Safety Perception Survey

• Document No.1

• Safety Perception Survey

• Site safety perception question

• Contractor

• Conducted on

  Date

• Prepared by

• What floor is the survey being conducted on?
  Address

• Personnel

Foreman questions

• 1. Have you ever made a safety suggestion?

  Yes

  No

  N/A

• 2. What safety conversations did you have with your crew?

  Yes

  No

  N/A

• 3. What risk do other trades pose to the people you have working?

  Yes

  No

  N/A

• 4. What hazards are identified , and do you feel the management team will resolve the issue in a timely manner?

  Yes

  No

  N/A

Employee Questions-Questions asked to the employees of the foreman

• 1. What was the topic of the tool box talk?

  Yes

  No

  N/A

• 2. Are the Pre Task Planning meetings active or passive?<br>

  Yes

  No

  N/A

• 3. Has anyone given you praise about working safely?

  Yes

  No

  N/A

• 4. What is the safety perception on your crew?

  Yes

  No

  N/A

• 5. Do you have the correct PPE for the job with the correct tools to perform your work safely?

  Yes

  No

  N/A

• 6. Have you felt like you've been pressured to work unsafely?

  Yes

  No

  N/A

• 7. What are the hazards associated with your work today?

  Yes

  No

  N/A

• 8. Do you believe hazards will be taken are of when they are identified?<br>

  Yes

  No

  N/A

• 9. If you see any hazards will you report? If so to whom would you make your observation?

  Yes

  No

  N/A