Health and safety questionnaire
Produced in partnership with DG Legal

The following Practice Management precedent produced in partnership with DG Legal provides comprehensive and up to date legal information covering:

  • Health and safety questionnaire

Health and safety questionnaire

Please complete the questionnaire by ticking boxes and giving further details as appropriate. If you find that you require further advice or assistance in completing this questionnaire, please contact [insert name] by [insert contact details].

Name[Insert name]
Role[Insert role]
Department[Insert department]
Date form completed[Insert date]
QuestionAnswerComments
Please use this space to note any additional comments to explain your answer or note any specific issues you would like us to address
Do you know to whom you should report any health and safety incidents?☐ Yes
☐ No
☐ Unsure
[Additional comments to be inserted here]
Do you know the name of the nominated first aider?☐ Yes
☐ No
☐ Unsure
[Additional comments to be inserted here]
Have you been provided with a copy of our Health and safety policy?☐ Yes
☐ No
☐ Unsure
[Additional comments to be inserted here]
Did you receive training on health and safety issues during your induction?☐ Yes
☐ No
☐ Unsure
[Additional comments to be inserted here]
Have you received training on health and safety issues

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