𝗦𝗧𝗔𝗙𝗙 𝗦𝗨𝗥𝗩𝗘𝗬 - 𝗪𝗛𝗦 𝗛𝗔𝗭𝗔𝗥𝗗𝗦

This survey is designed to consult with workers about 𝗽𝗵𝘆𝘀𝗶𝗰𝗮𝗹 𝗮𝗻𝗱 𝗽𝘀𝘆𝗰𝗵𝗼𝘀𝗼𝗰𝗶𝗮𝗹 𝗵𝗮𝘇𝗮𝗿𝗱𝘀 they may experience at work, in line with WHS consultation requirements.

The feedback will help to:
- identify hazards
- review existing control measures and assess whether they are adequate, and;
- support continuous improvement

𝗔𝗹𝗹 𝗿𝗲𝘀𝗽𝗼𝗻𝘀𝗲𝘀 𝗮𝗿𝗲 𝗰𝗼𝗻𝗳𝗶𝗱𝗲𝗻𝘁𝗶𝗮𝗹. 𝗣𝗹𝗲𝗮𝘀𝗲 𝗮𝗻𝘀𝘄𝗲𝗿 𝗵𝗼𝗻𝗲𝘀𝘁𝗹𝘆 𝗯𝗮𝘀𝗲𝗱 𝗼𝗻 𝘆𝗼𝘂𝗿 𝗲𝘅𝗽𝗲𝗿𝗶𝗲𝗻𝗰𝗲.

𝘚𝘶𝘳𝘷𝘦𝘺 𝘳𝘦𝘴𝘱𝘰𝘯𝘴𝘦𝘴 𝘸𝘪𝘭𝘭 𝘣𝘦 𝘳𝘦𝘷𝘪𝘦𝘸𝘦𝘥, 𝘥𝘰𝘤𝘶𝘮𝘦𝘯𝘵𝘦𝘥 (𝘢𝘯𝘥 𝘪𝘯𝘤𝘭𝘶𝘥𝘦𝘥 𝘪𝘯 𝘵𝘩𝘦 𝘤𝘭𝘶𝘣'𝘴 𝘳𝘪𝘴𝘬 𝘳𝘦𝘨𝘪𝘴𝘵𝘦𝘳), 𝘢𝘯𝘥 𝘶𝘴𝘦𝘥 𝘵𝘰 𝘵𝘳𝘢𝘤𝘬 𝘢𝘤𝘵𝘪𝘰𝘯𝘴 𝘢𝘯𝘥 𝘤𝘰𝘯𝘵𝘪𝘯𝘶𝘢𝘭 𝘪𝘮𝘱𝘳𝘰𝘷𝘦𝘮𝘦𝘯𝘵.

This field is for validation purposes and should be left unchanged.

SECTION 1: ABOUT YOU

𝟭. 𝗬𝗼𝘂𝗿 𝗪𝗼𝗿𝗸 𝗔𝗿𝗲𝗮 / 𝗗𝗲𝗽𝗮𝗿𝘁𝗺𝗲𝗻𝘁?(Required)
(Choose One)

𝟮. 𝗬𝗼𝘂𝗿 𝗘𝗺𝗽𝗹𝗼𝘆𝗺𝗲𝗻𝘁 𝗧𝘆𝗽𝗲?(Required)
(Choose One)
𝟯. 𝗟𝗲𝗻𝗴𝘁𝗵 𝗼𝗳 𝘁𝗶𝗺𝗲 𝘄𝗼𝗿𝗸𝗶𝗻𝗴 𝗮𝘁 𝘁𝗵𝗲 𝗢𝗿𝗴𝗮𝗻𝗶𝘀𝗮𝘁𝗶𝗼𝗻?(Required)
(Choose One)

SECTION 2: PHYSICAL HAZARDS

𝟭. 𝗔𝗿𝗲 𝘆𝗼𝘂 𝗲𝘅𝗽𝗼𝘀𝗲𝗱 𝘁𝗼 𝗮𝗻𝘆 𝗣𝗛𝗬𝗦𝗜𝗖𝗔𝗟 𝗵𝗮𝘇𝗮𝗿𝗱𝘀 𝗮𝘁 𝘄𝗼𝗿𝗸?(Required)
(Tick all that apply)
(If you answered NONE OF THE ABOVE to the previous question, please enter N/A here before continuing)
(If you answered NONE OF THE ABOVE to Question 1 above, please enter N/A here before continuing)
𝟰. 𝗗𝗼 𝘆𝗼𝘂 𝗯𝗲𝗹𝗶𝗲𝘃𝗲 𝘁𝗵𝗲𝘀𝗲 𝗖𝗢𝗡𝗧𝗥𝗢𝗟 𝗠𝗘𝗔𝗦𝗨𝗥𝗘𝗦 𝗮𝗿𝗲 𝗮𝗱𝗲𝗾𝘂𝗮𝘁𝗲?(Required)
(Choose One)
(If you answered YES to the question above, please enter N/A here before continuing)

