Safety And Health Survey Checklist

Safety and Health Program Assessment

Worksheet

I. MANAGEMENT LEADERSHIP

AND EMPLOYEE INVOLVEMENT

A. Clear worksite safety and health policy		There is a S&H policy and all employees accept, can explain, and fully understand it.
		There is a S&H policy and majority of employees can explain it.
		There is a S&H policy and some employees can explain it.
		There is a written (or oral, where appropriate) policy.
		There is no policy.

B. Clear goals and objectives are set and communicated		All employees are involved in developing goals and can explain desired results and how results are measured.
		Majority of employees can explain results and measures for achieving them.
		Some employees can explain results and measures for achieving them.
		There are written (or oral, where appropriate) goals and objectives.
		There are no safety and health goals and objectives.

C-1. Management Leadership		All employees can give examples of management's commitment to safety and health.
		Majority of employees can give examples of management's active commitment to safety and health.
		Some employees can give examples of management's commitment to safety and health.
		There is some evidence that top management is committed to safety and health.
		Safety and health is not a top management value or concern.

C-2. Management example		All employees recognize that management always follows the rules and addresses the safety behavior of others
		Management follows the rules and usually addresses the safety behavior of others.
		Management follows the rules and occasionally addresses the safety behavior of others.
		Management generally follows basic safety and health rules.
		Management does not follow basic safety and health rules.

D. Employee involvement		All employees have ownership of safety and health and can explain their roles.
		Majority of employees feel they have a positive impact on identifying and resolving safety and health issues.
		Some employees feel that they have a positive impact on safety and health.
		Employees generally feel that their safety and health input will be considered by supervisors.
		Employee involvement in safety and health issues is not encouraged nor rewarded.

E. Assigned safety and health responsibilities		All employees can explain what performance is expected of them.
		Majority of employees can explain what performance is expected of them.
		Some employees can explain what performance is expected of them.
		Performance expectations are generally spelled out for all employees.
		Specific job responsibilities and performance expectations are generally unknown or hard to find.

F. Authority and resources for safety and health		All employees believe they have the necessary authority and resources to meet their responsibilities.
		Majority of employees believe they have the necessary authority and resources to meet their responsibilities.
		Authority and resources are spelled out for all, but there is often a reluctance to use them.
		Authority and resources exist, but most are controlled by supervisors.
		All authority and resources come from supervision and are not delegated.

G. Accountability		Personnel are held accountable and all performance is addressed with appropriate consequences.
		Accountability systems are in place, but consequences used tend to be for negative performance only.
		Personnel are generally held accountable, but consequences and rewards do not always follow performance.
		There is some accountability, but it is generally hit or miss.
		There is no effort towards accountability.

H. Program Review (Quality Assurance)		In addition to a comprehensive review, a process is used which drives continuous correction.
		A comprehensive review is conducted at least annually and drives appropriate program modifications.
		A program review is conducted, bit it doesn't drive all necessary program changes.
		Changes in programs are driven by events such as accidents or near misses.
		There is no program review process.

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