3 Phase B, Safety Culture Survey

Attachment C5 Form Approved

OMB # ________

Expires ________

Phase B, Safety Culture Survey

What follows is a set of questions about working at ABC Mine. The purpose of these questions is to try to understand what you think about the working environment here. Please think about a typical work week when responding.

When answering the survey, please keep the following points in mind:

 Mark your answer directly on each page.

 Please answer all questions on both sides of the page.

When you have completed the survey, please return your booklet to us. This is to protect your identity. Your supervisors will not see your responses. In fact, these individual forms will not be made available to any management personnel. We will combine the data from everyone into larger groups to analyze the results.

In advance, thank you for your participation in this survey.

Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS E-11, Atlanta, Georgia 30333; ATTN: PRA (0920-09BH).

Please mark the number below each statement or question that best describes your opinion:

1) I talk up this organization to my friends as a great organization to work for.

strongly disagree

1

2

3

4

5

6

7

strongly agree

2) I find that my values and the organization's values are very similar.

strongly disagree

1

2

3

4

5

6

7

strongly agree

3) I am proud to tell others that I am part of this organization.

strongly disagree

1

2

3

4

5

6

7

strongly agree

4) How well do the different job and work activities in this organization fit together?

perfectly

1

2

3

4

5

6

7

not at all

5) How much do people performing different work activities try to avoid creating problems or interfering with each other's duties and responsibilities?

to a very great extent

1

2

3

4

5

6

7

to a very small extent

6) How much do people performing different work activities who have to work together do their jobs properly and efficiently without getting in each other's way?

they work together completely perfectly

1

2

3

4

5

6

7

they do not work together smoothly at all

7) How well timed are all related things and activities in the everyday routine of this organization's work?

perfectly timed

1

2

3

4

5

6

7

poorly timed

8) How well planned are the work assignments of the people performing different work activities?

extremely well planned

1

2

3

4

5

6

7

not well planned at all

9) How well established are the routines of performing different work activities?

extremely well established

1

2

3

4

5

6

7

not well established at all

10) To what extent do you believe that you are really part of your work group?

very much a part

1

2

3

4

5

6

7

not a part at all

11) If you could do the same kind of work for the same pay in another work group, how would you feel about moving?

would want very much to move

1

2

3

4

5

6

7

would want very much to stay where I am

12) How well do you get along together in your work group compared to other work groups?

better than most

1

2

3

4

5

6

7

not as well as most

13) How much do you stick together in your work group compared to other work groups?

better than most

1

2

3

4

5

6

7

not as well as most

14) How much do members of your work group help each other on the job compared to other work groups?

more than most

1

2

3

4

5

6

7

not as well as most

15) If poor performance was to occur how likely is it that serious injury and/or the loss of life would result?

not at all likely

1

2

3

4

5

6

7

very likely

16) If poor performance was to occur in how likely is it that serious and potentially expensive damage would result?

not at all likely

1

2

3

4

5

6

7

very likely

17) If poor performance was to occur how likely is it that an expensive - but not necessarily very destructive - incident would result?

not at all likely

1

2

3

4

5

6

7

very likely

18) If poor performance was to occur how likely is it that serious offsite environmental damages/consequences would result?

not at all likely

1

2

3

4

5

6

7

very likely

19) If poor performance was to occur, how likely is it that serious onsite environmental damages/consequences would result?

not at all likely

1

2

3

4

5

6

7

very likely

20) How much danger or chance for danger is there in your work?

no danger in my work

1

2

3

4

5

6

7

work is very dangerous

21) How much emphasis do you believe this organization's management places on environmental issues relevant to this site?

no emphasis

1

2

3

4

5

6

7

a lot of emphasis

22) How well informed are this organization's employees of potential risks in their work environment?

not informed

1

2

3

4

5

6

7

very well informed

For this section, please mark the number next to each item that indicates how much that item helps you do your job well in this organization.

