A health and safety survey is a survey done to analyze the condition of health of an individual and the safety measures taken by him to stay healthy. The survey assesses the chances of the person getting hurt if he is not taking any precautionary measures. The questions in the survey should be based on the healthy and precautionary measures taken by the individual.

Sample Health and Safety Survey

1. Did you ever meet with an accident?

a) Yes

b) No

2. If the answer is yes, has that accident caused any permanent injury to your body?

a) Yes

b) No

3. What are the safety measures taken at your office to avoid accidents?

___________________

4. What are the safety measures that you have taken at home to avoid accidents?

______________________

5. How often do you exercise for a good health?

a) Everyday

b) Sometimes

c) Never

6. Do you have control over your diet?

a) Always

b) Often

c) Sometimes

d) Rarely

e) Never

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