Assess safety culture, incident reporting, and leadership support across your e-commerce teams. Use this template to spot risks, boost compliance, and act fast.
What's Included
AI-Powered Questions
Intelligent follow-up questions based on responses
Automated Analysis
Real-time sentiment and insight detection
Smart Distribution
Target the right audience automatically
Detailed Reports
Comprehensive insights and recommendations
Sample Survey Items
Q1
Opinion Scale
In the past 30 days, how often did you follow documented safety procedures for your tasks?
Range: 1 – 10
Min: NeverMid: SometimesMax: Always
Q2
Rating
In the past 30 days, how would you rate the availability of required PPE when you needed it?
Scale: 11 (star)
Min: Very poorMax: Excellent
Q3
Multiple Choice
Which factors made PPE use difficult in the past 30 days? Select all that apply.
Not available near the task
Uncomfortable or poor fit
Slows down the work
Unsure which PPE to use
Limited reinforcement from supervisors
Peer norms made PPE use less common
None of the above
Q4
Multiple Choice
Do you know how to report a safety concern or near miss?
Yes
No
Not sure
Q5
Multiple Choice
Which channels did you use to report a safety concern, if any, in the past 90 days? Select all that apply.
Mobile app or online form
Directly to supervisor
Safety hotline
Paper form or log
Team messaging platform
I did not report
Q6
Dropdown
How many near misses did you personally notice in the past 30 days?
0
1
2
3
4
5 or more
Q7
Opinion Scale
In the past 30 days, how comfortable did you feel reporting concerns without fear of negative consequences?
Range: 1 – 10
Min: Not at allMid: NeutralMax: Completely
Q8
Matrix
Based on your experience in the past 30 days, how would you rate the condition of the following?
Rows
Very poor
Poor
Adequate
Good
Excellent
Not applicable
Conveyors
•
•
•
•
•
•
Forklifts or powered carts
•
•
•
•
•
•
Shelving and racking
•
•
•
•
•
•
Dock and loading areas
•
•
•
•
•
•
Pick/pack stations
•
•
•
•
•
•
Delivery vehicles
•
•
•
•
•
•
Q9
Rating
In the past 30 days, how often did production pressure make it harder to work safely?
Scale: 11 (star)
Min: NeverMax: Very often
Q10
Numeric
How many times did you encounter blocked aisles or exits in the past 30 days? Enter 0 if none.
Accepts a numeric value
Whole numbers only
Q11
Matrix
Thinking about the past 60 days, how much do you agree with each statement?
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Leaders put safety before speed or output
•
•
•
•
•
Supervisors act quickly on reported hazards
•
•
•
•
•
Time and resources are provided to work safely
•
•
•
•
•
Safe behaviors are recognized and reinforced
•
•
•
•
•
Safety rules apply equally to everyone
•
•
•
•
•
Q12
Dropdown
In the past 30 days, how often did your team hold safety huddles/toolbox talks?
Never
Once
2 to 3 times
Weekly
More than weekly
Q13
Opinion Scale
When hazards are reported, how often are fixes completed promptly? (past 60 days)
Range: 1 – 10
Min: NeverMid: SometimesMax: Always
Q14
Ranking
Rank the areas where improvements would best reduce injuries in your work area (top = biggest impact).
Drag to order (top = most important)
Training and coaching
PPE availability and fit
Equipment maintenance
Housekeeping and orderliness
Workload and pace management
Reporting and feedback process
Q15
Long Text
Briefly describe one unsafe situation you observed in the past 30 days and what would fix it.
Max 600 chars
Q16
Short Text
If you could change one safety policy or practice, what would it be?
Max 100 chars
Q17
Multiple Choice
Attention check: To confirm you are reading the questions, please select "Neutral" for this item.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Q18
Dropdown
What is your primary job role?
Picker/Packer
Stower/Putaway
Forklift or powered cart operator
Delivery driver
Supervisor/Lead
Safety professional
Maintenance/Facilities
Other
Q19
Dropdown
What shift do you typically work?
Day
Evening
Night
Rotating
Varies
Q20
Dropdown
How long have you been in your current role?
Less than 3 months
3 to 11 months
1 to 3 years
More than 3 years
Q21
Multiple Choice
Are you a people manager (supervise others)?
Yes
No
Q22
Dropdown
What is your employment status?
Full-time
Part-time
Temporary/Seasonal
Contractor
Q23
Dropdown
What type of location do you primarily work at?
Fulfillment center
Sortation center
Delivery station
Office
Multiple locations
Other
Q24
Long Text
Is there anything else you would like to share about safety at work?
Max 600 chars
Q25
AI Interview
AI Interview: 2 Follow-up Questions on Safety Priorities
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Q26
Chat Message
Thank you for completing the survey. Your feedback helps us improve safety for everyone.
Ready to Get Started?
Launch your survey in minutes with this pre-built template