Response Format:

does not help at all

1

2

3

4

5

6

7

helps a great deal

23) Attending to detail 1 2 3 4 5 6 7

24) Asking questions whenever necessary 1 2 3 4 5 6 7

25) Being able to rely on others 1 2 3 4 5 6 7

26) Being aware of others' actions 1 2 3 4 5 6 7

27) Fixing potential problems 1 2 3 4 5 6 7

28) Respecting the nature of one's work activities 1 2 3 4 5 6 7

29) Respecting the nature of the organization's activities 1 2 3 4 5 6 7

30) Paying attention to potential danger 1 2 3 4 5 6 7

31) Being a reliable team member 1 2 3 4 5 6 7

32) Resolving problems 1 2 3 4 5 6 7

33) Fixing small mistakes before they grow into big ones 1 2 3 4 5 6 7

34) Doing one's job well 1 2 3 4 5 6 7

35) Reporting mistakes 1 2 3 4 5 6 7

36) Having training formally signed off 1 2 3 4 5 6 7

37) Being alert to the potential for serious accidents 1 2 3 4 5 6 7

38) Challenging a directive if it might not work 1 2 3 4 5 6 7

39) Having clearly defined job boundaries 1 2 3 4 5 6 7

40) Learning from mistakes 1 2 3 4 5 6 7

41) Having supervisors who readily pitch in whenever necessary 1 2 3 4 5 6 7

42) Suspending operations as needed 1 2 3 4 5 6 7

43) Reporting problems 1 2 3 4 5 6 7

44) Being prepared to deal with the unexpected 1 2 3 4 5 6 7

45) Having experienced personnel teach newcomers 1 2 3 4 5 6 7

46) Acknowledging mistakes 1 2 3 4 5 6 7

47) Taking care of others' well-being 1 2 3 4 5 6 7

48) "Owning" a problem until its resolved 1 2 3 4 5 6 7

49) Expecting people to perform reliably 1 2 3 4 5 6 7

50) Staying with a problem until it is resolved 1 2 3 4 5 6 7

51) Cutting corners 1 2 3 4 5 6 7

Please indicate how much you agree or disagree with each statement below by marking the number next to each item that best describes your opinion.

Response Format:

Strongly disagree

1

2

3

4

5

6

7

Strongly agree

52) I am responsible for identifying problems 1 2 3 4 5 6 7

53) I can openly challenge decisions made by management 1 2 3 4 5 6 7

54) I feel free to approach management with any concerns I have 1 2 3 4 5 6 7

55) Management wants concerns reported and willingly listens

to problems 1 2 3 4 5 6 7

56) Management ensures any concerns raised are addressed 1 2 3 4 5 6 7

57) Helpful criticism is encouraged 1 2 3 4 5 6 7

58) Management does not tolerate retaliation of any kind for raising

concerns 1 2 3 4 5 6 7

Please indicate how much you agree or disagree with each statement by marking the number below each statement that best describes your opinion.

59) How free do you feel to discuss with your immediate supervisor the problems and difficulties you have in your job without jeopardizing your position or having it "held against" you later in this organization?

completely free

1

2

3

4

5

6

7

very cautious

60) How often is your immediate supervisor successful in overcoming barriers in getting you the things you need in your job, such as equipment, person­nel, etc.?

always successful

1

2

3

4

5

6

7

never successful

61) Immediate supervisors at times must make decisions which seem to be against the interests of their employee. When this happens to you, how much trust do you have that your immediate supervisor's decision was justified by other considerations?

trust completely

1

2

3

4

5

6

7

feel very distrustful

62) To what extent do you have confidence and trust in your immediate supervisor regarding his/her general fairness?

have little confidence or trust

1

2

3

4

5

6

7

have complete confidence and trust

63) When you receive information at work, how accurate do you believe it usually is?

completely accurate

1

2

3

4

5

6

7

completely inaccurate

64) How desirable do you feel it is to interact frequently with others at work?

very desirable

1

2

3

4

5

6

7

completely undesirable

65) Choose the number of the face that expresses how you feel about communica­tions in general, including the amount of information you receive, interaction with your immediate superior and others, the accuracy of information available, etc.

12345 6 7

66) Overall, taking everything into consideration, how satisfied are you with your job? Choose the number of the face that best expresses how satisfied you are with your job.

123456 7