Free Occupational Health and Safety Questionnaire Form Template

Are you struggling to create a comprehensive assessment for workplace safety? This Occupational Health and Safety Questionnaire template is designed for managers, HR professionals, and safety officers to gather vital information about work conditions and employee well-being. Benefit from streamlined data collection, improved compliance with regulations, enhanced employee engagement, and the ability to identify potential hazards quickly, all while ensuring WCAG-aligned labels for accessibility. Try out the live template and start making your workplace safer today.

When to use this form

Use this questionnaire when you onboard new hires, brief contractors, or start higher-risk tasks like confined space entry, hot work, or electrical maintenance. It helps you confirm hazards, controls, and worker readiness before the job, and documents due diligence for audits and insurers. For planned jobs, pair it with a Safety plan form to lock in responsibilities and controls. During drills and seasonal reviews, attach an Emergency evacuation checklist form to verify routes and muster points. After trends emerge, feed results into an Employee safety performance review form to target coaching. Field crews can also use it during morning stand-ups to surface issues early.

Must Ask Occupational Health and Safety Questionnaire Questions

What tasks will you perform today, and what specific hazards are associated with each?
This prompts task-based risk thinking instead of generic answers. It helps you prioritize controls and assign owners before work starts.
What controls (engineering, administrative, and PPE) are in place for those hazards, and are they sufficient?
Asking about control type and adequacy reveals gaps you can fix now. It also reduces vague responses by tying controls to each hazard.
Have you been trained and authorized to perform this work and use the required equipment?
This confirms competence and regulatory compliance, which reduces incident and liability risk. It also flags the need for training or reassignment before the job proceeds.
Do you have any symptoms, medications, or fatigue that could affect safe work today?
This safeguards fitness for duty, enabling reasonable accommodations and safer tasking. Keeping responses confidential builds trust and accuracy.
Did you observe any near misses or unsafe conditions in the last week, and have they been reported?
Near-miss data is a leading indicator that drives preventive action. If follow-up is needed, capture decisions during a Tailboard meeting form to close the loop.

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Question		Response
Full name		John Smith
Work email		[email protected]
Job title or role		This is a test
Primary work location or site		This is a test
What best describes your typical work environment?		Workshop or factory
Which higher-risk activities or hazards are present in your work? Select all that apply.		Lone work or remote fieldwork
How often do you work alone or in remote areas?		Rarely
Are written procedures or SOPs available for your tasks?		Not applicable
I have received adequate safety training for my tasks.		3
I know how to report hazards, near misses, and incidents.		1
Required certifications or licenses for my role are current.		Not applicable
I can access safety data sheets (SDS) and procedures when needed.		4
Which PPE do you use for your work? Select all that apply.		Safety glasses or goggles
Required PPE is available when needed.		2
PPE fits and is comfortable enough to wear correctly.		2
Pre-use inspections are performed before operating tools or equipment.		Often
Machine guards and safety devices are in place and functional.		4
Energy isolation/lockout procedures are followed when required.		2
My workstation or tasks are set up to reduce strain and awkward postures.		4
How often do you feel stressed or fatigued due to your work?		Always
I know the emergency exits and evacuation routes for my location.		3
First aid supplies and eyewash or safety showers are accessible.		4
I feel comfortable reporting safety concerns without fear of negative consequences.		2
Management demonstrates commitment to workplace safety.		4
In the past 12 months, have you had a work-related injury, illness, or near miss?		Yes
Additional comments or suggestions about health and safety		This is a test
Type your full legal name as your signature to confirm the information is accurate		This is a test
Date		2025-10-15T00:00:00.000Z

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Occupational Health and Safety Questionnaire Form Template

Streamline Workplace Assessments with Our Easy-to-Use Template

When to use this form

Must Ask Occupational Health and Safety Questionnaire Questions

More Forms

Unlock hundreds more featuresSave your Form to the DashboardView and Export ResultsUse AI to Create Forms and Analyse Results

Occupational Health and Safety Questionnaire Form Template

Streamline Workplace Assessments with Our Easy-to-Use Template

When to use this form

Must Ask Occupational Health and Safety Questionnaire Questions

More Forms

Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results