Workplace Safety and Health (WSH) Questionnaire

To be filled up by Human Resource (HR) Manager and WSH Officer (or equivalent)
 Please tick  the box provided. Some questions may require you to elaborate further.
 Please indicate “NA” if the question is not applicable to your company.

(Workplace Safety and Health (WSH) Services are activities that aim to maintain and enhance the work
abilities of workers in an optimal work environment, to protect the workers’ safety and health at
workplaces, as well as to prevent occupational and work-related diseases and injuries.)

SECTION A BACKGROUND INFORMATION

A1. Name of Company

A2. Address

Construction
A3. Type of Industry (please circle)
Transport & Storage

Manufacturing

Cleaning

Food & Beverage

Others (please state): _________________________

A4. Total Number of Employees

A5.1 Multinational Company (MNC)

A5. Type of Company
A5.2 Non-SME
A5.3 SME

A6. How many worksites does your

Company have?

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SECTION B SPECIFIC COMPANY INFORMATION
ORGANISATIONAL STRUCTURE
B1. Can you provide the organisational structure of the company?
B1.1 Yes
B1.1a If Yes, please provide the structure of the organisation: Please attach a copy
B1.2 No
B2. Does your company have a committee that oversees workplace safety?
B2.1 Yes
B2.2 No
B2.3 Not sure
B3. What are the meetings/committees that discuss safety issues?
B3.1 Top management safety meeting (Organisation group level committee meeting)
B3.2 Safety committee meeting (also referred to as Health & Safety Committee or Environment,
Health and Safety (EHS) Committee etc.)
B3.3 Operations meeting
B3.4 Toolbox or departmental meeting
B3.5 Sub-contractor's safety meeting
The following questions aim to understand the dynamics of the different safety and health committees.

B4. Who are the people involved in your company's safety committee? (Tick all that apply)
B4.1 Safety personnel B4.7 Supervisors
B4.2 Senior management B4.8 Sub-contractors/ sub-contractor
B4.3 Doctor/ Nurse representatives
B4.4 Human resource personnel B4.9 Employees
B4.5 Department heads B4.10 Others:
B4.6 On-site WSH officers
B5. Who chairs the workplace safety committee?
B5.1 Senior Management
B5.2 Head of the Safety department
B5.3 Human Resource Director/Manager
B5.4 Others:
B6. Who takes care of the occupational/ workplace health initiatives in your company?
B6.1 Workplace Health committee - A separate committee
B6.2 Workplace Health committee that is combined with the Safety committee
(Skip B7 and go to B8)
B6.3 Others: Please specify ______________

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 B7. Who are the people involved in occupational/ workplace health initiatives? (Tick all that apply)
B7.1 Head of the Safety Department B7.7 Supervisors
B7.2 Senior management B7.8 Sub-contractors/ sub-contractor
B7.3 Doctor/ Nurse representatives
B7.4 Human resource personnel B7.9 Employees
B7.5 Department heads B7.10 Others:
B7.6 On-site WSH officers
B8. Who takes care of the general health promotion in your company?
B8.1 Sports & recreation committee – a separate committee
B8.2 Human resources department- there is no formal committee but the HR handles all health-
related matters.
B8.3 Others: Please specify ______________
B9. Who are the people involved in the general health promotion initiatives?
(Tick all that apply)
B9.1 Head of the Safety Department B9.7 Supervisors
B9.2 Senior management B9.8 Sub-contractors/ sub-contractor
B9.3 Doctor/ Nurse representatives
B9.4 Human resource personnel B9.9 Employees
B9.5 Department heads B9.10 Workplace Health Promotion Practitioner
B9.6 WSH officers B9.11 Others:
B10.Please provide the structure of all the above mentioned committee(s) in the organisation?
[If applicable]
*Please attach a copy
GOALS AND OBJECTIVES
B11. Does the organisation set goals and/or objectives in relation to safety at the workplace?
B11.1 Yes
B11.1a Please elaborate on the goals and objectives:

B11.2 No
B12. Does the organisation set goals and/or objectives in relation to occupational health at the
workplace?
B12.1 Yes
B12.1a Please elaborate on the goals and objectives:

B12.2 No

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 B13. Does the organisation set goals and/or objectives in relation to health promotion at the
workplace?
B13.1 Yes
B13.1a Please elaborate on the goals and objectives:

B13.2 No
EMPLOYEES
*as measured against total number of employees
Percentage* of employees who are:
B14. Permanent employees:
B15. Temporary employees:
B16. Contract workers:

Percentage* of employees who are

B17. 18 to 29 years old:
B18. 30 to 39 years old:
B19. 40 to 49 years old:
B20. 50 to 59 years old:
B21. 60 to 69 years old:
B22. 70 years old and above:

Percentage* of employees who are

B23. Male:
B24. Female:

Percentage* of employees who are

B25. Chinese:
B26. Malay:
B27. Indian:
B28. Others:

Percentage* of employees who are

B29. Singapore Citizen:
B30. Permanent Resident:
B31. Foreigner:

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 Sickness Absenteeism for the past one year:
Percentage* (%) of Employees who applied for
B32. Outpatient Sick Leave
B33. Hospitalisation Leave

Average Number of Sick Leave Days Taken per Employee* on:

B34. Outpatient Sick Leave
B35. Hospitalisation Leave

Number of workplace incidents for the past one year:

B36. Total Work-related accidents (both
reportable and non-reportable to MOM)
B37. Work-related accidents (reportable to
MOM, i.e. Employee injured in accident and died,
or hospitalised for more than 24 hours; or given
MC for more than 3 calendar days in a row OR A
member of public or self-employed contractor
who was injured and subsequently died, or was
sent to the hospital for treatment)
B38. Occupational Diseases
B39. Dangerous Occurrences
B40. Near-misses
B41. List what were the top 3 types of workplace
1. _________________
incidents (E.g. Slips, trips and falls, noise-
2. _________________
induced deafness, fire outbreak, etc)
3. _________________

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SECTION C PERSONNEL INVOLVED IN THE WSH SERVICES
Type of Personnel
a. b. If YES:
In-house: Employees within Company
YES NO No. of In-house (I) or
Outsourced: Work done by another company Personnel Outsourced (O)
C1. WSH Professionals

C1.1 WSH Auditor/ Consultant C1.1a1 C1.1a2

C1.2 WSH Officer/ Advisor/ Manager/ Engineer/ C1.2a1 C1.2a2

Specialist
C1.3 WSH Coordinator/ Supervisor C1.3a1 C1.3a2

C1.4 WSH representative/ Promoter/ Advocate C1.4a1 C1.4a2

C2. Human Resource personnel C2.a1 C2.a2

C3. Doctor (please tick, you can tick more than one)
C3.1 General Practitioner/ Panel doctor C3.1a1 C3.1a2
C3.2 Designated Workplace Doctor (DWD)* C3.2a1 C3.2a2
[* Formerly known as Designated Factory Doctor
(DFD)]
C3.3 Specialist Occupational Physician C3.3a1 C3.3a2
C3.4 Occupational Health Nurse C3.4a1 C3.4a2
C3.5 Others:
C3.5.1 Physiotherapist and/or Occupational C3.5.1a1 C3.5.1a2
therapist (to assist with vocational
rehabilitation and re-education of injured
worker)
C3.5.2 Industrial Hygienist C3.5.2a1 C3.5.2a2
C3.5.3 Ergonomist C3.5.3a1 C3.5.3a2
C3.5.4 Psychologist C3.5.4a1 C3.5.4a2
C3.5.5 Nutritionist/ Dietician C3.5.5a1 C3.5.5a2
C3.5.6 Workplace Health Promotion C3.5.6a1 C3.5.6a2
Practitioner
a. Yes b. No c. Not Applicable d. Don’t know
C4. If your company engages a DWD, is
he/she also the same GP or panel doctor
who provides medical service to your
company?
C5. If your company engages a specialist
occupational physician, does he/she also
function as the DWD for your company?
C6. If your company employs a nurse, do
you know if he/she has a formal
qualification in occupational/ industrial
health?

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SECTION D TYPES OF WORKPLACE SAFETY AND HEALTH SERVICE PROVIDED
SURVEILLANCE OF WORKERS’ HEALTH

D1. Are the following health examination(s) conducted for employees?

a. Yes b. No c. Not
Applicable
D1.1 Pre-employment examination

D1.2 Post-retirement examination i.e. when staff retire and are re-
hired, do they go through a medical examination at that stage?

D1.3 Periodic medical examination (e.g. yearly hearing test, blood

or urine tests for workers exposed to certain hazards at the
workplace)
D1.3a1 Please specify Types of Medical tests (If applicable):

D1.4 Fitness to return to work after “failing” statutory medical

examination
D1.5 Fitness to return to work medical examination after prolonged
(Please state duration _____ ) absence for injuries or health reasons
D1.5.a1 (If you answered yes to D1.5)
If your company has a policy for fitness to return to work medical examination, please provide a copy
of the policy.
D1.6 Health examination at termination of assignment involving
hazards which may cause future health impairment
D1.7 General Health Screening (e.g. blood pressure, blood
cholesterol and glucose)
D1.8 Lifestyle and behaviour survey (e.g. smoking, alcohol
consumption, physical activity, diet and mental well-being)

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 GENERAL HEALTH CARE AND REHABILITATIVE SERVICES
D2. Which of the following services are available?
a. Yes b. No
D2.1 GP-level general health services
D2.2 Inspection and advice on working/ resting/ eating facilities
D2.3 Vocational re-training and rehabilitation
D2.4 Others
D2.4a Please specify:

D2.5 What is the mode of payment for GP-level general health services?
a. Full payment scheme by company
b. Co-payment scheme
c. Medical benefits capped at certain amount
d. Others: Please specify _________________

