Employee Emergency Preparedness Survey
is conducting an anonymous survey about our emergency preparedness. The intent of this survey is to gather information
to evaluate our employees’ ability to respond should an emergency or disaster occur. The results will help us determine
what additional training may be necessary.
Your input is important to us. Please take a few moments to complete this survey and return to (insert name) by (insert
date). Thank you!
1. I know where the fire extinguishers are and have been trained to use them.
Yes
No
2. If the building is evacuated, I know where to report.
Yes
No
3. I know where to go in the event of a tornado.
4.
5.
6.
7.
8.
Yes
No
I know how to respond in case of fire.
Yes
No
I know what to do if there is a chemical spill.
Yes
No
I know who to alert if an emergency occurs.
Yes
No
I know the emergency exits in the building and how to determine which one to take.
Yes
No
I know where emergency supplies are stored at work and/or in my vehicle.
Yes
No
I would like to receive training in:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______________________________________________________
I would like to receive more information on:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
______________________________________________________
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