Safety Survey

Please answer all questions. If you answer any questions with a “No”, please ask you supervisor to help you learn the answers that can prevent injury to you and others. We care about your safety!

Name ________________________ Department ______________________ Date ________

Yes	Does not apply	20 Questions	No
		Have you been trained to use the Personal Protective Equipment (PPE), such as safety glasses, respirators, hard hats, gloves, you use on your job?
		Do you know where all the emergency exits are?
		In an emergency, do you know where to go after evacuating the building?
		Do you know where to shelter at work during emergency weather conditions
		Do you know what to do if you see exposed electrical wires?
		Do you know what to do if you have a broken tool?
		Do you know what to do if a piece of equipment jams?
		Do you read the label on containers before using any chemical?
		Do you know who to ask if you need more information about a chemical you use?
		Have you been trained in proper lifting techniques?
		Do you encourage others to work safely?
		Do you always use safety glasses when using hand tools?
		Do you inspect all tools before use?
		Do you know how to report a fire?
		Do you report unsafe acts and unsafe conditions?
		Do you know that 85% of all accidents are caused by Unsafe Acts by employees?
		Do you know that “shortcuts” are unsafe acts?
		Do you obey all Warning & Danger signs and tags?
		Do you know not to attempt to repair or un-jam equipment unless you are specifically trained and authorized?
		Do you know who to ask if you have any safety related questions?