Occ health: Detailed Safety Questionnaire


– Who was injured?
– Who saw the injury?
– Who was working with him/her?
– Who had given the instruction, trained, and assigned the affected employee?
– Who else was involved?
– Who can prevent re-occurence?

– Was the incident?
– Was the injury?
– Was being done at the time of the incident?
– Were they told to do?
– Tools were being used?
– Machinery was being used?
– Operation was being performed?
– Instruction had been given?
– Precautions were given?
– Precautions were necessary?
– PPE was used used or should have been used?
– Did others do to contribute to the incident?
– Problems were encountered?
– Did the employee and others do after the incident?
– Did witnesses see?
– Will be done to prevent re-occurences?
– Safety rules and procedures were violated?
– Safety rules and procedures were lacking?
– Additional training should be included?

– Did the injury or incident occur?
– Did the employee begin the task?
– Was the employee assigned the task?
– Were the hazard or risk pointed out to the employee?
– Did the supervisor last check the employee’s progress?
– Did the employee last notice that something was wrong?
– Was the appropriate training provied?
– Was a risk assessment done?

– Was the employee injured?
– Did the employee behave that way?
– Did the other person behave that way?
– Was PPE not used?
– Were the specific instructions not given to the employee?
– Was the employee in that position / place?
– Was the employee using that machine or tool?
– Did the employee not check with supervisor?
– Did the employee continue working under the circumstances?
– Was the employee allowed to keep on working?
– Wasn’t the supervisor there all of the time?

– Did the injury or incident occur?
– Was the employee at the time of the incident?
– Was the supervisor at the time of the incident?
– Were the co-workers at the time of the incident?
– Were the other persons at the time of the incident?
– Were the witnesses when the incident occurred?
– Else does this or a similar condition exist?

– Was the employee injured?
– Could the injury have been avoided?
– Could co-workers avoid similar injuries?
– Could the supervior have prevented the injury?