Safety Procedure Feedback Form
Employee Information:
Employee Name: [Your Name]
Department/Division: [Your Department]
Date of Feedback: [Date]
Feedback Details:
1. Effectiveness of Safety Procedure:
Please rate the effectiveness of the safety procedure on a scale of 1 to 5, with 1 being highly ineffective and 5 being highly effective.
2. Clarity and Comprehensibility:
Please provide feedback on how clearly and comprehensibly the safety procedure is written. Are the instructions easy to understand?
___________________________________________________________________________
3. Implementation Challenges:
Have you encountered any challenges or difficulties while implementing the safety procedure? If yes, please describe them.
_____________________________________________________________________________
4. Suggestions for Improvement:
Please provide any suggestions or recommendations for improving the safety procedure. Include any specific changes you would like to see.
______________________________________________________________________________
5. Compliance with Safety Standards:
Do you believe the safety procedure complies with industry safety standards and regulations? If not, please specify the areas where improvements are needed.
________________________________________________________________________________
6. Training and Education:
Do you feel adequately trained and educated on the safety procedure? Are there any additional training or resources you believe would be helpful?
___________________________________________________________________________________
7. Reporting Incidents or Near-Misses:
Do you know the procedure for reporting safety incidents or near-miss incidents related to this safety procedure? If not, please specify what information is missing. ____________________________________________________________________________
8. Additional Comments:
Please use this space to provide any additional comments or feedback related to the safety procedure or safety practices within your department.
_____________________________________________________________________________________
Overall Rating of Safety Procedure:
Please provide an overall rating for the safety procedure on a scale of 1 to 5, with 1 being very poor and 5 being excellent.
Thank you for taking the time to provide feedback on our safety procedure. Your input is valuable in ensuring a safe and secure work environment.
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