Workplace Safety Survey

Approximate number of employees?

How many locations does your company have in the United States?

Does your company serve Consumers, Businesses, or Both?

Does your company have a dedicated safety department?

I believe that workplace safety is a priority for my company:

Every level of my company is dedicated to a positive workplace safety program:

Workplace health and safety is considered to be at least as important as production and quality:

My company's mission statement includes workplace safety as a value:

My company's safety department has a clear mission statement, that is communicated to all employees and endorsed by the highest person in the company:

At my company those in charge of safety have the authority to make the changes they have identified as necessary:

My company is proactive in identifying workplace safety hazards:

My company does a great job communicating safety concerns to employees:

My company does a great job listening to the safety concerns of employees:

My company dedicates adequate budget and resources into workplace safety:

My workplace has a safety committee:

My company utilizes a Behavior Based Safety Program:

My company's Behavior Based Safety Program is active and effective:

At my company employees identified acting safely receive positive recognition

My company uses predictive analytics for workplace safety:

My company uses leading indicators as part of their workplace safety program:

What leading indicators does your company use - Type N/A if not applicable:

What is your top workplace safety concern?

If given unlimited budget, and full company backing, what is one thing you would do to improve workplace safety:

My company collects information for incident reporting in the following manner:

My company reviews and updates the safety policies/procedures regularly, at minimum annually:

Workers are always involved in reviewing the safety procedures that impact their job:

My company always does a risk assessment when they start a new process or when a process is changed

My company has worked out all the jobs/tasks that have safety risks, and taken appropriate steps to mitigate risk to employees:

My workplace's safety program addresses the risks employee's encounter on a day-to-day basis:

My workplace considers safety when planning activities or projects:

Safety decisions at my workplace are made by qualified people.

My company makes employees aware of all policies that are relevant to the tasks they perform.

Safety is integrated into all procedures for work.

Employees receive safety and health training.

My company encourages employees to report ALL safety incidents:

All incidents are investigated quickly in order to improve safety at the workplace as soon as possible:

My company requires all employees to report all injuries immediately, no matter how minor:

My company has a near miss program, and treats it the same as an injury incident:

My company has a strong accident investigation program, including collecting evidence from incidents, and completing root causes analysis:

My company conducts a root cause analysis of all safety incidents and near miss reports:

My company's safety training is reviewed or updated if there is an incident:

My company reviews and updates relevant safety procedures after every incident root cause analysis:

My company always updates the job hazard analysis after a safety incident, regardless of injury:

Workers are always involved in reviewing the safety procedures that impact their job:

Does every employee have the authority to initiate action to correct hazardous conditions?

Are risks sometimes overlooked in order to "get the job done"?

Do you have problems obtaining support for the correction of hazardous conditions?

Are records kept of hazardous conditions found during an inspections?

A comprehensive baseline hazard survey has been conducted within the past five years.