Safety in the Workplace Survey
For agencies working with challenging populations

In order to better understand the challenges you are facing for your health and safety on the job, please take a few minutes to answer these questions. This survey is anonymous, however, there is an option at the end of the survey for you to provide contact information if you would like someone from PEF to get back in touch with you.

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* 1. What agency/facility do you work for?

OMH

OPWDD

OCFS

DOCCS (Facilities)

DOCCS (Community Supervision)

OASAS

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* 2. Is your work

primarily patient facing

primarily support for patient facing

primarily administrative and/or supervision

Other (please specify)

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* 3. Have you been injured on the job?

Yes

Other (please specify)

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* 4. Have you lost time due to a job injury?

Yes

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* 5. Do you know about the reporting procedures when injured? (for example, Workers Compensation, accident reports, unusual incident reports, etc.)

Yes

Other (please specify)

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* 6. If you have been injured on the job, have you completed the paperwork described above?

Yes

N/A

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* 7. If you were injured on the job and have NOT completed paperwork, please check all that apply.

I didn't know I needed to complete paperwork

I was too injured to complete the paperwork

Others said they would to it for me

I feel that completing the paperwork is a waste of time because my injury wasn't that bad

I feel that completing the paperwork is a waste of time because injuries like mine aren't dealt with at the workplace

My supervisor and/or others have told me that I can expect to get injuries like this in this line of work

N/A

Other (please specify)

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* 8. What caused your injury?

Act of aggression by a person who the agency is providing services for

Act of aggression by a coworker

Act of aggression by a community member

Other action by a person who the agency is providing services for

Other action by a coworker

Other action by a community member

Environmental issue (mold, asbestos, mice, ants, chemical, slips, trips)

Faulty equipment

Lack of equipment

Ergonomics (repetitive action, lifting, awkward posture)

Healthcare related exposure (radiation, blood borne pathogens, Covid, needlestick exposure)

N/A

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* 9. If you have been injured on the job, what statement(s) describes the outcome?

the agency/my supervisor quickly took care of the issue that caused my injury

the agency/my supervisor took care of the issue that caused my injury, but the problems still exist, and injuries can occur

the injury was a “one off” and I don’t think others would be injured for that reason

the agency/supervisor took care of the problem, but it took a while for it to be solved

A solution was put into place that had little impact on the problem

I don’t know if the agency did anything

Nothing has changed. The issue that caused my injury continues to exist

things are getting worse. Measures of safety that once were there have been taken away/allowed to lapse

I felt my input was valued for a solution

I was treated like I was to blame for my injury

I was told that injuries like mine can be expected in the line of work we do

N/A

Other (please specify)

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* 10. What types of hazards are common for your work?

Workplace Violence

Bullying

Environmental issues (mold, indoor air, pests, slips and falls, etc.)

Exposures (bloodborne pathogens, COVID, needlestick injuries, radiation, chemical)

Faulty equipment or lack of equipment

Ergonomics (repetitive strain, lifting injuries)

Other (please specify)

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* 11. Please check the statements below that you believe pertain to hazard mitigation in your workplace - check all that apply:

the agency/supervisor knows of the risks to my/my coworker's safety and mitigate the risks by putting in safety measures

the agency/supervisor knows of the risks to my/my coworker’s safety and only partially mitigate the risks

the agency/supervisor knows of the risks, and does not mitigate the risks

the agency/supervisor knows of the risks, and asks people to change their statements regarding the risks

the agency/supervisor ignores the risks when I bring them to their attention

the agency/supervisor targets people when they bring the risks to them

Other (please specify)

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* 12. Please check the following statements as they pertain to you - check all that apply:

I would like more information as to health and safety in the workplace

I would like more training /information and become more active in helping keep a safe workplace

I am currently active in providing health and safety in the workplace

I feel I have enough information at this time/I can seek out my stewards if I need more

I feel overwhelmed by this discussion and do not want further information

I would like face to face information at my workplace to help me and my coworkers understand the tools we need to keep us safe

Other (please specify)

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* 13. If you have been injured, would you be willing to work with PEF Health and Safety staff to share your story?

Yes

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* 14. If you are interested in talking to someone from PEF about your injuries or concerns, please provide your personal contact information as follows:

Full Name

Non-work Email Address

Phone Number

Safety in the Workplace SurveyFor agencies working with challenging populations

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* 1. What agency/facility do you work for?

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* 2. Is your work

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* 3. Have you been injured on the job?

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* 4. Have you lost time due to a job injury?

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* 5. Do you know about the reporting procedures when injured? (for example, Workers Compensation, accident reports, unusual incident reports, etc.)

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* 6. If you have been injured on the job, have you completed the paperwork described above?

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* 7. If you were injured on the job and have NOT completed paperwork, please check all that apply.

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* 8. What caused your injury?

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* 9. If you have been injured on the job, what statement(s) describes the outcome?

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* 10. What types of hazards are common for your work?

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* 11. Please check the statements below that you believe pertain to hazard mitigation in your workplace - check all that apply:

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* 12. Please check the following statements as they pertain to you - check all that apply:

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* 13. If you have been injured, would you be willing to work with PEF Health and Safety staff to share your story?

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* 14. If you are interested in talking to someone from PEF about your injuries or concerns, please provide your personal contact information as follows:

Safety in the Workplace Survey
For agencies working with challenging populations