Skip to content

Home
Services
Employment Opportunities
Announcements
Photo Gallery
Employee Resources
Contact Us

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:

Workplace Safety Survey
( * ALL Fields Are Required )

Department *

Date *

General

Do you find noise levels acceptable? *

YES

NO

N/A

Do you find the temperature levels acceptable? *

YES

NO

N/A

Do you find work areas properly lit? *

YES

NO

N/A

Do you think exits are marked correctly? *

YES

NO

N/A

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

YES

NO

N/A

Can you quickly reach the basic first aid supplies? *

YES

NO

N/A

Are there any active protocols for reporting safety violation? *

YES

NO

N/A

Electrical Safety

Do you think outlets and equipment are properly grounded? *

YES

NO

N/A

Do you consider power cords are safe enough? *

YES

NO

N/A

Did you notice the extension cords being used only occasionally? *

YES

NO

N/A

Are power strips provided with surge protectors? *

YES

NO

N/A

Fire Safety

Are the locations of fire extinguishers visible? *

YES

NO

N/A

Are fire extinguishers up to date regarding inspections? *

YES

NO

N/A

Do you think fire exits are visible enough? *

YES

NO

N/A

Do you think fire exits are unblocked? *

YES

NO

N/A

Do the smoke detectors function properly? *

YES

NO

N/A

Is the fire evacuation plan visible enough? *

YES

NO

N/A

Hazardous Materials

Is food separated from hazardous materials? *

YES

NO

N/A

Are the labels of the hazardous materials visible? *

YES

NO

N/A

Are there special storage places for hazardous materials? *

YES

NO

N/A

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

YES

NO

N/A

Are the handlers of hazardous materials trained properly? *

YES

NO

N/A

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

YES

NO

N/A

Do people wear safety gear when they handle hazardous materials? *

YES

NO

N/A

Sanitation

Is the dining area always clean? *

YES

NO

N/A

Do you find the restrooms clean enough? *

YES

NO

N/A

Are there always enough soaps and towels for employees? *

YES

NO

N/A

Is the workplace protected from rodents and insects? *

YES

NO

N/A

Tools and Equipment

When not used are hand tools kept in special places? *

YES

NO

N/A

Are the machine operators well trained? *

YES

NO

N/A

When working with machinery is the safety gear available? *

YES

NO

N/A

Do people that work with machinery wear proper safety gear? *

YES

NO

N/A

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

YES

NO

N/A

Are the machines used completely functional? *

YES

NO

N/A

How safe do you find your workplace? *

Very Safe

Safe

Neutral

Unsafe

Very Unsafe

Violations

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

reCAPTCHA

If you are human, leave this field blank.

Comments are closed.

Home Office | Arkansas
P.O. Box 50 / 111 N. 2nd St.
Gillham, AR 71841
Tel: 870-386-2451
Fax: 870-386-2071

For all Job Quotes & Inquiries Please Call
Tri-Lakes Services
870-386-2451

Contractor's Office | Oklahoma
890 IP Lane
Valliant, OK 74764
Tel: 580-933-1462
Fax: 580-933-1369

Powered by Nirvana & WordPress.

Workplace Safety Survey

Workplace safety should be a top priority for every employee!

Workplace Safety Survey ( * ALL Fields Are Required )

General

Electrical Safety

Fire Safety

Hazardous Materials

Sanitation

Tools and Equipment

Workplace Safety Survey
( * ALL Fields Are Required )