Mining Safety Culture & Incident Reporting Survey

Evaluate mine site safety culture and incident/near-miss reporting with a ready-to-use template. Engage crews, spot risk gaps, boost compliance, cut accidents.

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

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

Matrix

Please indicate how much you agree with each statement (past 30 days).

Rows	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I felt comfortable speaking up about hazards.	•	•	•	•	•
My team stops work when conditions feel unsafe.	•	•	•	•	•
Supervisors address reported safety issues promptly.	•	•	•	•	•
Safety rules were not overridden by production pressure.	•	•	•	•	•
Safety rules were enforced consistently.	•	•	•	•	•
I received useful feedback after raising a concern.	•	•	•	•	•

Rating

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

Scale: 11 (star)

Min: Strongly disagreeMax: Strongly agree

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

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)

Numeric

How many near-miss events did you personally observe in the past 30 days? Enter 0 if none.

Accepts a numeric value

Whole numbers only

Numeric

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

Accepts a numeric value

Whole numbers only

Multiple Choice

Which of the following have you reported in the past 90 days? Select all that apply.

Near miss
Minor injury (first aid)
Recordable injury
Unsafe condition/housekeeping
Equipment damage/failure
Environmental spill/release
Vehicle incident

Multiple Choice

What 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

Ranking

Please rank what most motivates you to report, from most to least motivating.

Drag to order (top = most important)

Protect coworkers and myself
Fix hazards quickly
Company expects it
Regulatory compliance
Recognition for reporting
Option to report anonymously

Q10

Opinion Scale

In the past 90 days, I could report issues without fear of blame or punishment.

Range: 1 – 10

Min: Strongly disagreeMid: NeutralMax: Strongly agree

Q11

Opinion Scale

I clearly know what should be reported and how to do it (past 30 days).

Range: 1 – 10

Min: Strongly disagreeMid: NeutralMax: Strongly agree

Q12

Opinion Scale

Attention check: To confirm you are paying attention, please select "Agree" for this item.

Range: 1 – 10

Min: Strongly disagreeMid: NeutralMax: Strongly agree

Q13

Dropdown

What is your primary job role on this site?

Operator/Production
Maintenance/Trades
Supervisor/Foreman
Safety/Health
Engineer/Planner
Contractor
Other

Q14

Dropdown

What is your employment status?

Employee
Contractor
Visitor/Temporary
Other

Q15

Dropdown

What shift do you typically work?

Day
Night
Rotating
Other

Q16

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

Q17

Dropdown

How long have you worked at this site?

Less than 1 month
1–6 months
7–12 months
1–3 years
More than 3 years

Q18

Dropdown

What is your primary work environment?

Surface
Underground
Both
Other

Q19

Dropdown

Which region do you primarily work in?

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

Q20

Long Text

What would make reporting easier or faster at this site? Be specific if possible.

Max 600 chars

Q21

Chat Message

Welcome! This short survey takes about 5–7 minutes. Please answer based on your recent experience (past 30–90 days). Your responses are confidential and used to improve safety.

Q22

AI Interview

AI Interview: 2 Follow-up Questions on Site Safety Reporting

AI InterviewLength: 2Personality: [Object Object]Mode: Fast

Q23

Chat Message

Thank you for completing the survey. Your input helps strengthen safety and reporting on site.

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Safety