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無料で始める
すべてのテンプレート
Employee & HR

Workplace Health & Safety Culture Survey

Measures how employees experience hazard awareness, incident reporting, and safety training in practice — not just policy on paper. An AI follow-up interview reconstructs what actually happened the last time someone saw or reported a safety issue, including any fear of retaliation, giving safety teams a real picture behind the scores.

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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14問・約7分
Q01
メッセージ

Thanks for taking a few minutes on this one — it's about your day-to-day experience with safety at work, not a compliance quiz. Honest answers help us fix real gaps. About 8 minutes.

Q02
選択式必須

In the last 30 days, how often have you noticed a safety hazard (spill, blocked exit, damaged equipment, exposed wiring, etc.) at your workplace?

  • Never
  • Once
  • A few times
  • Weekly or more
  • I'm not sure
Q03
オピニオンスケール必須

How comfortable do you feel reporting a safety concern without worrying about negative consequences for yourself?

スケール: 1 – 5
最小:Not comfortable at all最大:Extremely comfortable
Q04
マトリクス必須

How much do you agree with each statement about safety at your workplace?

4行 × 5列
  • My manager treats safety as a top priority
  • I know how to report a hazard or unsafe condition
  • The safety training I've received prepares me for my actual job tasks
  • I feel free to stop work if something seems unsafe, without pushback
列: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q05
選択式必須

In the last 6 months, have you witnessed or personally experienced a safety incident or near-miss at work?

  • Yes
  • No
  • Not sure
Q06
選択式

If you witnessed or experienced that incident, did you report it?

  • Yes, I reported it
  • No, I did not report it
  • I wasn't sure how or who to report it to
  • Not applicable — I haven't witnessed one
Q07
ベスト・ワースト選択（MaxDiff）必須

Which of these safety improvements matter most to you?

  • Additional or better-fitting personal protective equipment
  • More frequent hands-on safety training
  • Clearer hazard signage and labeling
  • Faster follow-up after incidents are reported
  • Regular equipment and machinery maintenance checks
  • Ergonomic workstation improvements
  • Mental health and stress-related safety support
  • More frequent emergency evacuation drills
各セットで最も良いもの・最も悪いものを選択最も良い:Matters most to me最も悪い:Matters least to me
Q08
評価スケール必須

How satisfied are you with the safety training you've received?

範囲: 1 – 5
最小:Not satisfied at all最大:Extremely satisfied
Q09
AIインタビュー

Explore what actually happened the last time this person witnessed or experienced a safety incident or near-miss: what it was, who they told (or didn't), how it was handled, and whether fear of retaliation played any role. If they said they'd feel uncomfortable reporting a concern, probe exactly what would need to change for that to feel safe. If they haven't witnessed an incident, ask what would make them confident enough to speak up if they did.

Q10
自由回答（長文）

Is there anything specific about safety at your workplace you'd like leadership to know that these questions didn't cover?

Q11
選択式

Which best describes your role type?

  • Frontline/production
  • Office/administrative
  • Field or mobile work site
  • Supervisory/management
  • Other
  • Prefer not to say
Q12
選択式

How long have you worked at this organization?

  • Less than 6 months
  • 6 months to 2 years
  • 2 to 5 years
  • More than 5 years
  • Prefer not to say
Q13
選択式

What is your primary work setting?

  • On-site/in-person
  • Remote
  • Hybrid
  • Field/mobile
  • Prefer not to say
Q14
メッセージ

Thank you for being honest with us. Your responses will be reviewed by the safety and HR team (anonymously, in aggregate) to prioritize real fixes — not just paperwork.

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。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Goes beyond static agree/disagree questions with an AI follow-up interview that reconstructs what actually happened the last time someone witnessed or reported a hazard, including any fear of retaliation.
  • Pairs quantitative measures (hazard-noticing frequency, training satisfaction rating, agreement matrix, max-diff on improvement priorities) with open-ended and conversational follow-up to surface the story behind the scores.
  • Directly asks whether an incident was reported and, if not, lets the AI interview probe why — giving safety teams visibility into underreporting instead of just top-line satisfaction numbers.
  • Closes with a transparent chat message telling respondents their answers will be reviewed by the safety team, supporting honest reporting on a sensitive topic.

Jotform

Workplace Health Safety Survey Form Template

A fielding-ready static form covering standard workplace safety topics, built on Jotform's drag-and-drop form builder. It's designed for quick deployment and easy customization rather than deep qualitative exploration. No mechanism to follow up on individual incidents or probe the context behind a low score.

優れている点

  • Fast to deploy and customize using a familiar drag-and-drop form builder
  • Broad template library ecosystem for related HR/compliance forms
  • Likely supports standard question types and basic conditional logic

物足りない点

  • Static question set with no adaptive follow-up to reconstruct what happened during a specific incident
  • No AI-driven or voice interview option to explore retaliation fears or reporting hesitancy
  • No published methodology on how questions were validated or scored

QuestionPro

Workplace Health and Safety Questionnaire

A structured questionnaire template covering hazard awareness, training, and incident-related topics, offered within QuestionPro's broader survey platform. It's a conventional fielding-ready template with standard analytics rather than conversational follow-up. Useful for benchmarking scores but not for surfacing the narrative behind a reported (or unreported) incident.

優れている点

  • Established survey platform with standard reporting and dashboard analytics
  • Template covers core H&S themes like hazard awareness and training
  • Supports typical question branching and segmentation by role or tenure

物足りない点

  • No adaptive AI interview to dig into the specifics of a witnessed or reported incident
  • No voice-based interview option for respondents who prefer speaking over typing
  • Automated per-response quality scoring and transparent AI prompts are not part of the offering

よくあるご質問

「Workplace Health & Safety Culture Survey」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14問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes on this one — it's about your day-to-day experience with safety at work, not a complianc…」・「In the last 30 days, how often have you noticed a safety hazard (spill, blocked exit, damaged equipment, exposed wiring,…」・「How comfortable do you feel reporting a safety concern without worrying about negative consequences for yourself?」。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、14問を約7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。

このテンプレートを使う無料で始める

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