1. Were the safety instructions clear and easy to understand? 

• Yes

• No

If No, please specify areas of improvement: 

The use of technical jargon made it difficult to understand certain steps.

2. Did you encounter any difficulties while following the procedure?

• Yes

• No

If Yes, please describe the difficulties:

3.Were all necessary safety equipment and materials provided?

• Yes

• No

4. Did the procedure adequately address potential hazards?

• Yes

• No

If No, please identify the hazards not addressed:

5. Did you witness any unsafe practices during the procedure?

• Yes

• No

If Yes, please describe the unsafe practices:

6. Any additional comments or suggestions for improving this safety procedure:

By submitting this form, you agree that the information provided is accurate to the best of your knowledge.

Signature: ______________________

Date: [Month Day, Year]