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Sample Questionnaire
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Q1
About you
Role:
Department:
Location:
Gender:
Female
Male
Not Disclosed
Age:
16-24
25-35
36-45
46-55
56+
Industry experience:
0-1 years
01-5 years
06-10 years
10-20 years
20+ years
Q2
Managers give a high priority to safety
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Q3
Senior managers talk to me about safety
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Q4
Managers respond positively when I raise health and safety issues
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Q5
I am supported in my work by my immediate supervisor
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Q6
"Getting the job done quickly" is management's highest priority
Strongly disagree
Disagree
Niether agree nor disagree
Agree
Strongly agree
Q7
The company puts sufficient resources into safety
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Q8
I have responsibilities for the safety of my colleagues
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Q9
Some H&S procedures/instructions/rules are not really practical
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Q10
Some H&S procedures/instructions/rules do not reflect how the job is done
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
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