Safety Questionnaire

This questionnaire is intended as an exercise of determining opportunities where Media Monkey can help clients digitize information, training, operating procedures, and compliance records regarding their safety and risk management programs. This questionnaire does not serve as a complete list of Media Monkey’s services or capabilities. Please check off the items on the list below that apply to your organization:

Business Information

Name *

Business Name *

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Website

Digital SDS

Do you currently have SDS for all chemicals used in your locations stored digitally? *YesNo

Do you utilize a single supplier for all chemicals such as Ecolab? *YesNo

Please share your supplier(s)

Safety Committee Meetings

Do you have a uniform safety awareness program for all your locations? *YesNo

Safety Surveys (i.e. Emergency Light and Exit Signs, Fire Extinguishers, First Aid, GFCI/electrical, equipment, PPE, slip and fall prevention, risk review checklists, OSHA 300 log, etc.)

How frequently does your state, or organization’s standard operating procedures require locations to conduct safety surveys?

What are the safety requirements of the states you do business in?

Do you require any additional safety measures beyond the state requirements? If yes, please explain *

Does your organization have a standardized Risk Review checklist for your brand(s)?

Are there other monthly surveys conducted at your location(s)?

Safety Training (i.e. Emergency Planning, Evacuation Training, First Aid/Nurse Triage, Hazard Communications, Workplace Violence Prevention, Temperature Related Illness)

Which topics are all employees trained on? *

How frequently do employees need to renew their training?

What are the safety requirements of the states you do business in?

Do you require additional safety training beyond state requirements for employees? If yes, please explain

Incidents and Corrective Actions

Do you have a standard method of recording incidents? *YesNo

If a violation of safety happens in your locations, how would you want responsible parties notified? Are you able to identify a hierarchy of users? (this is intended for reporting purposes, not emergency purposes)

How frequently would you like to your locations to be reminded of corrective actions?

Note: Media Monkey’s digital safety programs are intended for reporting and identifying opportunities to improve safety processes and training and not be utilized in the instance of an emergency. Should you experience an emergency, please follow your state or company procedures.