Employees Safety Perceptions Survey

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0

Healthcare facility
0

Job title
0

Rate your perception of safety at your workplace according to the following:

Poor

Excellent

Staff safety training

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Work procedures

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Safety protocols

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Risk assessments

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Hazard detection

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Safety issues

Poor

Excellent

1 Poor

2

3

4

5 Excellent
0

Rate your perception of management according to the following:

Poor

Excellent

Staff organization

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Staff management

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Regular feedback

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Personal hazard intervention

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Participation in safety training

Poor

Excellent

1 Poor

2

3

4

5 Excellent
0

How well-equipped do you think management has been to handle emergencies?
Not at all

Slightly

Moderately

Very

Extremely
0

How much do you feel management cares about safety?
Not at all

Slightly

Moderately

Very

Extremely
0

Were there hazards you observed that were not addressed?
No

Yes
0

Please elaborate

0 / 5000
0

Overall, how satisfied are you with the safety of the health care facility?
Very dissatisfied

Dissatisfied

Neutral

Satisfied

Very satisfied
0

How could the safety of the health care facility be improved? Comment briefly below.

0 / 5000

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0

Healthcare facility
0

Job title
0

Rate your perception of safety at your workplace according to the following:

Poor

Excellent

Staff safety training

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Work procedures

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Safety protocols

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Risk assessments

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Hazard detection

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Safety issues

Poor

Excellent

1 Poor

2

3

4

5 Excellent
0

Rate your perception of management according to the following:

Poor

Excellent

Staff organization

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Staff management

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Regular feedback

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Personal hazard intervention

Poor

Excellent

1 Poor

2

3

4

5 Excellent

Participation in safety training

Poor

Excellent

1 Poor

2

3

4

5 Excellent
0

How well-equipped do you think management has been to handle emergencies?
Not at all

Slightly

Moderately

Very

Extremely
0

How much do you feel management cares about safety?
Not at all

Slightly

Moderately

Very

Extremely
0

Were there hazards you observed that were not addressed?
No

Yes
0

Please elaborate

0 / 5000
0

Overall, how satisfied are you with the safety of the health care facility?
Very dissatisfied

Dissatisfied

Neutral

Satisfied

Very satisfied
0

How could the safety of the health care facility be improved? Comment briefly below.

0 / 5000