Safety Culture Assessment Form

Date(Required)

Name(Required)

First Name Last Name

Email(Required)

example@example.com

Phone Number(Required)

Please enter a valid phone number.

Number of Employees(Required)

What's Your Emod Score?

Tick N/A below if unkown

Emod Score is unknown

Safety Culture Assessment

Using a scale from 0 (No/Never) to 10 (Always) score the following statements that indicate your perception of the company’s safety culture.

1. Supervisors are engaged in your Safety Culture.(Required)

Please enter a number from 1 to 10.

2. Employees are engaged in your Safety Culture.(Required)

Please enter a number from 1 to 10.

3. Safety activities or goals are established for each location.(Required)

Please enter a number from 1 to 10.

4. Employees are given the tools, training and resources to achieve their activities or goals.(Required)

Please enter a number from 1 to 10.

5. When goals or activities are met, the effort is recognized.(Required)

Please enter a number from 1 to 10.

6. Employee safety activities are measured.(Required)

Please enter a number from 1 to 10.

7. Supervisor safety activities are measured.(Required)

Please enter a number from 1 to 10.

8. Employees can identify at-risk behaviors and unsafe conditions.(Required)

Please enter a number from 1 to 10.

9. Employees understand the personal benefits of reducing incidents.(Required)

Please enter a number from 1 to 10.

10. Employees understand the impact incidents have on production, quality, schedule, and resources.(Required)

Please enter a number from 1 to 10.

Here's your culture rating: Scores of 6 or below suggest a critical need for an in-depth evaluation and proactive steps towards improvement. It's a call to action for implementing comprehensive strategies and actionable steps to improve your organization's safety culture. Our RMA team would welcome the opportunity to discuss our SRS (Safety Risk Score) with you and how it will set a path for continuous improvement and an engaging safety culture. Please contact us.

Your Result