Health & Safety Committee Feedback Form
Health & Safety Committee Feedback Form
Your safety matters! We value your insights to enhance our workplace health and safety. Please take a moment to share your feedback with the Health & Safety Committee.
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Name: |
[Your Name] |
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Department: |
[Operations] |
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Position: |
[Job Title] |
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Contact Number: |
[Your Contact Information] |
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Email Address: |
[Your Email] |
I. General Feedback
A. Overall Perception
On a scale of 1 to 5, where 1 is "Not Effective" and 5 is "Highly Effective," please rate your overall perception of the effectiveness of health and safety measures in the workplace.
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5
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4
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3
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2
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1
B. Comments
We appreciate your rating! Please provide detailed comments or suggestions regarding the overall state of health and safety in the workplace:
II. Specific Areas of Concern
A. Emergency Procedures
Please rate the effectiveness of emergency procedures, including evacuation plans and fire drills.
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5
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4
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3
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2
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1
B. Training Programs
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C. Safety Equipment
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III. Incident Reporting
A. Incident/Near-Miss Reporting
Have you encountered or observed any incidents or near-misses recently? If yes, please provide details:
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B. Reporting Process
How would you rate the ease of use and efficiency of the incident reporting process?
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5
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4
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3
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2
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1
IV. Suggestions for Improvement
Please provide any additional comments or suggestions for improving health and safety in the workplace:
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V. Follow-up
A. Action Items
Have you observed any actions taken by the Health & Safety Committee as a result of previous feedback? If yes, please provide details:
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B. Further Assistance
Do you require further assistance or clarification regarding health and safety matters? If yes, please specify:
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