Q01
Message
All templatesOperations & Data
Warehouse Cobot Safety & Risk Perception Survey
Measures warehouse workers' safety perceptions, incident exposure, training adequacy, and improvement priorities related to collaborative robots. Designed for operations and safety teams managing human-cobot work environments.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
25 questions · ~11 min
Q02
Multiple Choice
Which best describes collaborative robot (cobot) use at your facility today?
- No cobots in this facility
- Piloting or limited trial only
- Used in several areas
- Used across most areas
Q03
Opinion Scale
In the past 30 days, how safe have you felt working near cobots?
Scale: 1 – 7
Min:Very unsafeMax:Very safe
Q04
Multiple Choice
In the last 6 months, have you personally experienced or directly witnessed any safety incident involving a cobot?
- No incidents
- Near miss (no contact)
- Minor contact, no injury
- Injury requiring first aid
- Injury requiring medical attention
- Prefer not to say
- Not applicable
Q05
Multiple Choice
In the last 12 months, which cobot safety training have you received? Select all that apply.
- Intro safety briefing
- Hands-on operation with a supervisor
- Refresher/update session
- Emergency stop and lockout drills
- Digital or e-learning module
- None
- Not sure
Q06
Ranking
Please rank your top 3 priorities for improving safety around cobots.
- More hands-on training time
- Slower speeds in shared zones
- Clearer floor markings and signage
- More predictable cobot routes
- Faster emergency stop response
- Better handover prompts and timing
- Improved visibility at corners
Drag to rank
Q07
AI Interview
We'd like to understand your cobot safety experience in more depth. An AI moderator will ask a few short follow-up questions based on your earlier responses.
Q08
Long Text
Based on your responses throughout this survey, please share any additional thoughts or suggestions about working safely with cobots.
Q09
Multiple Choice
What is your primary role?
- Picker/Packer
- Material handler/Forklift
- Technician/Maintenance
- Team lead/Supervisor
- Quality/Safety
- Other
- Prefer not to say
Q10
Message
Thank you for completing the survey! Your feedback will be used to improve cobot safety practices and training at your facility. All responses are anonymous and reported in aggregate.
Q11
Dropdown
In a typical week, how often do you work near a cobot?
- Never
- Less than weekly
- 1–2 days per week
- 3–5 days per week
- Daily (most shifts)
- Continuously during shifts
Q12
Opinion Scale
How confident are you that current safety procedures adequately protect you when working near cobots?
Scale: 1 – 7
Min:Not at all confidentMax:Extremely confident
Q13
Multiple Choice
If you experienced or witnessed an incident, how was it handled?
- Formally reported through the safety system
- Addressed informally on the floor
- Not reported
- No incident occurred
Q14
Multiple Choice
How well does current cobot-related training meet your needs?
- Fully meets my needs
- Mostly meets my needs
- Partly meets my needs
- Does not meet my needs
- No training received
Q15
Multiple Choice
What minimum distance would you prefer between you and a moving cobot in shared aisles?
- Less than 1 meter
- 1–2 meters
- 2–3 meters
- More than 3 meters
- No preference
Q16
Dropdown
How long have you worked at this site?
- Less than 3 months
- 3–11 months
- 1–2 years
- 3–5 years
- More than 5 years
- Prefer not to say
Q17
Multiple Choice
Which tasks do cobots assist with in your area? Select all that apply.
- Picking or put-wall
- Packing or kitting
- Palletizing/depalletizing
- Mobile transport (AMRs/tuggers)
- Sortation
- Quality or safety checks
- Replenishment
- None of these
Q18
Opinion Scale
How concerned are you about a cobot making an unexpected movement near you?
Scale: 1 – 7
Min:Not at all concernedMax:Extremely concerned
Q19
Multiple Choice
Which safety features are currently active in your work area? Select all that apply.
