Environmental Safety Pre-test Assessment Form
Complete this Environmental Safety Pre-test Assessment Form to evaluate your baseline knowledge and site-readiness for environmental safety topics.
Full Name
*
First Name
Last Name
Department or Work Area
*
Which of the following best describes your familiarity with environmental safety procedures?
*
Very familiar
Somewhat familiar
Not familiar
How confident are you in identifying environmental hazards in your work area?
*
1
2
3
4
5
Which of the following is NOT considered a common environmental hazard?
*
Chemical spills
Poor ventilation
Proper signage
Biological waste
Rate your agreement with the following statements about environmental safety at your site.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I know how to report an environmental safety incident.
1
2
3
4
5
Emergency exits are clearly marked and accessible.
6
7
8
9
10
Personal protective equipment is available when needed.
11
12
13
14
15
Check all environmental safety equipment available at your site:
*
Spill kits
Fire extinguishers
Eye wash stations
First aid kits
Other
Have you received environmental safety training in the past 12 months?
*
Yes
No
On a scale from 1 (Not Ready) to 5 (Fully Ready), how prepared do you feel to respond to an environmental emergency?
*
Not Ready
1
2
3
4
Fully Ready
5
1 is Not Ready, 5 is Fully Ready
Please share any additional comments or concerns regarding environmental safety at your site.
Submit Assessment
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