effective, 5 is Very Effective
What safety improvements would you suggest for your workplace?
Would you like to be contacted to discuss your feedback further?
*
Yes
No
If yes, please provide your email address.
example@example.com
Submit Survey
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