CURRENT HEALTH PROMOTION and WSH PROGRAMMES

Activities and practices your organisation currently has to support employee health
D3. Which programmes do you offer to your employees?
General Health Promotion programme a. Yes b. No
D3.1 Smoking cessation
D3.2 Nutrition (e.g. Healthy eating)
D3.3 Physical activity/ Exercise
D3.4 Vaccination/ Immunization programmes (e.g. flu)
D3.5 Mental health/ stress management or work/life
balance programmes
D3.6 Programmes to screen and treat alcohol and substance
misuse
D3.7 (a) Chronic Disease management by GP (e.g. for high
blood pressure, diabetes)
D3.7 (b) Chronic Disease management by GP and health
coaching
D3.8 HIV/AIDS/STD/Infectious Diseases Awareness
D3.9 Cancer awareness

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 D3.10 Other Health Promotion programmes?
D3.10a Please specify:

Workplace safety and health programme a. Yes b. No c. Not

Applicable
D3.11 Training/ Orientation Programme for the workers on
safe and healthy work practices
D3.12 Workplace Injury prevention
D3.13 Hearing conservation
D3.14 Management of Hazardous Chemicals
D3.15 Ergonomics
D3.16 Fatigue management
D3.17 Violence/Abuse at work
D3.18 Radiation Protection
D3.19 Laser Protection
D3.20 Other health and safety programmes? (e.g., back care)
D3.20a Please specify:

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SECTION E PROCEDURES AND ACTIONS

PREVENTIVE ACTIONS
Reporting of events and injuries with the aim of preventing future occurrences
E1. Which of the following events are to be reported:
a. Yes b. No
E1.1 Dangerous occurrences (e.g. failure of lifting equipment, fire in the
workplace)
E1.2 Near-misses (an unplanned event that did not result in injury,
illness, or damage – but had the potential to do so e.g. falling objects
that do not make contact with individuals, any non-compliance that
could have led to an accident)
E1.3 Occupational diseases (e.g. noise-induced hearing loss)

E1.4 Work-related injuries/ accidents (e.g. fall from height)

FIRST AID/ EMERGENCY READINESS

E2. Which of the following is present?

a. Yes b. No
E2.1 Provision of first-aid service (e.g. first-aider, first-aid box, first-aid
room) at the workplace

E2.2 Periodic maintenance and inspection of first-aid facilities

E2.3 Training and re-training of workers / supervisors in emergency
response (e.g. fire, chemical spills).

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SECTION F ROLES AND RESPONSIBILITIES

Which of the following area is present? a. YES b. No c. Not If YES:

Applicable Designation of
Company Person
Responsible
HAZARD IDENTIFICATION AND RISK ASSESSMENT

F1.1 Identification of workplace hazards

F1.1a1

F1.2 Identification of workers exposed to

specific hazards F1.2a1
F1.3 Identification of individuals with
special vulnerabilities (pre-existing medical F1.3a1
conditions)
F1.4 Periodic review of risk assessment F1.4a1

SURVEILLANCE OF WORK ENVIRONMENT

F1.5 Identification, evaluation and measures
to eliminate, prevent or reduce exposure to F1.5a1
workplace hazards
F1.6 Training and Assessment of Personal
Protective Equipment (PPE) usage, including
fit testing and monitoring on correct use F1.6a1
F1.7 Hygiene monitoring (e.g. noise,
chemical)
F1.7a2
F1.7a1 If yes, please specify:

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SECTION G PROVISION OF INFORMATION AND DATA COLLECTION
INFORMATION* (*includes programmes, policies, regulations, events and general information)
a. Yes b. No
G1. Is information on workplace hazards and risks communicated to the
managers/ supervisors responsible for implementing prevention and
control measures?
G2. Is information regarding the possible workplace hazards and risks
communicated to the employees?
RECORD KEEPING

G3. Please indicate the type(s) of records which are available:

a. YES b. No c. Not Applicable
G3.1 General Health Examination Data (e.g. pre-
employment medical check-up, health screening)
G3.2 Results of medical surveillance (e.g. hearing test for
workers exposed to noise)
G3.3 Results of Hygiene surveillance (e.g. monitoring of
noise level, indoor air quality, etc)
G3.4 Risk assessments and documents for preventive and
control measures
G3.5 Lifestyle and behaviour survey
G3.6 Others (If applicable)
G3.6a Please specify:

ORIENTATION AND PLANNING

G4. Which of the following statistics are available:
a. YES* b. No c. Not Applicable
G4.1 Statistics on Dangerous Occurrences
G4.2 Statistics on Near-misses
G4.3 Statistics on Occupational Diseases
G4.4 Statistics on Work-Related injuries/ accidents
G4.5 Statistics on Sickness Absence
G4.6 Statistics on Employees’ health status, lifestyle and
behavior
*If you have a Service Provider to help analyze your safety data across your workers’ health, do share
your company’s incident data (if possible, breakdown by occupation, accident type and department)
over the past 3 years with the Service Provider.

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