Workplace Health & Safety Survey

1. Optional

2. Industry Type

Industry Type Manufacturing

Retail

Finance, Insurance or Real Estate

Healthcare and Social Services

Government and Education

Other (please specify)

3. Approximate Number of Employees

Approximate Number of Employees 2-9 Employees

10-49 Employees

50-99 Employees

100-249 Employees

250-999 Employees

1000+ Employees

4. Tell us about your successes in implementing health and/or safety programs

Tell us about your successes in implementing health and/or safety programs

5. Tell us about your greatest challenges in implementing your health and/or safety program.

Tell us about your greatest challenges in implementing your health and/or safety program.

6. Tell us about a job or program you have been involved with that had an effective health, wellness or safety intiative.

Tell us about a job or program you have been involved with that had an effective health, wellness or safety intiative.

7. What is your favorite way to be healthy and safe at work?

What is your favorite way to be healthy and safe at work?

8. Can the HWCE contact you for more information about your health and/or safety program?

Can the HWCE contact you for more information about your health and/or safety program? yes

9. Do you give the HWCE permission to use your responses in the HWCE monthly electronic newsletter or on the HWCE website?

Do you give the HWCE permission to use your responses in the HWCE monthly electronic newsletter or on the HWCE website? yes

10. Is there anything else you would like to share with us?

Is there anything else you would like to share with us?

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