Health & Safety Training Needs Assessment Form

Employee Information

Employee Name: ____________________________________________

Department: ________________________________________________

Job Title: ____________________________________________________
Date of Last Training: ________________________________________

Training History

List the current training programs in place:

1. Fire Safety Awareness

2. ______________________________________________________________________________

3. ______________________________________________________________________________

   Employee Participation Rates:

Program: Fire Safety Awareness Rate: 75%

Program: _____________________ Rate: ____

Risk Assessment

List recent workplace incidents and identified high-risk areas:

Incident: Minor hand injury in manufacturing Number of Occurrences: 2 incidents

Incident: _________________________________ Number of Occurrences: __________

Incident: _________________________________ Number of Occurrences: __________

Training Needs Analysis

Skills and Knowledge Gaps Identified:

1. Lack of knowledge in machine safety protocols

2. ____________________________________________________

3. ____________________________________________________

Proposed Training Programs:

1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

Feedback

Comments/Suggestions (if any):

__________________________________________________________________________________

Approved by: 

[Your Name]

[Job Title]

[Date]

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