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Questionnaire template

Workplace Health and Safety Review

Employee review of how workplace health and safety measures are communicated, implemented, and how effective they are.

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Questions in this template

Your Workplace

  1. This review looks at how well health and safety is managed where you work. Please answer frankly; your answers will be used to decide what to improve.

  2. Roughly how many people does your organisation employ?

    Choose one:

    • 1-50
    • 51-200
    • 201-1000
    • More than 1000

  3. Are the health and safety arrangements at work explained to you clearly?

    Choose one:

    • Yes
    • No
    • Not sure

Measures in Place

  1. Which of these measures does your organisation currently have?

    Choose any that apply:

    • Regular cleaning of work areas
    • Personal protective equipment
    • Physical distancing arrangements
    • Regular health and safety training
    • Option to work remotely
    • None of these

  2. How well is each measure carried out? Rate only those your organisation has.

    Condition: Shown when at least one measure is in place

    • Cleaning of work areas
    • Personal protective equipment
    • Physical distancing arrangements
    • Health and safety training
    • Remote working

    For each row: choose one:

    • Very poor
    • Poor
    • Fair
    • Good
    • Excellent

How Well the Measures Work

  1. How effective is each measure at keeping people safe and healthy? (1 = not at all effective, 10 = extremely effective)

    Condition: Shown when at least one measure is in place

    • Cleaning of work areas
    • Personal protective equipment
    • Physical distancing arrangements
    • Health and safety training
    • Remote working

    For each row: choose one:

    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10

  2. How comfortable are you personally with following each measure?

    Condition: Shown when at least one measure is in place

    • Cleaning of work areas
    • Personal protective equipment
    • Physical distancing arrangements
    • Health and safety training
    • Remote working

    For each row: choose one:

    • Very uncomfortable
    • Uncomfortable
    • Neutral
    • Comfortable
    • Very comfortable

  3. Do you have any other observations on how well these measures work? (optional)

    Open answer

Room for Improvement

  1. What one change would do most to improve health and safety where you work?

    Open answer

  2. Would you be willing to talk to us about your answers in a short follow-up interview?

    Choose one:

    • Yes
    • No

  3. How can we contact you to arrange the interview?

    Condition: Shown to respondents willing to be interviewed

    Open answer