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Safety Culture Survey Form Template

Enhance Safety and Trust Within Your Organization

Finding out how your employees feel about safety can be challenging. Our Safety Culture Survey Form Template is designed to help you gauge perceptions, identify issues, and foster a safer work environment. With clear questions tailored for all levels of your organization, you can easily measure safety behaviors, uncover areas for improvement, and engage your team in safety discussions, all while ensuring compliance with WCAG-aligned labels. Explore the live template to get started on enhancing safety today.

Leaders in my organization prioritize safety over operational pressures.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Supervisors act promptly when safety concerns are raised.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
People at all levels lead by example in following safety rules.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I can report safety concerns without fear of blame or negative consequences.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
It is easy to report hazards, near misses, or incidents.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I have the training I need to do my job safely.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Safety procedures for my tasks are clear and up to date.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
The right equipment and PPE are available and in good condition.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
We complete pre-task risk assessments (for example, JSA or LMRA).
Strongly disagree
Disagree
Neither
Agree
Strongly agree
We stop work when conditions are unsafe.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Time pressure does not lead to safety shortcuts in my team.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Safety information is communicated clearly and in a timely manner.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Employees are involved in safety decisions and problem solving.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I can take breaks and manage fatigue during my work.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Staffing and workload levels support safe work.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Overall, how would you rate our safety performance?
Poor
Fair
Good
Very good
Excellent
How satisfied are you with the safety culture here?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
How likely are you to recommend this organization as a safe place to work?
0 Not at all likely
1
2
3
4
5 Extremely likely
Which hazard types are most relevant to your work? (Select all that apply)
Please Specify:
In the past 12 months, have you experienced a work-related injury or near miss?
Yes
No
Department or team
Job role or title
Employment type
Full-time employee
Part-time employee
Contractor
Temporary or casual
Intern or apprentice
Prefer not to say
Other
Please Specify:
Time with the organization
<6 months
6-12 months
1-3 years
3-5 years
5-10 years
10+ years
Prefer not to say
What is one improvement that would most strengthen our safety culture?
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Paper art illustration depicting a safety culture survey form with icons representing safety and teamwork

When to use this form

Use this form to take the pulse of day-to-day safety behaviors across crews, sites, and shifts. It is ideal during quarterly audits, after an incident, or before rolling out new procedures. Supervisors, safety managers, and executives use results to spot blind spots, track trends, and prioritize fixes. Ask frontline teams to complete it alongside routine checks like the Hazard identification checklist form and drills documented in the Fire drill checklist form. In high-turnover operations, send it during onboarding and again at 30/60/90 days to confirm training sticks. The outcome is a clear action list, owners, and timelines so you reduce risk and raise reporting rates.

Must Ask Safety Culture Survey Questions

  1. How confident are you that you can stop work if something feels unsafe?

    This gauges psychological safety and whether stop-work authority is real in practice. If confidence is low, you can coach leaders and adjust workflows to remove pressure to take risks.

  2. When did you last report a near miss, and what happened after?

    You learn whether people report and if follow-up closes the loop. Responses reveal trust in your process and where feedback or recognition is missing.

  3. Do you have the tools, PPE, and time to do the job safely every day?

    This exposes resource gaps that lead to shortcuts or injuries. Use results to budget for equipment, improve scheduling, or update procurement.

  4. Which topics should we cover in upcoming safety briefings or tailgate talks?

    Employees point to the training they actually need, keeping sessions relevant. Feed high-priority topics into your Tailgate safety meeting form to reinforce lessons on the job.

  5. What is the single biggest hazard in your area that we are not addressing?

    This invites plain, actionable risks from those closest to the work. You can tie the issue to an owner, mitigation plan, and due date, then report back.

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