Question Title

* 1. What is your title?

Question Title

* 2. How long have you worked in the environmental, health and safety (EHS) field or had safety responsibilities?

Question Title

* 3. What is your current salary?

Question Title

* 4. For which of the areas do you have responsibility? (Check all that apply.)

Question Title

* 5. What is your educational background? (Choose highest attained.)

Question Title

* 6. Check any of the certifications you currently hold:

Question Title

* 7. Describe your work environment:

Question Title

* 8. How many EHS professional events did you attend last year?

Question Title

* 9. How would you describe the EHS program in your facility/organization?

Question Title

* 10. What is your top EHS goal this year?

Question Title

* 11. Does top management in your organization provide active and visible support for occupational safety and health?

Question Title

* 12. Does your organization prioritize safety over production and/or other business demands?

Question Title

* 13. Do you use leading indicators to measure safety performance?

Question Title

* 14. If you answered “yes” to Question 13, please check all leading indicators that you track:

Question Title

* 15. Which of the following types of injuries/illnesses are you actively targeting in your organization/facility? (Check all that apply.)

Question Title

* 16. Compared to the previous year, did the budget for occupational safety and health in your organization in 2013:

Question Title

* 17. Which of the following programs are conducted in your facility/organization? (Check all that apply.)

Question Title

* 18. Does your organization/facility have or make use of the following? (Check all that apply.)

Question Title

* 19. Does your organization have a formal workplace wellness program in place?

Question Title

* 20. If you answered “yes” to Question 19, which of the following wellness components do you offer? (Check all that apply.)

Question Title

* 21. Have you ever witnessed or been directly affected by workplace violence?

Question Title

* 22. If you answered “yes” to Question 21, please describe:

Question Title

* 23. Do you regularly follow the news, updates, regulatory decisions, announcements and/or publications from any of the following agencies? (Check all that apply.)

Question Title

* 24. How would you rate David Michaels’ performance as OSHA administrator?

Question Title

* 25. In what area would you most like to see improvement in your organization/facility’s EHS program?

Question Title

* 26. What is the most frequent complaint that you hear from employees about your organization’s EHS program?

Question Title

* 27. What is the most common type of injury or illness you see within your organization?

Question Title

* 28. Can you share an example of a workplace EHS-related challenge that your company solved or improved in the last year?

Question Title

* 29. May we contact you for more information for our feature report on the National Safety Survey?

Question Title

* 30. If you answered “yes” to Question 29, please provide your contact information below:

Question Title

* 31. If you would like to be entered in the drawing, please fill-in your information below:

( Privacy & Cookie Notice

T