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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.

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

Template Overview

27

Questions

AI-Powered

Smart Analysis

Ready-to-Use

Launch in Minutes

This professionally designed survey template helps you gather valuable insights with intelligent question flow and automated analysis.

Sample Survey Items

Q1
Chat Message
Welcome to the Mine Site Safety Culture Survey. This survey takes approximately 5–7 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.
Q2
Multiple Choice
Are you currently working at or regularly visiting a mine site?
  • Yes
  • No
Q3
Opinion Scale
Over the past 30 days, safety was prioritized over production on my crew.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q4
Opinion Scale
Over the past 30 days, my supervisor consistently demonstrated a commitment to safety.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q5
Opinion Scale
Over the past 30 days, my coworkers looked out for each other's safety.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q6
Opinion Scale
Over the past 30 days, safety information and updates were communicated clearly to my crew.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q7
Opinion Scale
Over the past 30 days, I received adequate training to perform my tasks safely.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q8
Multiple Choice
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)
Q9
Dropdown
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)
Q10
Dropdown
How many near-miss events did you personally observe in the past 30 days?
  • 0
  • 1–2
  • 3–5
  • 6–10
  • More than 10
Q11
Multiple Choice
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)
Q12
Dropdown
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
Q13
Multiple Choice
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)
Q14
Ranking
Please rank the following motivations for reporting from most to least important to you.
Drag to order (top = most important)
  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
Q15
Opinion Scale
In the past 30 days, I could report safety issues without fear of blame or punishment.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q16
Opinion Scale
In the past 30 days, I clearly understood what safety issues should be reported and how to report them.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q17
Opinion Scale
In the past 30 days, I received meaningful feedback after submitting a safety report.
Range: 1 7
Min: Strongly disagreeMid: NeutralMax: Strongly agree
Q18
AI Interview
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.
AI InterviewLength: 2Personality: [Object Object]Mode: Fast
Reference questions: 6
Q19
Long Text
Based on your responses in this survey, what would make safety reporting easier or more effective at this site? Please share any additional thoughts.
Max chars
Q20
Dropdown
What is your primary job role on this site?
  • Operator/Production
  • Maintenance/Trades
  • Supervisor/Foreman
  • Safety/Health
  • Engineer/Planner
  • Other
Q21
Dropdown
What is your employment status?
  • Employee
  • Contractor
  • Visitor/Temporary
  • Other
Q22
Dropdown
What shift do you typically work?
  • Day
  • Night
  • Rotating
  • Other
Q23
Dropdown
How long have you worked in mining?
  • Less than 1 year
  • 1–3 years
  • 4–9 years
  • 10–19 years
  • 20 or more years
Q24
Dropdown
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
Q25
Dropdown
What is your primary work environment?
  • Surface
  • Underground
  • Both
  • Other
Q26
Dropdown
Which region do you primarily work in?
  • North America
  • South America
  • Europe
  • Africa
  • Asia
  • Australia/New Zealand
  • Other
Q27
Chat Message
Thank you for completing this survey. Your input is valued and will be used to strengthen safety practices and reporting at this site.

Frequently Asked Questions

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How do AI interviews work?
AI interviews conduct adaptive conversations with respondents. The AI asks follow-up questions based on what the respondent says, probing for clarity and depth. You control the personality, tone, model (Haiku, Sonnet, or Opus), and question mode (fixed count, AI decides when to stop, or time-based).
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