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Workplace Health and Safety Questionnaire + Sample Survey Template

Workplace health and safety is a multidisciplinary field also known as Occupational Health and Safety (OH&S )which is associated with the health, welfare, and safety of people at work. This questionnaire is designed to collect responses from employees based on their awareness of the same. As a business owner, there are legal requirements that you should comply and ensure your workplace meets the health and safety standards.

This a general health and safety survey template that will help an organization understand if they provide safe work premises, know the risk associated, ensure the safety of its employees and more. Through this survey, an organization can also know if it’s employees comply with instructions, don’t take unnecessary risks at the workplace, etc.


1. Following questions are based on workplace hazards. Please choose the most appropriate answer options.
How often do you …. ?
Never
Once a year
Every 6 months
Every 3 months
Every month
NA
Manually push or lift items that are more than 20 kgs
Do repetitive movement with your hands for at least 3 hours during the day
Perform tasks that you are not familiar with
Interact with chemicals or inflammable substances
Work in awkward positions (bend, twist, heavy manual labor)
Work at a height that is more than 5 meters
Work in high decibel levels
Stand for more than 3 hours a day
2. Following questions are based on workplace policies and procedures. Please choose the most appropriate answer options.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Everyone receives compulsory health and safety training
Management is extremely particular about the certification
Systems are in place to identify and deals with hazards
Workplace health and safety is considered extremely important
There is an active health and safety committee
An incident report is filed with due diligence
Health and safety procedures are clearly communicated
3. Following questions are based on workplace health and safety awareness. Please choose the most appropriate answer options.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I am clear about health and safety regulations at work
I have been certified by proper authorities
I know I can refuse to work in an unsafe environment
If I notice a workplace I am obligated to report it
I help my teammates understand the importance of health and safety

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Need a longer questionnaire? Check out Exit Interview Questions (Long Template)