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YOUR OPINION ABOUT WORKPLACE SAFETY IS EXTREMELY IMPORTANT! Your responses will be kept strictly confidential; PLEASE DO NOT SIGN OR PUT YOUR NAME ANYWHERE ON THIS FORM. Your completed form will be placed along with all the others, where the results will be reviewed and communicated to management. Please indicate your level of agreement or disagreement with each of the statements below by filling in one circle in each row. Your responses should reflect what you have personally experienced as well as what you have generally observed or believe to be true at your facility. Read each statement carefully; some statements are positively phrased, others are negatively phrased. It is common for employees to take part in identifying and eliminating worksite hazards. There is frequent contact and communication between employees and management. Safety takes a backseat to assigned tasks. Employees often get involved in developing or revising workplace health and safety practices. My supervisor maintains a high standard of job safety performance. Detailed inspections of the facilities are made at regular and frequent intervals. Managements views on the importance of safety are seldom stressed in employee communications. Safety meetings are held less often than they should be. Good team work exists among departments. Management shows that it cares about employee safety. I can protect myself and coworkers through my actions while on the job. My supervisors behavior often goes against safe work procedures. Designated employees are well trained in emergency practices, including evacuation. Management has published written policies that express their attitude about employee safety. Near Miss Incidents are thoroughly investigated. Employee morale is poor. Management does no more than the law requires to keep employees safe. I understand the health and safety legislation relating to my job. My supervisor enforces safe work procedures. Standardized precautions are used by workers who deal with hazardous materials. Management has provided adequate staff to manage and support its safety program. Awards and recognition programs are used in our facility are not good at promoting safe behavior. Job performance standards are higher for getting the job done than for safety. My supervisor understands the job safety problems I face. Workers follow a regular lockout / tag out procedure. Strongly Agree Agree Neutral Disagree Strongly Disagree
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Ventilation, lighting, noise and other environmental conditions are kept at a good level. Many workers dont use the necessary personal protective 46 equipment (PPE) to do their job safely. Job stress is a significant problem for me and my 47 coworkers. Management insists that supervisors will think about safety 48 when doing their jobs. Management annually sets injury rate or other safety goals 49 for which all employees are held accountable. Employees rarely take part in the development of safety 50 requirements for their jobs. 51 How long have you worked with Tarpon Energy Service, or a previous business unit now part of Tarpon Energy Services (Please circle): 0 1 Year 1-5 Years 5 10 years 11 20 years More than 20 years 52 OPTIONAL: What branch / facility do you work within (Please Circle):
Office / Fabrication Shop / Paint Shop / Mod Yard / Field Branch / Site Location
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