SECTION 3: PSYCHOSOCIAL HAZARDS

𝟭. 𝗔𝗿𝗲 𝘆𝗼𝘂 𝗲𝘅𝗽𝗼𝘀𝗲𝗱 𝘁𝗼 𝗮𝗻𝘆 𝗣𝗦𝗬𝗖𝗛𝗢𝗦𝗢𝗖𝗜𝗔𝗟 𝗵𝗮𝘇𝗮𝗿𝗱𝘀 𝗮𝘁 𝘄𝗼𝗿𝗸?(Required)
(Tick all that apply)
(If you answered NONE OF THE ABOVE to the previous question, please enter N/A here before continuing)
(If you answered NONE OF THE ABOVE to Question 1 above, please enter N/A here before continuing)
𝟰. 𝗗𝗼 𝘆𝗼𝘂 𝗯𝗲𝗹𝗶𝗲𝘃𝗲 𝘁𝗵𝗲𝘀𝗲 𝗖𝗢𝗡𝗧𝗥𝗢𝗟 𝗠𝗘𝗔𝗦𝗨𝗥𝗘𝗦 𝗮𝗿𝗲 𝗮𝗱𝗲𝗾𝘂𝗮𝘁𝗲?(Required)
(Choose One)
(If you answered YES to the question above, please enter N/A here before continuing)

SECTION 4: CONSULTATION, REPORTING AND SUPPORT

𝟭. 𝗗𝗼 𝘆𝗼𝘂 𝗳𝗲𝗲𝗹 𝗰𝗼𝗺𝗳𝗼𝗿𝘁𝗮𝗯𝗹𝗲 𝗿𝗮𝗶𝘀𝗶𝗻𝗴 𝗪𝗛𝗦 𝗰𝗼𝗻𝗰𝗲𝗿𝗻𝘀 𝗼𝗿 𝗵𝗮𝘇𝗮𝗿𝗱𝘀 𝘄𝗶𝘁𝗵 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁?(Required)
(Choose One)
𝟮. 𝗗𝗼 𝘆𝗼𝘂 𝗸𝗻𝗼𝘄 𝗵𝗼𝘄 𝘁𝗼 𝗿𝗲𝗽𝗼𝗿𝘁 𝗮 𝗪𝗛𝗦 𝗵𝗮𝘇𝗮𝗿𝗱 𝗼𝗿 𝗶𝗻𝗰𝗶𝗱𝗲𝗻𝘁?(Required)
(Choose One)
𝟯. 𝗛𝗮𝘃𝗲 𝘆𝗼𝘂 𝗿𝗲𝗰𝗲𝗶𝘃𝗲𝗱 𝗮𝗱𝗲𝗾𝘂𝗮𝘁𝗲 𝗪𝗛𝗦 𝘁𝗿𝗮𝗶𝗻𝗶𝗻𝗴 𝗿𝗲𝗹𝗲𝘃𝗮𝗻𝘁 𝘁𝗼 𝘆𝗼𝘂𝗿 𝗿𝗼𝗹𝗲?(Required)
(Choose One)
𝟰. 𝗗𝗼 𝘆𝗼𝘂 𝗳𝗲𝗲𝗹 𝘀𝘂𝗽𝗽𝗼𝗿𝘁𝗲𝗱 𝗯𝘆 𝘁𝗵𝗲 𝗢𝗿𝗴𝗮𝗻𝗶𝘀𝗮𝘁𝗶𝗼𝗻 𝗶𝗻 𝗺𝗮𝗻𝗮𝗴𝗶𝗻𝗴 𝘀𝘁𝗿𝗲𝘀𝘀, 𝗳𝗮𝘁𝗶𝗴𝘂𝗲 𝗮𝗻𝗱 𝘄𝗲𝗹𝗹𝗯𝗲𝗶𝗻𝗴?(Required)
(Choose One)

SECTION 5: OVERALL SAFETY & IMPROVEMENT

𝟭. 𝗢𝘃𝗲𝗿𝗮𝗹𝗹, 𝗵𝗼𝘄 𝘄𝗼𝘂𝗹𝗱 𝘆𝗼𝘂 𝗿𝗮𝘁𝗲 𝘄𝗼𝗿𝗸𝗽𝗹𝗮𝗰𝗲 𝘀𝗮𝗳𝗲𝘁𝘆?(Required)
(Choose One)

SECTION 6: OPTIONAL COMMENTS

(Please enter N/A if not applicable)