SAFETY AUDIT ASSESSMENT
Assessment Date: [Date]
I. Personal Information
Please provide the necessary details before proceeding with the audit assessment.
Name:
Position:
Department:
Year of Experience in the Role:
II. Safety Knowledge
This section is designed to assess your knowledge regarding safety protocols, regulations, and standards in the workplace.
Multiple Choice Questions
Select the most suitable answer from the given options:
1. What does PPE stand for?
2. Why should you not run in the workplace?
Short Answer Questions
Provide concise answers for the following questions:
3. What is your understanding of good housekeeping in a safety context?
Answer:
4. What measures should be taken if a fire breaks out in the workplace?
Answer:
III. Safety Practice
This section will assess how effectively safety protocols and procedures are being implemented and executed within your area of responsibility.
Rate the following statements on a scale of 1 to 5, where 1 represents 'Strongly Disagree' and 5 represents 'Strongly Agree'.
IV. Incident Reporting and Management
Please explain procedures you have encountered while handling safety incidents in your workplace. Try to be as detailed as possible while maintaining brevity and clarity.
Incident Reporting procedure experienced:
Incident management steps take:
End of Assessment
Thank you for your participation. The data collected will be used to improve safety standards and protocols in the workplace. Please submit the completed form by _______.
[Sign Here] __________
[Date] __________
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