Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Health and Safety at Work
이메일 주소*(e-mail address)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
1. I understand the health & safety risks associated with my work
agree
Disagree
Clear selection
2.I have had no training in the risks associated with my job
agree
Disagree
Clear selection
3.Accidents are not always reported
agree
Disagree
Clear selection
4. My supervisor/manager does not talk to me about safety
agree
Disagree
Clear selection
5.Some health & safety rules are too difficult for me to follow
agree
Disagree
Clear selection
6.Getting the job done is more important than safety at this site
agree
Disagree
Clear selection
7.The health & safety committee do a good job at this site
agree
Disagree
Clear selection
8.The company takes health & safety seriously
agree
Disagree
Clear selection
9.People here work safely
agree
Disagree
Clear selection
10.I am not sure of the correct safety procedures for my job
agree
Disagree
Clear selection
11.Training is not seen as important at this site
agree
Disagree
Clear selection
12.I understand my health & safety responsibilities
agree
Disagree
Clear selection
13.People I work with often break the rules
agree
Disagree
Clear selection
14.My supervisor/manager would never allow unsafe practices
agree
Disagree
Clear selection
15.No recognition is given to people who work safely
agree
Disagree
Clear selection
15.No recognition is given to people who work safely
agree
Disagree
Clear selection
16.The hazard reporting system works well here
agree
Disagree
Clear selection
17. Are all break glass fire alarm call points accessible?
yes
No
Clear selection
18.Are all escape routes clear of items that would impede an evacuation?
YES
No
Clear selection
19.Are all fire exits clear of obstructions?
YES
No
Clear selection
20.Are all fire extinguishers fitted with safety pins and intact/undamaged?
YES
No
Clear selection
CHECKLIST COMPLETION DECLARATION//: DATE
*
MM
/
DD
/
YYYY
Submit
Clear form
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report