Workplace Safety Assessment


Thanks for taking this survey. Your answers will be kept confidential.The data collected in the survey will be used to create a safer workplace.

Answer the Following Questions:
1. Please indicate your level in the organization by selecting the option that best describes your role.

1. Hourly employee
2. Salaried employee
3. First-level supervisor/manager
4. Mid-level manager
5. Senior manager
2a. Think of the people you work with on a daily basis. How many take shortcuts that skirt safety practices from time to time?

1. None
2. 10%
3. 11-25%
4. 26-50%
5. 51-75%
6. 76-100%
2b. When you see someone taking one of these shortcuts, how often do you confront that person and take time to share your full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
2c. In general, when people take these kinds of shortcuts, how often do others in your organization confront them and take time to share their full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
3a. Think of the people you work with on a daily basis. How many are missing the basic skills, the good judgment, or the physical strength or coordination required to keep themselves and others as safe as you’d like?

1. None
2. 10%
3. 11-25%
4. 26-50%
5. 51-75%
6. 76-100%
3b. When you see someone who is missing basic skills, good judgment, or the physical strength or coordination to keep themselves and others safe, how often do you confront them and take time to share your full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
3c. In general, when people are missing basic skills, good judgment, or the strength or coordination to keep themselves and others safe, how often do others in your organization confront them and take time to share their full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
In many otherwise safe organizations, people still make a few informal exceptions to their normal safety practices. Typical examples of times these exceptions occur include: when an important production deadline is at risk, during short-term repairs to a piece of equipment, during a trial period while a machine is still being tested.
4a. How common is it for people to make these informal exceptions in your organization?

1. I have never seen one.
2. I see a few a year
3. I see a few a month
4. I see a few a week
5. I see them every day
4b. When you see one of these informal exceptions, how often do you confront the people making them and take time to share your full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
4c. In general, when people make these informal exceptions, how often do others in your organization confront them and take time to share their full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
It’s not uncommon for people to think that some safety precautions go too far. An example is the warning on coffee cups: “Contents may be hot” or on shin pads: “Shin pads cannot protect any part of the body they do not cover.” Are there safety warnings or practices where you work that are ignored at least some of the time because people find them unnecessary or “over the top”? Typical examples we’ve heard include: always using lockouts, always wearing safety goggles, and never reaching into a machine.
5a. Think of the people you work with on a daily basis. How many bypass safety warnings or practices that they believe are unnecessary or “over the top” from time to time?

1. None
2. 10%
3. 11-25%
4. 26-50%
5. 51-75%
6. 76-100%
5b. When you see someone treating a safety warning or practice as unnecessary, how often do you confront that person and take time to share your full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
5c. In general, when people treat safety warnings or practices as unnecessary, how often do others in your organization confront them and take time to share their full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
Sometimes people decide to live with an unsafe working condition because they know the solution will be expensive, time consuming, or a bother to their boss. They want to be a “good soldier,” and not a “complainer,” so they don’t bring up the issue. Typical examples we’ve heard include: not pulling an alarm until they’ve talked with a manager, continuing to lift heavy weights even though they are pregnant, and working in awkward positions that cause repetitive stress injuries.
6a. Think of the people you work with on a daily basis. How many fail to bring up or correct an unsafe condition because they want to be seen as a team player from time to time?

1. None
2. 10%
3. 11-25%
4. 26-50%
5. 51-75%
6. 76-100%
6b. When you see people failing to bring up concerns because they don’t want to be seen as complainers, how often do you confront them and take time to share your full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
6c. In general, when people fail to bring up their own concerns because they don’t want to be seen as complainers, how often do others in your organization confront them and take time to share their full concerns?

1. Never
2. About 10% of the time
3. About 25% of the time
4. About half the time
5. About 75% of the time
6. Always
Please provide the following information about yourself.
Your Workplace Safety Assessment results will be automatically scored sent to you at the e-mail
address you provide.

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*e-mail Address:  
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