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Employee & HR

Workplace Safety Climate and Incident Reporting Survey

Measures how safe employees feel day-to-day, how strong your safety culture and reporting habits actually are, and what stops people from speaking up — with an AI follow-up that reconstructs a real near-miss or incident and what would change how it's handled next time.

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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. We want an honest picture of how safe work feels day-to-day and whether our reporting process actually works — your name is never attached to your answers. About 8 minutes.

Q02
選択式必須

In the last 12 months, how many workplace safety trainings have you completed?

  • None
  • One
  • Two to three
  • Four or more
Q03
オピニオンスケール必須

Overall, how safe do you feel doing your day-to-day tasks at work?

スケール: 1 – 10
最小:Not safe at all最大:Extremely safe
Q04
マトリクス必須

How much do you agree with each statement about safety where you work?

5行 × 5列
  • Safety equipment and PPE are well-maintained and available when I need them.
  • Safety procedures for my role are clear and easy to follow.
  • I feel comfortable raising a safety concern without fear of blame.
  • My supervisor treats safety as a genuine priority, not just a checkbox.
  • I know exactly how to report a safety incident or near-miss.
列: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q05
選択式必須

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

  • Yes, and I reported it
  • Yes, but I did not report it
  • No, not that I'm aware of
Q06
選択式

What, if anything, has stopped you from reporting a safety concern in the past?

  • Didn't think it was serious enough
  • Wasn't sure who to tell or how
  • Worried about blame or repercussions
  • Didn't think anything would change as a result
  • Too busy or forgot
Q07
ベスト・ワースト選択（MaxDiff）必須

Which of these would do the most, and the least, to improve safety in your day-to-day work?

  • Better personal protective equipment (PPE)
  • More frequent safety training
  • Clearer safety signage and labeling
  • Faster response when incidents are reported
  • Additional staffing during high-risk tasks
  • Better lighting and facility maintenance
  • More open communication about past incidents
各セットで最も良いもの・最も悪いものを選択最も良い:Would improve safety the most最も悪い:Would improve safety the least
Q08
AIインタビュー

Reconstruct one specific near-miss or safety incident the respondent experienced or witnessed in the last 6 months: what happened, what they did in the moment, and whether they reported it. If they reported it, ask what happened after — did anything change? If they didn't report it, dig into the real reason (not just the checkbox reason) and ask what would have made them report it. Keep it concrete and behavioral, not hypothetical.

Q09
評価スケール必須

How confident are you that management actually acts on safety concerns once they're reported?

範囲: 1 – 5
最小:Not at all confident最大:Extremely confident
Q10
自由回答（長文）

What's one change that would make you feel safer at work? Be as specific as you'd like.

Q11
選択式

Which area of the business do you work in? (Template note: replace these with your own department list before launching.)

  • Operations
  • Warehouse/Production
  • Office/Administrative
  • Field/Delivery
  • Other
  • Prefer not to say
Q12
選択式

How long have you worked here?

  • 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 shift do you typically work?

  • Day shift
  • Evening shift
  • Night shift
  • Rotating/variable shift
  • Prefer not to say
Q14
メッセージ

Thanks for your honesty — this really helps. Responses are combined into a safety report for leadership, and specifics from the follow-up conversation help us fix real gaps in how incidents get reported and handled.

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 scaled ratings with an AI follow-up interview that reconstructs one specific near-miss or incident and probes what would change how it's handled next time — something static forms can't do
  • Combines quantitative signals (opinion scale on daily safety, a matrix of safety-culture agreement statements, and a MaxDiff to rank what would most improve day-to-day safety) with open-ended long-text on what change would make people feel safer
  • Directly measures reporting barriers with a dedicated question on what's stopped people from reporting, plus a rating on whether management actually acts on concerns — closing the loop from perception to action
  • Segments results by department, tenure, and shift so safety leaders can see where risk and silence are concentrated, then auto-generates a summary report from combined responses

SurveySparrow

Free Workplace Safety Templates That Actually Work

This reads as a roundup/landing page of multiple free workplace safety templates rather than a single fielding-ready survey. SurveySparrow's conversational chat-style UI is a reasonable fit for this topic, but the page is oriented toward browsing templates rather than one deep, ready-to-send instrument.

優れている点

  • Chat-style conversational format that can feel more human than a plain form
  • Multiple free template variants to choose from
  • Likely easy to customize and brand within their builder

物足りない点

  • No adaptive AI follow-up — questions are fixed regardless of what a respondent says
  • No mention of voice AI interviews or automated per-response quality scoring
  • Positioned as a template gallery/guide rather than a single deployable safety-climate instrument

Jotform

Workplace Safety and Concerns Form Template

A straightforward form-builder template for logging safety concerns, which is useful for intake but is structurally a form rather than a survey designed to measure safety climate. It benefits from Jotform's drag-and-drop customization and widget ecosystem, but has no research-style question logic built in.

優れている点

  • Highly customizable fields via drag-and-drop form builder
  • Easy to embed or share for quick concern intake
  • Free tier available for basic use

物足りない点

  • No adaptive AI interviewing or incident reconstruction — just static form fields
  • No automated quality scoring of open-text responses
  • Framed as a concerns/incident form, not a full safety-climate and reporting-culture survey

QuestionPro

Employee Safety Survey Questions + Sample Questionnaire Template

This is primarily a guide-style page with sample survey questions and explanations rather than a one-click deployable template. QuestionPro brings established survey-research credibility and analytics, but the page itself reads as educational content plus a downloadable question set.

優れている点

  • Sample questionnaire draws on established survey-research question types
  • Backed by QuestionPro's broader analytics and dashboard tooling
  • Useful as a reference for building question logic manually

物足りない点

  • No adaptive AI follow-up or incident reconstruction — questions are pre-written and static
  • Page functions as a guide/article with sample questions, not a ready-to-field instrument
  • No mention of voice AI or automated quality scoring of responses

Typeform

Employee Safety Survey Template

A polished one-question-at-a-time conversational survey template, which is the closest product analog to QuestionPunk's interface style. It likely supports branching logic for a smoother respondent experience, but has no AI-driven follow-up or incident reconstruction built in.

優れている点

  • Clean one-question-at-a-time conversational UX
  • Conditional/branching logic to route respondents
  • Easy to theme and share, good completion rates typical of Typeform

物足りない点

  • No adaptive AI interviewer — follow-up questions are pre-set, not generated from the respondent's actual answer
  • No voice AI interview option or automated per-response quality scoring
  • No built-in mechanism to reconstruct a specific near-miss/incident in the respondent's own words

よくあるご質問

「Workplace Safety Climate and Incident Reporting 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. We want an honest picture of how safe work feels day-to-day and whether our rep…」・「In the last 12 months, how many workplace safety trainings have you completed?」・「Overall, how safe do you feel doing your day-to-day tasks at work?」。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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