Sample Health and Safety Risk Assessment

2
15. I see my physician for routine check-ups,
health screenings, and disease prevention.
1 2 3 4 5
Safety
16. I wear a seat belt when traveling in a vehicle.
1 2 3 4 5
17. I stay within five miles per hour of the speed limit.
1 2 3 4 5
18. I know where to locate and properly use a first aid
kit and fire extinguisher in case of an emergency.
1 2 3 4 5
19. I use the recommended safety equipment for all
activities that I p articipate in (i.e. mouth guards,
life jackets, hard hats, etc.).
1 2 3 4 5
20. I take the proper precautions to avoid or reduce
workplace accidents. (i.e. clean up spills)
1 2 3 4 5
Social and Environmental Wellness
21. I regularly recycle my paper, plastic, glass and
aluminum.
1 2 3 4 5
22. I respect the integrity and property of my
fellow co-worker s and th e surrounding
environment.
1 2 3 4 5
23. I take time to have meaningful interactions
with family and friends.
1 2 3 4 5
24. I contribute time and/or money to at least one
organization that strives to better the
community where I live.
1 2 3 4 5
25. I regularly take interest in an d interact with
others.
1 2 3 4 5
Emotional Awareness
26. My relationships and behaviors are maintained
in a manner which is healthy for me and for
others.
1 2 3 4 5
27. I am able to develop close, personal
relationships with others.
1 2 3 4 5
28. I have positive relationships with both men and
w omen in my life.
1 2 3 4 5
29. I feel that I am a confident individual.
1 2 3 4 5
30. I am able to respect others for who they are,
regardless of race, gender, age, attitude, and
interests.
1 2 3 4 5
Mental Wellness
31. I express my feelings of anger and frustration
in ways that are not hurtful to myself or others.
1 2 3 4 5
32. I set reasonable objectives for myself and strive
to accomplish them.
1 2 3 4 5
33. I realize when I make mistakes; and I
understand the consequences that they have on
myself and others.
1 2 3 4 5
34. I feel that I have family and friends that I can
confide in to assist in managing stress.
1 2 3 4 5
Page 2/4
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