Industrial Safety System Assessment Form
Use this form to comprehensively assess and evaluate key aspects of your industrial safety systems.
General Safety Compliance
*
Rows
Fully Compliant
Partially Compliant
Not Compliant
Not Applicable
Machine guarding
1
2
3
4
Lockout/tagout procedures
5
6
7
8
Hazard communication
9
10
11
12
Personal protective equipment (PPE)
13
14
15
16
Emergency exits clearly marked
17
18
19
20
Condition of Safety Equipment
*
1
2
3
4
5
Emergency Preparedness
*
Rows
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Emergency plans are up to date
21
22
23
24
25
Regular emergency drills conducted
26
27
28
29
30
Emergency equipment is accessible
31
32
33
34
35
Staff trained in first aid
36
37
38
39
40
Incident Reporting Process
*
Clear and well-communicated
Somewhat clear
Unclear or inconsistent
Frequency of Safety Training
*
Quarterly or more often
Biannually
Annually
Less than annually
Safety Culture Rating
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Housekeeping and Workspace Organization
*
1
2
3
4
5
How effective are current hazard identification processes?
*
Very effective
Somewhat effective
Ineffective
How would you rate the communication of safety policies?
*
1
2
3
4
5
Additional Comments or Observations
Submit Assessment
Should be Empty: