Work Environment Survey

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0

Rate your satisfaction of the following aspects of your work environment:
(Very dissatisfied) 1 - - 2 - - 3 - - 4 - - 5 (Very satisfied)

Comfort

1

2

3

4

5

Resting areas

1

2

3

4

5

Quality of food

1

2

3

4

5

Equipment availability

1

2

3

4

5

Facility maintenance

1

2

3

4

5
0

Rate how dangerous you perceive the following aspects of your workplace:
(Very dangerous) 1 - - 2 - - 3 - - 4 - - 5 (Safe)

Lighting conditions/visibility

1

2

3

4

5

Vibrations

1

2

3

4

5

Noise pollution

1

2

3

4

5

Radiation/thermal environment

1

2

3

4

5
0

How would you describe your workplace's lighting conditions?
Too dim

Slightly dim

Adequate

Slightly glaring

Too glaring
0

What types of elemental hazards are you exposed to at work? Check all that apply.
Radiation

Thermal

Noise

Vibration

Odors

Smoke
0

Are there appropriate safety precautions for these hazards?
Yes

No
0

Please explain

0 / 5000
0

Have you been injured because of work?
Yes

No
0

Please explain

0 / 5000
0

Are there medical personnel on standby for such emergencies?
Yes

No
0

In your opinion, how can your work environment be improved?

0 / 5000

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0

Rate your satisfaction of the following aspects of your work environment:
(Very dissatisfied) 1 - - 2 - - 3 - - 4 - - 5 (Very satisfied)

Comfort

1

2

3

4

5

Resting areas

1

2

3

4

5

Quality of food

1

2

3

4

5

Equipment availability

1

2

3

4

5

Facility maintenance

1

2

3

4

5
0

Rate how dangerous you perceive the following aspects of your workplace:
(Very dangerous) 1 - - 2 - - 3 - - 4 - - 5 (Safe)

Lighting conditions/visibility

1

2

3

4

5

Vibrations

1

2

3

4

5

Noise pollution

1

2

3

4

5

Radiation/thermal environment

1

2

3

4

5
0

How would you describe your workplace's lighting conditions?
Too dim

Slightly dim

Adequate

Slightly glaring

Too glaring
0

What types of elemental hazards are you exposed to at work? Check all that apply.
Radiation

Thermal

Noise

Vibration

Odors

Smoke
0

Are there appropriate safety precautions for these hazards?
Yes

No
0

Please explain

0 / 5000
0

Have you been injured because of work?
Yes

No
0

Please explain

0 / 5000
0

Are there medical personnel on standby for such emergencies?
Yes

No
0

In your opinion, how can your work environment be improved?

0 / 5000