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Free Workplace Hazard Survey Template

Free Workplace Hazard Survey

Workplace Hazard Survey

Employee Information

Employee Name:
Department:
Role:
Years of Service:

Workplace Environment

Physical Environment Assessment
Lighting:
Brightness Level (Lux):
Adequacy for Tasks:	Yes No
Temperature:
Average Temperature (°F):
Comfort Level:	Satisfactory Unsatisfactory
Noise:
Average Noise Level (dB):
Disruption Level:	High Medium Low
Workstation Ergonomics
Chair Comfort:	Excellent Good Fair Poor
Desk Height:	Appropriate Too High Too Low
Monitor Position:	Comfortable Uncomfortable
Keyboard and Mouse Usage:	Comfortable Uncomfortable

Chemical and Biological Hazards

Chemical Usage:
Types of Chemicals Used:
Frequency of Use:	Daily Weekly Monthly
Safety Equipment Availability:	Yes No
Biological Hazards
Exposure to Biological Materials:	Yes No
Safety Measures in Place:	Yes No

Equipment and Machinery

Machinery Operation
Types of Machinery Used:
Frequency of Use:	Daily Weekly Monthly
Safety Training Received:	Yes No Partial
Maintenance and Safety
Last Maintenance Date:
Reported Issues:
Resolution Status:	Resolved Pending

Health and Safety Practices

Safety Training
Last Safety Training Date:
Training Topics Covered:
Emergency Procedures
Familiarity with Emergency Exits:	Yes No
Participation in Drills:	Yes No

Feedback and Suggestions

Please provide any additional feedback or suggestions regarding workplace safety and hazard mitigation:

Declaration

I hereby confirm that the information provided is accurate to the best of my knowledge.

Employee Signature: ____________________________ Date: _____________

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Explore Workplace Hazard Survey Template at Template.net. Crafted for efficiency, this editable and customizable template streamlines hazard assessment. With our Ai Editor Tool, effortlessly tailor surveys to your workplace needs. Ensure safety with ease, utilizing Template.net's intuitive solutions for hazard management.