Full Name:

Job Title:

Department:

Employee ID:

1. I have received adequate safety training for my job.

• 1 (Strongly Disagree)

• 2 (Disagree)

• 3 (Neutral)

• 4 (Agree)

• 5 (Strongly Agree)

2. Safety equipment (e.g., PPE) is readily available and in good condition.

• 1 (Strongly Disagree)

• 2 (Disagree)

• 3 (Neutral)

• 4 (Agree)

• 5 (Strongly Agree)

3. Unsafe conditions or incidents are promptly reported and addressed.

• 1 (Strongly Disagree)

• 2 (Disagree)

• 3 (Neutral)

• 4 (Agree)

• 5 (Strongly Agree)

4. Have you identified any potential safety hazards in your work area?

• Yes

• No

If yes, please describe:

5. Do you have suggestions for improving safety in your workplace?

• Yes

• No

If yes, please describe: 

6. Are you familiar with the company's emergency evacuation procedures?

• Yes

• No

7. Have you participated in any emergency drills or training sessions?

• Yes

• No