Maritime PPE Safety Survey Form
Please complete this survey to help us assess and improve personal protective equipment safety practices in maritime operations.
Which of the following PPE are available on your vessel? (Select all that apply)
*
Life jackets
Hard hats
Protective gloves
Safety boots
Eye protection
Hearing protection
Respiratory protection
Other
How often do you use the following PPE during your daily tasks?
*
Rows
Always
Often
Sometimes
Rarely
Never
Life jackets
1
2
3
4
5
Hard hats
6
7
8
9
10
Protective gloves
11
12
13
14
15
Safety boots
16
17
18
19
20
Eye protection
21
22
23
24
25
How would you rate the overall condition of the PPE provided on your vessel?
*
1
2
3
4
5
Have you received formal training on the correct use of PPE?
*
Yes, within the last year
Yes, more than a year ago
No
Indicate your level of agreement with the following statements about PPE safety.
*
Rows
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
PPE is always available when needed.
26
27
28
29
30
I feel confident using all provided PPE.
31
32
33
34
35
Supervisors enforce PPE use consistently.
36
37
38
39
40
PPE is comfortable to wear for long periods.
41
42
43
44
45
Have you ever reported a PPE-related safety concern?
*
Yes
No
How satisfied are you with the response to PPE-related safety concerns?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
Which factors most influence your decision to use PPE? (Select all that apply)
*
Company policy
Personal safety
Peer influence
Supervisor enforcement
Comfort and fit
Other
Have you experienced any PPE failures or malfunctions in the past year?
*
Yes
No
Please provide any additional comments or suggestions regarding PPE safety.
Submit Survey
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