Occupational Safety and Health Program Evaluation Survey Year 1

Attachment H-2:

Occupational Safety and Health Program Evaluation Survey Year 2

NOTE: All Year 2 respondents will answer the same Questions 1-65 from Year 1 (Attachment H-1).

If the Year 2 respondent is the same person as Year 1, the respondent will then answer questions A-D:

Question A: Do you have a new role in your company since you last completed this survey?

⃝ Yes

⃝ No  Skip to question C

Question B: What is your new role within your company? ________________

Question C: In the past 12 months has…

	Yes	No	Don’t know
…your workplace had a fatality?	⃝	⃝	⃝
…your workplace had a catastrophic injury which made return to work improbable for the injured employee?	⃝	⃝	⃝
…your workplace received a visit from an OSHA consultant?	⃝	⃝	⃝
…your workplace had a consultation with a BWC safety consultant?	⃝	⃝	⃝
…your workplace had a consultation with a BWC ergonomist?	⃝	⃝	⃝
…your workplace had a consultation with a BWC industrial hygienist?	⃝	⃝	⃝
…your workplace had a consultation with a private occupational safety & health consultant?	⃝	⃝	⃝
…personnel in your workplace participated in occupational safety & health initiatives through business associations?	⃝	⃝	⃝
…personnel in your workplace participated in other Occupational Safety and Health initiatives arising external to your workplace?	⃝	⃝	⃝
…your workplace conducted any wellness activities (i.e. fitness activities, smoking secession, health and fitness support)?	⃝	⃝	⃝
…your work place participated in the Ohio Bureau of Workers’ Compensation (BWC) Industry-Specific Safety Program?	⃝	⃝	⃝
	If Yes answer question below:
…your workplace participated in any of the other BWC Destination: Excellence Programs?	⃝	⃝	⃝

Question D: Have any major changes occurred at your company in the past year that may have impacted Occupational Safety and Health? ___________________________________

If the Year 2 respondent is a different person from Year 1, the respondent will then answer questions C,D (above) and questions E-I:

E: What is your role within your company?

⃝ Owner/CEO/President/Senior Management (VP)

⃝ Manager

⃝ Supervisor

⃝ Lead Worker

⃝ Professional Staff

⃝ Skilled/Trades Staff

⃝ Administrative Staff

⃝ Worker

F: How long have you been working at your company?

⃝ Less than 1 year

⃝ 1 to 5 years

⃝ More than 5 years

G: Have you been working as a Health and Safety professional for your company?

⃝ Yes

⃝ No  Skip H

H: How long have you been working in a Health and Safety role for your company?

⃝ Less than 1 year

⃝ 1 to 5 years

⃝ More than 5 years

I: Are you…

⃝ Female?

⃝ Male?

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