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300-AQ0-01-IGDO © 2019, Workplace Safety & Prevention Services (WSPS)
1 877 494 WSPS (9777) | 905 614 1400 | www.wsps.ca
This survey may be used to ask workers and management about their perception of their safety in the workplace. It
can also be used as part of Step 1 in Developing Workplace Violence and Harassment Policies and Programs: What
Employers Need to Know.
Workplaces are not required to use this survey, or any survey, in order to comply with the Occupational
Health and Safety Act.
Before distributing this survey, add an introduction that outlines the purpose of the survey, how the results of the
survey will be reported, with whom the results will be shared, and how it will be used. The survey should be
anonymous.
Physical Environment
1
Developing Workplace Violence and Harassment Policies and Programs: A Toolbox
Workplace Violence Survey
(Based on material from the Ontario Safety Association for Community and Healthcare.)
Do you feel safe at work? ■ Yes ■ No
Has your workplace been designed to protect you from workplace violence? ■ Yes ■ No
In your opinion, are there adequate measures to protect you? ■ Yes ■ No
If you answered No to any of the previous questions, please indicate whether the
following areas require improvement:
Yes No N/A
Lighting
Security checks or protocols (identification checks, sign-in sheets, etc.)
Restrictions on public access to work areas (secured elevators, stairwells, etc.)
Security in areas used to store personal belongings (locker rooms, etc.)
Security staff
Security of restrooms
Security of parking lots
Communication procedures (for example, when and how to call for help)
Layout of work areas (visual obstructions, unsecured objects and furniture, etc.)
Security devices (surveillance equipment, silent or sounding alarms, panic
buttons, personal alarms, telephones, cell phones, etc.)
Other:
WSPS.CA
