Danger Assessment Scoring Questionnaire Form
Please complete this assessment to help evaluate and score potential danger or risk factors. All questions are required for a comprehensive analysis.
How likely is it that a dangerous event could occur in this environment?
*
Very Unlikely
1
2
3
4
Very Likely
5
1 is Very Unlikely, 5 is Very Likely
What is the potential severity of harm if a dangerous event occurs?
*
Minor
1
2
3
4
Severe
5
1 is Minor, 5 is Severe
Are there visible warning signs or indicators of danger present?
*
Yes
No
Not Sure
How frequently are safety protocols followed in this environment?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Rate your overall perception of risk in this situation.
*
1
2
3
4
5
Which of the following best describes the current risk level?
*
Low
Moderate
High
Critical
Please indicate agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Safety measures are adequate
1
2
3
4
5
Staff is well-trained for emergencies
6
7
8
9
10
Danger is communicated effectively
11
12
13
14
15
Is there a clear emergency plan in place?
*
Yes
No
Not Sure
How confident are you in your ability to respond to a dangerous situation here?
*
Not Confident
1
2
3
4
Very Confident
5
1 is Not Confident, 5 is Very Confident
What is the most significant risk factor you have observed?
*
Please Select
Physical hazards
Lack of training
Equipment failure
Environmental conditions
Other
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