Audit / Inspection Details

  • Title of safety culture survey

  • Survey completed by title (Select)

  • Survey completed by (Name optional)

  • Survey completed by (Name optional)

  • Date and time

Safety Culture Survey

  • Select a tab in each question.
    Use the rater at the end of each field.
    The survey is designed for management and staff to work together to provide a safer work environment.
    The survey and its accuracy will help us in achieving this outcome. Thank you for completing this safety survey.

1. Management Commitment

  • Managers and workers safety responsibilities clearly understood and acted upon

  • Safety responsibilities identified but not understood or operating

  • Time and money allocated to meet safety responsibilities

  • Insufficient time and money allocated to meet safety responsibilities

  • Managers promote safety as a high priority

  • Safety not always a priority

  • Managers involved in all recommended safety initiatives

  • Limited involvement by managers

  • Managers lead by example

  • Managers do not always lead by example

  • Rater: Green score 2 - Yellow score 1 - Red score 0 - Blue 0

2. Consultation

  • Agreed consultation arrangements are used to discuss safety issues and are working effectively

  • Consultation in place but not working effectively

  • Workers involved in safety decisions and developing procedures

  • Workers are not always involved in safety decisions and developing procedures

  • The views of workers are valued and taken into account

  • Workers views are not always valued or taken into account

  • The business consults, cooperates and coordinates with other businesses where duties are shared

  • Other businesses not always consulted where duties are shared

  • Rater: Green score 2 - Yellow score 1 - Red score 0 - Blue 0

3. Safe work procedures

  • All tasks with safety risks have been identied

  • Only some tasks with safety risks have been identified and controlled (Please add detail of risks in above cell)

  • Safe work procedures developed and implemented for these tasks

  • Limited development and implementation of safe work procedures

  • Workers involved in developing safe work procedures

  • Limited involvement of workers in developing safe work procedures

  • Procedures followed in day to day operations

  • Procedures developed but not always followed in day to day operations

  • Safe work procedures are reviewed and revised if necessary

  • Safe work procedures not always reviewed when they are known to be deficient

  • Rater: Green score 2 - Yellow score 1 - Red score 0 - Blue 0

4. Training and supervision

  • All workers inducted into safety management systems i.e. general induction

  • Workers receive a minor induction only

  • Workers trained in safe work procedures before commencing tasks

  • Some workers not able to demonstrate they can do tasks competently

  • Workers understand procedures and demonstrate they can do the tasks safely.

  • Some workers not able to demonstrate they can do the task safely.

  • Workers are supervised to ensure safe work procedures are followed

  • Supervision does nor always result in safe work procedures being followed

  • Rater: Green score 2 - Yellow score 1 - Red score 0 - Blue 0

5. Reporting safety

  • Procedures for reporting safety issues and incidents are implmented

  • Reporting procedures developed but not always followed

  • Safety issues and incidents are reported and acted upon

  • Some incidents reported but follow-up action limited

  • Safe work procedures and training reviewed following incident reports

  • Safe work procedures and training not always reviewed following an incident

  • SafeWork NSW is notified of all serious incidents

  • Site preserved if notifiable incident?

  • Rater: Green score 2 - Yellow score 1 - Red score 0 - Blue 0

6. Workers compensation and return to work

  • Workers compensation insurance policy is current and reflects the nature of the business

  • Workers compensation insurance policy does not accurately reflect the nature of business, number of workers and total wages

  • Workers use an injury reporting system and are provided with information about return to work plans an policies.

  • Workers given some information about return to work plans, policies and injury reporting systems.

  • Return to work plans are developed and put in place for injured workers to assist them return to work as quickly as possible

  • Return to work plans are not effective in getting injured workers to return to work as quickly as possible.

  • Managers maintain regular contact with injured workers to ensure expectations are set and information shared

  • Managers have regular contact with injured workers but do not set clear expectations or share information

  • Workers are given suitable employment if they have the capacity to work

  • Limited thought given to suitable duties for injured workers

  • All injuries are reported to the insurance company within 48 hours

  • Not all injuries reported to insurance company within required time

  • Rater: Green score 2 - Yellow score 1 - Red score 0 - Blue 0

Overall score

Name and signature optional

  • Other safety issues you would like to comment on?

  • Name and signature optional

  • Overall Score Rater: Green score 2 - Yellow score 1 - Red score 0 - Blue 0

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.