HSE QUESTIONNAIRE

Document Number: HSE-DAM011

Document Type: HSE System/Subsystem: Revised Date: 15/09/16

HEALTH SAFETY & ENVIROMENT QUESTIONNAIRE

Department

: _________________________________________

Year of the experience with company

: ________________________________________

Gender

: _________________________________________

Age

: _________________________________________

The purpose Damagix designed this questionnaire is to obtain your views and opinions about Health
Safety and Environment matters concerning you, your workplace, colleagues and Top Management.
Please ring the response that you think is most appropriate to each statement by ticking. If you wish to
make any comments in addition to these ratings, please do so on the back page.
Statement

Strongly
Agree

Agree

No Strong
Feelings

Disagree

Strongly
Disagree

Management provides required PPE in a

timely manner

Meetings, trainings, quiz and games carried

out in Damagix actually promotes positive
culture towards HSE.

HSE policies and objectives

understood by employees

Responsiveness of the management on

HSE matter is usually timely and effective.

Employees have received

emergency response training

appropriate

Management encourages the no blame

culture

Employees have the right tools and

resources needed to do their job safely.

Management recognizes road safety as a

hazardous activity

Management encourages employees to

participate in HSE briefs and trainings.

10

Unsafe acts are reported to punish the

employee who is responsible for the act

11

Employees are exposed to various risk and

hazard in Damagix

12

Employees have the proper training

required to do their job in a healthy and
safety manner.

are

well

HSE QUESTIONNAIRE

Document Number: HSE-DAM011

Document Type: HSE System/Subsystem: Revised Date: 15/09/16

HEALTH SAFETY & ENVIROMENT QUESTIONNAIRE

13

Improvement programs are supported by

sufficient resources

14

awareness and competency procedure has

been developed

15

Management allows opportunities for asking

questions during HSE meetings and
trainings.

16

Management has an effective HSE lecture

delivery.

17

Management has good relationship with

new employees on HSE matters.

18

The use of personal protective equipment is

fully implemented

19

Management monitors implementation of

HSE policies via your departmental head

20

Damagix HSE Officers are approachable

and friendly.

21

Management is
employees level.

22

Provides useful handouts of notes.

23

HSE Policies, Objectives, Briefs & Trainings

are clear and comprehensible.

24

Management is enthusiastic about HSE

matters.

25

Employee whose work may impact the

environment have been Identified

26

whose work may impact have been trained

on consequences of deviating from
procedure

27

Employee have full awareness and

understanding of policies, objectives and
improvement programs

28

HSE committee communicates results of

audits and HSE management review to
employees adequately

29

Damagix has clear documented references

related HSE manual, procedures, work
instructions, etc.

30

HSE
manual
has
been
reviewed,
understood
and
communicated
to

able

to

train

at

the

HSE QUESTIONNAIRE

Document Number: HSE-DAM011

Document Type: HSE System/Subsystem: Revised Date: 15/09/16

HEALTH SAFETY & ENVIROMENT QUESTIONNAIRE

employees (awareness training)

31

There is evidence to suggest that

equipment/procedures (or lack thereof) in
the work environment is not suitable to
achieve the defined targets and objectives

32

Damagix has an emergency drill schedule

33

Damagix takes issues of Nonconformance,

Corrective and Preventive Action serious

34

Damagix has a good system for mitigation

on non-conformance

35

there is evidence of lack of understanding or

commitment on the part
of departmental head and subordinates
regarding corrective or preventive action

36

Corrective or preventive actions

implemented are adequate to resolve the
incident and prevent re-occurrence.

37

Damagix HSE audit gathers objective

evidence to draw conclusions

38

Damagix HSE audit interprets policies and

procedures and determine conformance
with the standard

39

Damagix HSE audit checks for corrective

action status including any Incident Reviews

40

Corrective actions are timely, recorded, and

evaluated for effectiveness

Reviewed by:

Senior Auditors Name:

Date:

Signature: