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Questionnaire template

Workplace Safety Questionnaire

Employee survey on safety culture, training, protective equipment, hazards and incident reporting at work.

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Human Resources · Employee questionnaires. All Human Resources templates

Questions in this template

Your Work

  1. This questionnaire asks how safe you feel at work and how well safety is managed where you work. Your answers are confidential and will be used to decide where to improve.

  2. Where do you spend most of your working time?

    Choose one:

    • Office
    • Warehouse or logistics
    • Production or manufacturing
    • Field or outdoor work
    • Laboratory
    • Retail or customer-facing
    • Other

  3. Which of these are a regular part of your work? Select all that apply.

    Choose any that apply:

    • Heavy lifting
    • Working at height
    • Machinery
    • Chemicals
    • Loud noise
    • Slippery or uneven floors
    • Vehicles or forklifts
    • Long periods of screen work
    • None of these

Safety Culture

  1. How much do you agree with each statement about your workplace?

    • Managers put safety ahead of getting work done faster
    • I feel comfortable speaking up about a safety concern
    • My colleagues follow safety procedures
    • Safety concerns that are raised get dealt with

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree

  2. Overall, how safe do you feel while you are at work?

    Choose one:

    • Very unsafe
    • Unsafe
    • Neither safe nor unsafe
    • Safe
    • Very safe

  3. How often does time pressure lead people in your area to skip safety steps?

    Choose one:

    • Never
    • Rarely
    • Sometimes
    • Often
    • Always

Training and Protective Equipment

  1. In the last twelve months, have you received safety training relevant to your job?

    Choose one:

    • Yes
    • No
    • Not sure

  2. How well did that training prepare you to work safely?

    Asked only when q_training_received.outcome == 1

    Choose one:

    • Not at all well
    • Slightly well
    • Moderately well
    • Very well
    • Extremely well

  3. Does your job require personal protective equipment, such as gloves, helmets or safety glasses?

    Choose one:

    • Yes
    • No

  4. How often is suitable protective equipment available when you need it?

    Asked only when q_ppe_needed.outcome == 1

    Choose one:

    • Never
    • Rarely
    • Sometimes
    • Often
    • Always

Incidents and Reporting

  1. In the last twelve months, have you been involved in or witnessed an injury or a near miss at work?

    Choose one:

    • Yes
    • No

  2. About how many such incidents were there?

    Asked only when q_incident_experienced.outcome == 1

    A number from 1 to 50

  3. Were these incidents formally reported?

    Asked only when q_incident_experienced.outcome == 1

    Choose one:

    • Yes, all of them
    • Some of them
    • None of them
    • Not sure

  4. Why were some incidents not reported? Select all that apply.

    Asked only when q_incident_reported.outcome == 2 or q_incident_reported.outcome == 3

    Choose any that apply:

    • It seemed too minor
    • Unclear how to report
    • Worry about the consequences
    • Reporting takes too long
    • Someone else was expected to report it
    • Other

  5. What other reason was there?

    Asked only when q_not_reported_reason.outcome is not None and q_not_reported_reason.outcome & 32 != 0

    Open answer

  6. How satisfied are you with the way reported incidents were followed up?

    Asked only when q_incident_reported.outcome == 1 or q_incident_reported.outcome == 2

    Choose one:

    • Very dissatisfied
    • Dissatisfied
    • Neither satisfied nor dissatisfied
    • Satisfied
    • Very satisfied

Improvements

  1. What do you see as the biggest safety risk in your area?

    Open answer

  2. What would make your workplace safer?

    Open answer