Safety Procedure Feedback Form

Employee Information:

Employee Name: [Your Name]

Department/Division: [Your Department]

Date of Feedback: [Date]

Feedback Details:

1. Effectiveness of Safety Procedure:

Please rate the effectiveness of the safety procedure on a scale of 1 to 5, with 1 being highly ineffective and 5 being highly effective.

• 1 (Highly Ineffective)

• 2 (Ineffective)

• 3 (Neutral)

• 4 (Effective)

• 5 (Highly Effective)

2. Clarity and Comprehensibility:

Please provide feedback on how clearly and comprehensibly the safety procedure is written. Are the instructions easy to understand?

___________________________________________________________________________

3. Implementation Challenges:

Have you encountered any challenges or difficulties while implementing the safety procedure? If yes, please describe them.

_____________________________________________________________________________

4. Suggestions for Improvement:

Please provide any suggestions or recommendations for improving the safety procedure. Include any specific changes you would like to see.

______________________________________________________________________________

5. Compliance with Safety Standards:

Do you believe the safety procedure complies with industry safety standards and regulations? If not, please specify the areas where improvements are needed.

________________________________________________________________________________

6. Training and Education:

Do you feel adequately trained and educated on the safety procedure? Are there any additional training or resources you believe would be helpful?

___________________________________________________________________________________

7. Reporting Incidents or Near-Misses:

Do you know the procedure for reporting safety incidents or near-miss incidents related to this safety procedure? If not, please specify what information is missing. ____________________________________________________________________________

8. Additional Comments:

Please use this space to provide any additional comments or feedback related to the safety procedure or safety practices within your department.

_____________________________________________________________________________________

Overall Rating of Safety Procedure:

Please provide an overall rating for the safety procedure on a scale of 1 to 5, with 1 being very poor and 5 being excellent.

• 1 (Very Poor)

• 2 (Poor)

• 3 (Average)

• 4 (Good)

• 5 (Excellent)

Thank you for taking the time to provide feedback on our safety procedure. Your input is valuable in ensuring a safe and secure work environment.

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