Safety Leadership Validation Questionnaire

Name: People Solutions
Address: 5 Agnew Way, Subiaco, WA, 6008, Australia
Telephone: 0893880300

Name*
First Last
Please indicate your age in years?*
Please indicate your gender*
- Male
- Female
- Other
What is the name of your job position?*
How many years have you been working in a safety critical environment?*
What is the highest level safety qualification you have?*
- Post-Graduate
- Degree
- Diploma
- Certificate
- I have no formal safety qualifications
How many years have you been supervising staff in a safety critical environment?*
How many people do you supervise/manage (direct and indirect reports) in your current role?*
How many of these report directly to you?*

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	Never	Rarely	Sometimes	Mostly	Always
My team uses all the necessary safety equipment to do their job.
My team uses the correct safety procedures for carrying out their job.
My team ensures the highest levels of safety when they carry out their job.
My team promotes safety within the organisation.
My team puts in extra effort to improve the safety of the workplace.
My team voluntarily carries out tasks or activities that help to improve workplace safety.

	Never	Rarely	Sometimes	Mostly	Always
I express satisfaction when my team performs their job safely.
I make sure that my team receives appropriate rewards for achieving safety targets on the job.
I show determination to my team to maintain a safe work environment.
I suggest to my team new ways of doing their jobs more safely.
I encourage my team to express their ideas and opinions about safety at work.
I talk about my values and beliefs of the importance of safety to my team.
I behave in a way that displays to my team a commitment to a safe workplace.
I spend time showing my team the safest way to do things at work.
I listen to my team’s concerns about safety on the job.
I avoid making decisions that affect safety on the job.
I fail to intervene until safety problems become serious.
I wait for things to go wrong before taking action.
I constantly monitor my team’s safety behaviours.
I take action on safety before problems occur.
I set specific safety goals with my team.
I praise my team for their safety efforts.
I communicate a compelling vision for safety.
I walk the talk when it comes to safety.
I have genuine concern for the safety of my team.