- Speed/force limiting
- Accessible emergency stop buttons
- Visual beacons or floor lights
- Audible alerts
- Virtual fences or safe zones (no hard guarding)
- Remote pause/stop capability
- Interlocked guarding
- Not sure
Q20
Multiple Choice
Which shift do you mainly work?
- Day
- Evening
- Night
- Rotating/Varies
- Prefer not to say
Q21
Opinion Scale
How concerned are you about limited visibility at corners or intersections where cobots operate?
Scale: 1 – 7
Min:Not at all concernedMax:Extremely concerned
Q22
Dropdown
What is your age?
- Under 18
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65 or older
- Prefer not to say
Q23
Opinion Scale
How concerned are you about a cobot's speed when it is moving through a shared zone?
Scale: 1 – 7
Min:Not at all concernedMax:Extremely concerned
Q24
Dropdown
In which region is your primary work site located?
- North America
- South America
- Europe
- Middle East
- Africa
- Asia
- Oceania
- Prefer not to say
Q25
Opinion Scale
How concerned are you about timing and coordination during task handovers with a cobot?
Scale: 1 – 7
Min:Not at all concernedMax:Extremely concerned
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Includes cobot-specific exposure and concern items (unexpected movement, visibility at intersections, speed in shared zones, handover timing) rather than generic workplace safety questions
- Combines quantitative opinion-scale tracking of safety perception and confidence with an AI follow-up interview to probe the reasoning behind low scores or reported incidents
- Captures training adequacy, active safety features, and incident handling in the same flow so operations and safety teams can connect perception data to concrete program gaps
- Ends with a ranked prioritization question and open-text reflection, giving safety teams both a quantifiable priority list and qualitative context for action planning
Jotform
Workplace Safety and Concerns Form TemplateA general-purpose workplace safety and concerns form built on Jotform's drag-and-drop form builder. It's designed for broad workplace hazard reporting rather than cobot- or robotics-specific risk perception, so it would need significant customization to capture human-robot interaction dynamics. Useful as a generic incident/concern intake form, not a purpose-built safety perception survey.
What it does well
- Easy to customize with Jotform's widely-used drag-and-drop builder
- Likely supports file/photo uploads common to incident reporting forms
- Broad applicability across many workplace types, not tied to one industry
Where it falls short
- No cobot-specific content (proximity, speed, handover, visibility) out of the box
- Static question set with no adaptive AI follow-up to probe unsafe experiences further
- No published methodology for how questions were validated for safety-perception research
QuestionPro
Workplace Health and Safety QuestionnaireA general workplace health and safety questionnaire covering standard hazard, compliance, and wellbeing topics. It's a solid generic starting point for EHS teams but is not tailored to collaborative robot exposure, incident specifics, or robot-related training gaps. Best suited as a broad safety climate check rather than a cobot risk-perception tool.
What it does well
- Established survey platform with standard reporting/dashboard features
- Covers general health and safety compliance topics likely relevant to many industries
- Template-based approach speeds up initial survey setup
Where it falls short
- No cobot- or robotics-specific items (speed, shared zones, handovers) evident in the template
- Fixed-form format without adaptive follow-up interviews to explore individual incident narratives
- No transparent prompt/methodology disclosure for how questions probe safety perception
SurveySparrow
Free Workplace Safety Templates That Actually WorkThis page reads as a blog-style roundup of workplace safety templates rather than a single fielding-ready survey, so it functions more as a guide/gallery than a deployable instrument. Content likely spans generic workplace hazard and concern topics without cobot-specific detail. Teams would need to pick and heavily adapt a template rather than use it as-is for cobot risk assessment.
What it does well
- Conversational survey format may improve completion rates for frontline workers
- Offers multiple template options rather than a single rigid form
- Positioned as easy to launch quickly for general safety feedback
Where it falls short
- Presented as a general guide/collection, not a ready-made cobot safety instrument
- No cobot-specific risk items (proximity distance, handover timing, unexpected movement)
- No adaptive AI interview or automated per-response quality scoring to deepen incident understanding
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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