HFA Safety Survey (1)

• Title of safety culture survey

• Survey completed by title (Select)

  Select Manager Supervisor Staff

  • Manager
  • Supervisor
  • Staff

• Survey completed by (Name optional)

  Select Filipe Thomas Koehler Andrew Rouen Terry Allen Taila Johnston Simon Crocker Sharon Farley Matthew Leziak Matt Madlener Evi Waldron Lee Hobbs Peter Brunt

  • Filipe
  • Thomas Koehler
  • Andrew Rouen
  • Terry Allen
  • Taila Johnston
  • Simon Crocker
  • Sharon Farley
  • Matthew Leziak
  • Matt Madlener
  • Evi Waldron
  • Lee Hobbs
  • Peter Brunt

• Survey completed by (Name optional)

• Date and time

  Date

• 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

  Yes

  Partial

  No

  N/A

• Safety responsibilities identified but not understood or operating

• Time and money allocated to meet safety responsibilities

  Yes

  Partial

  No

  N/A

• Insufficient time and money allocated to meet safety responsibilities

• Managers promote safety as a high priority

  Yes

  Partial

  No

  N/A

• Safety not always a priority

• Managers involved in all recommended safety initiatives

  Yes

  Partial

  No

  N/A

• Limited involvement by managers

• Managers lead by example

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• Consultation in place but not working effectively

• Workers involved in safety decisions and developing procedures

  Yes

  Partial

  No

  N/A

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

• The views of workers are valued and taken into account

  Yes

  Partial

  No

  N/A

• Workers views are not always valued or taken into account

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

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• Limited development and implementation of safe work procedures

• Workers involved in developing safe work procedures

  Yes

  Partial

  No

  N/A

• Limited involvement of workers in developing safe work procedures

• Procedures followed in day to day operations

  Yes

  Partial

  No

  N/A

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

• Safe work procedures are reviewed and revised if necessary

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• Workers receive a minor induction only

• Workers trained in safe work procedures before commencing tasks

  Yes

  Partial

  No

  N/A

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

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

  Yes

  Partial

  No

  N/A

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

• Workers are supervised to ensure safe work procedures are followed

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• Reporting procedures developed but not always followed

• Safety issues and incidents are reported and acted upon

  Yes

  Partial

  No

  N/A

• Some incidents reported but follow-up action limited

• Safe work procedures and training reviewed following incident reports

  Yes

  Partial

  No

  N/A

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

• SafeWork NSW is notified of all serious incidents

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• 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.

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• 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

  Yes

  Partial

  No

  N/A

• Limited thought given to suitable duties for injured workers

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

  Yes

  Partial

  No

  N/A

• 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?

  Yes

  No thank you

• Name and signature optional

  Sign

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