Safety - Employee Survey Sample #7

Surveys Measuring Safety:
Example 1 (5-point scale; numbers; NA)
Example 2 (7-point scale; radio buttons)
Example 3 (4-point scale; radio buttons)
Example 4 (5-point scale; radio buttons)
Example 5 (5-point scale; words)
Example 6 (Pulse Survey)
Example 7 (5-point scale; item comments)
Example 8 (3-point scale; words; N/A)
Example 9 (4-point scale; numbers)
Example 10 (Comment boxes only)
Example 11 (Single rating per dimension)
Example 12 (Slide-bar scale)

Dear Employee:

Welcome to the Employee Survey. We are on a journey to create a workplace that encourages success! A critical component of creating this culture is building a business you recognize as being a great place to work and one that provides you with challenge and recognition. We want to build a thriving and successful business that provides motivation and satisfaction. In order to do so we need to assess how we are doing and understand your thoughts, views and feelings.

We have developed this survey with questions tailored for our staff and business to provide you with an opportunity to anonymously rate many facets of the business. The survey will assess what you value most in your employment and allow you to make positive suggestions for improvement.

The survey is web-based, quick and simple to complete which allows fast reporting and analysis. To ensure your anonymity, the survey is being hosted by an external organization. You will not be required to identify yourself. We want to be very clear that we will not be able to attribute this data to any specific individual and it is not our intention to do so.

Dimensions Included:
Safety, Equipment, Career Development, Supervision, Corporate Culture, Vision, Turnover, Employee Assistance Program, Rewards/Recognition

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

What changes would you like to see in your benefit plans? Please note that some of these may increase premium rates. Please check all that apply.

Add a higher deductible plan ($1,000 - $2,500)
Increase vision care
Increase dental care
Add wellness program (weight loss, nutrition, smoking cessation programs, etc.)
Add a Medical Spending Account (MSA) (allows employees to enroll in a high deductible health plan,

and then [Company] and the employee contribute on a pre-tax basis to an account used for eligible medical expenses)

What changes would you be willing to accept in order to help hold down premium increases? Please check all that apply.

Higher annual deductibles (the amount you pay out-of-pocket before benefits begin)
Higher office visit co pays (the dollar amount you pay for office visits)
Higher prescription drug co pays (the dollar amount you pay for prescription drugs)
More network restrictions (smaller group of doctors and specialists to choose from)
No dental coverage
Other, please specify

How often would you like to participate in after hours company event?

Every other month
Quarterly
Twice a year
Just the Christmas Party
How would you rate your satisfaction with the communication between you and [Company]?

Very Dissatisfied
Dissatisfied
No Opinion
Satisfied
Very Satisfied
What would you change about your current job or position?
Please identify factors that would improve your job performance in the coming year.
When your performance was discussed with you in the past,
how often did you receive practical suggestions for improving your work?

Very Often
Sometimes
Rarely
Never
How would you rate your overall satisfaction with the company in the past year?

Very Dissatisfied
Dissatisfied
No Opinion
Satisfied
Very Satisfied
Please give any comments or suggestions on how the company can be improved in the coming year:

Safety	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
Safety is a primary concern at the Company (Click here to add a comment)
My Supervisor would not ask me to perform an unsafe procedure (Click here to add a comment)
My manager does not compromise on safety (Click here to add a comment)
I know what to do in an emergency situation (Click here to add a comment)
Managers pay attention to workplace safety (Click here to add a comment)
If [Participant Name] were to make improvements in Safety, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?

Equipment	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
All employees in my department conduct pre- and post-trip assessments of the equipment (Click here to add a comment)
Employees in my department know the proper safety protocols (Click here to add a comment)
I regularly perform minor maintenance procedures to prevent major issues from developing (Click here to add a comment)
All employees in my department are aware of the proper safety procedures (Click here to add a comment)
Employees in my department have the appropriate certifications required to operate the equipment (Click here to add a comment)
If [Participant Name] were to make improvements in Equipment, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?

Career Development	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
Job promotions are awarded fairly and without bias (Click here to add a comment)
My supervisor works with me to develop my Individual Development Plan (Click here to add a comment)
My Supervisor has taken an interest in my career development (Click here to add a comment)
There is opportunity for me to advance at the Company (Click here to add a comment)
I have the skills needed to advance my career. (Click here to add a comment)
If [Participant Name] were to make improvements in Career Development, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?

Supervision	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
My supervisor listens to the concerns of employees (Click here to add a comment)
Supervisors determine appropriate staffing levels for the job (Click here to add a comment)
Supervisors in our department are respectful toward employees (Click here to add a comment)
My manager is clear when assigning tasks to be completed (Click here to add a comment)
Staff are accountable for their work and job performance (Click here to add a comment)
If [Participant Name] were to make improvements in Supervision, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?

Corporate Culture	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
The Company culture promotes employees to stay within the organization. (Click here to add a comment)
The culture helps employees work together (Click here to add a comment)
The Company strives hard to provide a good environment for clients and staff. (Click here to add a comment)
The Company new employee orientation includes information about our culture (Click here to add a comment)
The Company is a good community neighbor (Click here to add a comment)
If [Participant Name] were to make improvements in Corporate Culture, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?

Vision	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
The department works to facilitate employees' adoption of the organization vision (Click here to add a comment)
My manager creates a compelling vision inspires employees, giving them a sense of purpose and direction (Click here to add a comment)
My manager stays ahead of the curve and guides the team towards innovative solutions and strategic decisions (Click here to add a comment)
My manager pinpoints challenges and devises strategies (Click here to add a comment)
I know how to provides the vision needed to help the organization remain competitive and adaptable in a dynamic market (Click here to add a comment)
If [Participant Name] were to make improvements in Vision, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?

Turnover	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I would describe my department as toxic (Click here to add a comment)
My current work environment is hostile (Click here to add a comment)
I have reached the maximum position within my career (Click here to add a comment)
The recent terminations in our department were from a reduction in force (Click here to add a comment)
I plan to be working at the Company forever (Click here to add a comment)
If [Participant Name] were to make improvements in Turnover, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?

Employee Assistance Program	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I am satisfied with the confidentiality of information that I provide to the EAP practitioners. (Click here to add a comment)
The EAP used provides confidential counseling services to both the employee and family members. (Click here to add a comment)
The EAP process includes opportunities for me to provide feedback to help improve the process. (Click here to add a comment)
I am able to reach someone quickly when I have questions or need to use the service. (Click here to add a comment)
The Employee Assistance Program meets my needs. (Click here to add a comment)
If [Participant Name] were to make improvements in Employee Assistance Program, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?

Rewards/Recognition	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree	Not Applicable
I am made to feel that I am an important part of the Company (Click here to add a comment)
My Supervisor praises me for a job well done (Click here to add a comment)
My supervisor values and appreciates my contributions. (Click here to add a comment)
I am recognized whenever I do a good job (Click here to add a comment)
Performance incentives are clearly linked to standards and goals (Click here to add a comment)
If [Participant Name] were to make improvements in Rewards/Recognition, which item do you think should be emphasized most over the next two years in order to make us a more effective organization.
Type the number here:
What are your suggestions for how we can improve this?