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Questionnaire template

Workplace Safety Perceptions

Asks employees how they rate workplace safety, training, safety equipment, incident reporting and emergency procedures.

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Questions in this template

Current Safety Measures

  1. Your view of safety at work helps us decide where to improve first. The survey takes about five minutes.

  2. Overall, how would you rate the safety arrangements in our workplace today?

    Choose one:

    • Very poor
    • Poor
    • Average
    • Good
    • Very good

  3. Which area of safety should we work on first?

    Choose one from a list:

    • Fire protection
    • Equipment safety
    • Personal protective equipment
    • Hygiene
    • Other

  4. Which other area do you have in mind?

    Condition: Shown when Other was chosen

    Open answer

  5. What concrete changes would you like to see in that area?

    Condition: Shown once a priority area has been chosen

    Open answer

Training and Equipment

  1. Do you feel you have been given enough safety training for your role?

    Choose one:

    • Yes
    • No

  2. What condition is each type of safety equipment in?

    • Fire extinguishers
    • First aid kits
    • Safety signs
    • Personal protective equipment

    For each row: choose one:

    • Very poor
    • Poor
    • Average
    • Good
    • Very good

Incident Reporting and Emergencies

  1. Which of these would you like the incident reporting process to offer?

    Choose any that apply:

    • Anonymous reporting
    • Immediate confirmation that a report was received
    • Updates on how a report is being handled
    • A clear point of contact

  2. Do you think our emergency procedures would work well in a real emergency?

    Choose one:

    • Yes
    • No

  3. What would make the emergency procedures more effective?

    Condition: Shown when the procedures were judged not effective

    Open answer