Free Workplace Safety Survey template by 123ContactForm

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Workplace Safety Survey
Workplace safety should be a top priority for every employee. Please take the time to evaluate your safety by filling in the information below.
Department

General
	Yes No N/A
Do you find noise levels acceptable?

Do you find the temperature levels acceptable?

Do you find work areas properly lit?

Do you think exits are marked correctly?

Do people with disabilities have complete access to all the areas?

Can you quickly reach the basic first aid supplies?

Are there any active protocols for reporting safety violation?

Electrical Safety
	Yes No N/A
Do you think outlets and equipment are properly grounded?

Do you consider power cords are safe enough?

Did you notice the extension cords being used only occasionally?

Are power strips provided with surge protectors?

Fire Safety
	Yes No N/A
Are the locations of fire extinguishers visible?

Are fire extinguishers up to date regarding inspections?

Do you think fire exits are visible enough?

Do you think fire exits are unblocked?

Do the smoke detectors function properly?

Is the fire evacuation plan visible enough?

Hazardous Materials
	Yes No N/A
Is food separated from hazardous materials?

Are the labels of the hazardous materials visible?

Are there special storage places for hazardous materials?

Would you consider the disposal of hazardous materials a safe process?

Are the handlers of hazardous materials trained properly?

Is the safety gear for working with hazardous materials near by?

Do people wear safety gear when they handle hazardous materials?

Sanitation
	Yes No N/A
Is the dining area always clean?

Do you find the restrooms clean enough?

Are there always enough soaps and towels for employees?

Is the workplace protected from rodents and insects?

Tools and Equipment
	Yes No N/A
When not used are hand tools kept in special places?

Are the machine operators well trained?

When working with machinery is the safety gear available?

Do people that work with machinery wear proper safety gear?

Do they keep the safety guards for moving parts in special places?

Are the machines used completely functional?

How safe do you find your workplace?	Very Safe Safe Neutral Unsafe Very Unsafe

Feel free to mention any safety violations that you feel are being ignored or improperly resolved.

Verification No.