Employee Safety Perception Survey
  • Healthcare facility
  • Job title
  • Rate your perception of safety at your workplace according to the following:
    (Poor) 1 - - 2 - - 3 - - 4 - - 5 (Excellent)
    Staff safety training
    Work procedures
    Safety protocols
    Risk assessments
    Hazard detection
    Safety issues
  • Rate your perception of management according to the following:
    (Poor) 1 - - 2 - - 3 - - 4 - - 5 (Excellent)
    Staff organization
    Staff management
    Regular feedback
    Personal hazard intervention
    Participation in safety training
  • Do you think management has been well-equipped to handle emergencies?
  • How much do you feel the management cares about safety?
  • Were there hazards you observed that were not addressed?
  • Please specify
  • Overall, how satisfied are you with the safety of the health care facility?
  • What could be improved regarding the safety of the health care facility? Comment briefly below.

That's all, folks!

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