Questionnaire: Occupational Health and Safety Questionnaire

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Compliance
Do you have a health and safety policy programme?  Yes
 No
 Not Applicable
Do you have an emergency plan?  Yes
 No
 Not Applicable
Do you have the appointed responsible persons for safety (safety officers? safety representatives? machinery supervisors? fire marshals? first aid officers?  Yes
 No
 Not Applicable
Does your business qualify for the appointment of any of these officers?  Yes
 No
 Not Applicable
Is your business registered with the workmen's' compensation authority?  Yes
 No
 Not Applicable
Do you have a copy of your latest letter of good standing with the authority?  Yes
 No
 Not Applicable
If you make use of contract service providers, are they registered with the workmen's' compensation authority?  Yes
 No
 Not Applicable
Are copies of the Occupational Health & Safety Act displayed in the workplace or available on request?  Yes
 No
 Not Applicable
Do your employees receive safety induction training to explain what hazards exist in your company and what your safety procedures are who and where the first aid officer and first aid kit is?  Yes
 No
 Not Applicable
Do you have a first aid officer?  Yes
 No
 Not Applicable
Do you have a first aid kit on site?  Yes
 No
 Not Applicable
If an employee/visitor has an accident/heart attack/asthma attack is there anyone on site that will cope while another person can call for professional assistance?  Yes
 No
 Not Applicable
Has your company been accident / incident free for the last six months?  Yes
 No
 Not Applicable
Is there a policy in place to investigate incidents and accidents?  Yes
 No
 Not Applicable
Physical Safety Measures: Personal Protection Equipment
Are you aware of the hazards in your workplace?  Yes
 No
 Not Applicable
Do you believe that your workplace is safe?  Yes
 No
 Not Applicable
Do you know if your machinery/electrical appliances have been checked in the last seven days?  Yes
 No
 Not Applicable
Do you know who is responsible for checking the safety of your equipment?  Yes
 No
 Not Applicable
Does your company receive reports of hazardous situations?  Yes
 No
 Not Applicable
Can the safety mechanism of any machine or tool on your property be over-ridden or by-passed?  Yes
 No
 Not Applicable
Do your employees have and use the necessary personal protection equipment?  Yes
 No
 Not Applicable
Are your safety control measures being adhered to and implemented?  Yes
 No
 Not Applicable
Are your ladders inspected and safe?  Yes
 No
 Not Applicable
Physical Safety Measures: Lighting
Is the lighting on your premises legally compliant for safety purposes?  Yes
 No
 Not Applicable
Have you checked that all lights are working in the last seven days?  Yes
 No
 Not Applicable
Do you require emergency lighting?  Yes
 No
 Not Applicable
Physical Safety Measures: Buildings
Is the National Tobacco Products Act (smoking law) being complied with?  Yes
 No
 Not Applicable
Are all the emergency exit doors on your premises outward opening? Can they be opened at all times during work hours?  Yes
 No
 Not Applicable
Do you have the required symbolic fire and exit signs in place?  Yes
 No
 Not Applicable
Are the windows and ventilation of your premises adequate?  Yes
 No
 Not Applicable
Is your air conditioning plant healthy?  Yes
 No
 Not Applicable
Do you have adequate and properly maintained fire fighting equipment?  Yes
 No
 Not Applicable
Do you have a fire equipment service register?  Yes
 No
 Not Applicable
Are flammable substances stored on your premises? Are they controlled?  Yes
 No
 Not Applicable
Do contractors on site obtain hot work permits from you?  Yes
 No
 Not Applicable
Do you have vessels under pressure on your property or on any of the neighbouring properties next to your property?  Yes
 No
 Not Applicable
Does your business deposit toxic substances into the storm water drainage system?  Yes
 No
 Not Applicable
Is your storage racking safe?  Yes
 No
 Not Applicable
Electronic Safety
Do you have a close down check procedure that all non-essential equipment is switched off at close of business every day? (Heaters in the workplace)?  Yes
 No
 Not Applicable
Are your power points being overloaded?  Yes
 No
 Not Applicable
Is your distribution board safe and properly marked?  Yes
 No
 Not Applicable
Do you have an electrical certificate of compliance for your premises?  Yes
 No
 Not Applicable
Would your premises be safe if there was power cut and a surge?  Yes
 No
 Not Applicable
Are your appliances plugs, wiring and switches safe?  Yes
 No
 Not Applicable
Do unauthorised persons do any work on your electrical equipment?  Yes
 No
 Not Applicable
Vehicles
Do you operate forklift trucks?  Yes
 No
 Not Applicable
Are your drivers trained and licensed?  Yes
 No
 Not Applicable
Are your vehicles inspected regularly and maintained?  Yes
 No
 Not Applicable
Do you operate other lifting gear? Is it inspected regularly?  Yes
 No
 Not Applicable
Facilities
Are your staff changing room and toilet facilities clean and safe?  Yes
 No
 Not Applicable
Is there hot and cold water?  Yes
 No
 Not Applicable
Are there clean hand drying facilities?  Yes
 No
 Not Applicable
Is there toilet paper available?  Yes
 No
 Not Applicable
Legal
Do you believe you would be free from any penalties in respect of any Occupational Health & Safety and Environmental legislation?  Yes
 No
 Not Applicable

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