すべてのテンプレート
Industry-Specific

Mine Site Safety Culture & Incident Reporting Assessment

Measures safety climate perceptions, incident/near-miss reporting behaviors, and barriers to reporting among mine-site personnel. Designed to identify risk gaps and prioritize safety-culture interventions across shifts, roles, and work environments.

設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全27問・約12分
Q01
メッセージ

Welcome to the Mine Site Safety Culture Survey. This survey takes approximately 12 minutes. Your responses are confidential, anonymized, and reported only in aggregate to improve safety practices at this site. There are no right or wrong answers—we want your honest experience from the past 30 days. Participation is voluntary, and you may stop at any time. Please tap 'Next' to begin.

Q02
選択式

Are you currently working at or regularly visiting a mine site?

  • Yes
  • No
Q03
オピニオンスケール

Over the past 30 days, safety was prioritized over production on my crew.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q04
選択式

How do you usually report hazards, near misses, or incidents on this site? Select all that apply.

  • Tell supervisor in person
  • Paper or card
  • Radio/phone call
  • Mobile app
  • Computer kiosk/terminal
  • Safety hotline
  • Toolbox talk/team meeting
  • Other (please specify)
Q05
選択式

What, if anything, makes reporting harder on your site? Select all that apply.

  • Unclear what should be reported
  • Takes too much time to complete
  • Fear of blame or negative consequences
  • Little or no feedback after reporting
  • Reporting system is difficult to use
  • Belief that minor issues don't matter
  • Lack of supervisor support
  • Language or communication barriers
  • None—I don't experience barriers
  • Other (please specify)
Q06
オピニオンスケール

In the past 30 days, I could report safety issues without fear of blame or punishment.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q07
AIインタビュー

We'd like to learn a bit more about your safety reporting experience. An AI moderator will ask you 1–2 brief follow-up questions based on your responses.

Q08
プルダウン

What is your primary job role on this site?

  • Operator/Production
  • Maintenance/Trades
  • Supervisor/Foreman
  • Safety/Health
  • Engineer/Planner
  • Other
Q09
メッセージ

Thank you for completing this survey. Your input is valued and will be used to strengthen safety practices and reporting at this site.

Q10
オピニオンスケール

Over the past 30 days, my supervisor consistently demonstrated a commitment to safety.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q11
プルダウン

When a hazard or near miss occurs, how often do you personally report it? (past 30 days)

  • Every time
  • Most times
  • About half the time
  • Occasionally
  • Never
  • Not applicable (no issues observed)
Q12
ランク付け

Please rank the following motivations for reporting from most to least important to you.

  1. Protect coworkers and myself
  2. Fix hazards quickly
  3. Company expects it
  4. Regulatory compliance
  5. Recognition for reporting
  6. Option to report anonymously
ドラッグして順位を付ける
Q13
オピニオンスケール

In the past 30 days, I clearly understood what safety issues should be reported and how to report them.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q14
自由回答(長文)

Based on your responses in this survey, what would make safety reporting easier or more effective at this site? Please share any additional thoughts.

Q15
プルダウン

What is your employment status?

  • Employee
  • Contractor
  • Visitor/Temporary
  • Other
Q16
オピニオンスケール

Over the past 30 days, my coworkers looked out for each other's safety.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q17
プルダウン

How many near-miss events did you personally observe in the past 30 days?

  • 0
  • 1–2
  • 3–5
  • 6–10
  • More than 10
Q18
オピニオンスケール

In the past 30 days, I received meaningful feedback after submitting a safety report.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q19
プルダウン

What shift do you typically work?

  • Day
  • Night
  • Rotating
  • Other
Q20
オピニオンスケール

Over the past 30 days, safety information and updates were communicated clearly to my crew.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q21
選択式

Which of the following have you reported in the past 30 days? Select all that apply.

  • Near miss
  • Minor injury (first aid)
  • Recordable injury
  • Unsafe condition/housekeeping
  • Equipment damage/failure
  • Environmental spill/release
  • Vehicle incident
  • None of the above
  • Other (please specify)
Q22
プルダウン

How long have you worked in mining?

  • Less than 1 year
  • 1–3 years
  • 4–9 years
  • 10–19 years
  • 20 or more years
Q23
オピニオンスケール

Over the past 30 days, I received adequate training to perform my tasks safely.

スケール: 1 – 7
最小:Strongly disagree最大:Strongly agree
Q24
プルダウン

On average, how many minutes does it take you to complete a typical safety report?

  • Less than 5 minutes
  • 5–10 minutes
  • 11–20 minutes
  • 21–30 minutes
  • More than 30 minutes
  • I have not filed a report
Q25
プルダウン

How long have you worked at this specific site?

  • Less than 1 month
  • 1–6 months
  • 7–12 months
  • 1–3 years
  • More than 3 years
Q26
プルダウン

What is your primary work environment?

  • Surface
  • Underground
  • Both
  • Other
Q27
プルダウン

Which region do you primarily work in?

  • North America
  • South America
  • Europe
  • Africa
  • Asia
  • Australia/New Zealand
  • Other

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

よくあるご質問

「Mine Site Safety Culture & Incident Reporting Assessment」テンプレートにはどのような設問が含まれていますか?

すぐに使える設問が27問含まれており、最初の設問は次のとおりです:「Welcome to the Mine Site Safety Culture Survey. This survey takes approximately 12 minutes. Your responses are confident…」・「Are you currently working at or regularly visiting a mine site?」・「Over the past 30 days, safety was prioritized over production on my crew.」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか?

回答者は通常、27問を約12分で回答し終えます。

テンプレートは編集できますか?

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか?

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか?

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

関連テンプレート

似たテーマのほかの調査もご覧ください。

すべて見る