Psychosocial Hazard Assessment Form
Please complete this assessment to help identify and evaluate psychosocial hazards present in your workplace. Your responses will inform workplace improvement efforts.
Which department or area are you assessing?
*
Please Select
Administration
Operations
Sales
Customer Service
IT/Technical
Other
How frequently do you observe psychosocial hazards (e.g., stress, bullying, lack of support) in this area?
*
Never
Rarely
Sometimes
Often
Always
Rate the overall level of psychosocial risk in this area.
*
1
2
3
4
5
Please rate the following psychosocial hazards as they apply to this workplace area.
*
Rows
Never
Rarely
Sometimes
Often
Always
Excessive workload or unrealistic deadlines
1
2
3
4
5
Lack of role clarity
6
7
8
9
10
Poor communication
11
12
13
14
15
Inadequate support from supervisors or colleagues
16
17
18
19
20
Exposure to bullying or harassment
21
22
23
24
25
How would you describe the overall workplace culture in this area?
*
Very positive
Somewhat positive
Neutral
Somewhat negative
Very negative
What is the impact of psychosocial hazards on staff in this area?
*
No impact
Minor impact
Moderate impact
Significant impact
Severe impact
How confident are you that psychosocial hazards are being effectively managed in this area?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Are there existing measures in place to address psychosocial hazards in this area?
*
Yes, comprehensive measures
Yes, some measures
No measures
Not sure
Do you believe additional action or follow-up is needed to address psychosocial hazards in this area?
*
No, everything is adequately managed
Yes, minor improvements needed
Yes, major improvements needed
Unsure
Please provide any additional comments or suggestions regarding psychosocial hazards in this area.
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