Safety Culture

Self Evaluation

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This survey can be completed by one or multiple administrators. The surveys will be consolidated to one company safety score.

Leading Indicators

Are you ready to evaluate employees on their level of engagement?*

Employee Engagement Scoring

0 Doesn't apply

1 Never

2 Rarely

3 Seldom

4 Usually

5 Always

Employees report potential hazards observed in the workplace.*
Employees report incidents that occur even if there is no injury involved.*
Employees complete inspections of vehicles on a daily basis.*
Employees complete regular inspections of all equipment.*
Employees complete daily PIT inspections.*
Employees are involved in area inspections.*
Employees receive scores of job performance showing competency.*
Employees are actively involved in monthly compliance training.*
Employees report all first aid cases.*
Employees are involved in creating Safe Job Procedures.*
Employees are involved in team discussions to make improvements.*
Are you ready to evaluate supervisors on their level of leadership?*

Supervisor Leadership Scoring

0 Doesn't apply

1 Never

2 Rarely

3 Seldom

4 Usually

5 Always

Supervisors report hazards observed in the workplace.*
Supervisors report incidents that occur in the workplace.*
Supervisors complete training to employees and evaluate the competency for all jobs.*
Supervisors evaluate employees on safe job performance of all jobs.*
Area inspections are completed on a regular basis and produce acceptable scores.*
Supervisors provide safety orientation for all new employees entering the department.*
Supervisors provide department training for all employees entering the department.*
Supervisors report and provide details of all injuries that occur in the department.*
Supervisors investigate all first aid reports.*
Supervisors complete monthly compliance trainings for all employees.*
Supervisors maintain written safe job procedures for all jobs and tasks in the department.*
Supervisors maintain written lockout procedures for all necessary areas in the department.*
Supervisors engage employees in team discussions to identify improvements needed.*
Supervisors maintain required PIT training for all employees.*
Supervisors maintain required lockout training for all employees.*
Are you ready to evaluate administrators on their level of involvement?*

Administrative Engagement Scoring

0 Doesn't apply

1 Never

2 Rarely

3 Seldom

4 Usually

5 Always

Administrators are involved in area inspections.*
Administrators are involved in accident investigations to identify root cause and corrective actions needed.*
Administrators are involved in safety orientations for new employees.*
Administrators support supervisors in holding team discussions for improvement.*
Administrators verify the completion and accuracy of safe job procedures.*
Are you ready to evaluate the current condition of making safety improvements?*

Improvement Driver Scoring

0 Doesn't apply

1 Never

2 Rarely

3 Seldom

4 Usually

5 Always

Root causes are identified for all accidents that occur.*
Needed corrective actions are identified during accident investigations, area inspections, and team discussions.*
Corrective actions are completed accurately and in a timely manner.*
Discussions are held with employees when corrective action projects are completed.*
Employees receive competent scores during job performance evaluations.*
Discussions are held on a regular basis to identify improvements that are needed.*
The Safety Committee is involved in accident investigations to identify root cause and correct actions needed.*
The Safety Committee is responsible to verify that all indicated necessary corrective actions are completed.*
The Safety Committee is responsible to ensure all area inspections are completed in the time frame required.*

Lagging Indicators

Are you ready to identify the current status of lagging indicators?*

Performance Indicator Scoring

1 Low

2

3

4

5 High

Indicate your level of success at decreasing all incidents that occur.*
Indicate your level of success at decreasing all first aid injuries that occur.*
Indicate your level of success at decreasing all injuries that require medical attention.*
Indicate your level of success at decreasing all serious injuries that occur.
Indicate your level of success at decreasing all OSHA Recordables that occur.*
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