Devon Health and Safety Service

Health & Safety Visit Evaluation Form

 

Devon Health, Safety & Wellbeing Service

Evaluation Form for Establishment Visits

1.
2.
3.
4.

Initial contact / request

5. Contact details for the team were easy to locate
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
6. Initial enquiry was dealt with promptly
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
7. Initial contact from the team was helpful
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
8.

Visit content

9. The length of the visit was appropriate
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
10. Sufficient opportunity provided to ask questions
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
11. Explanation / advice given was easily understood
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
12. Relevant documentation was provided
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
13.

Health & Safety Adviser

14. Arrived punctually
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
15. Presented themselves in a professional manner
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
16. Dressed appropriately
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
17. Provided relevant identification
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
18.

Follow-up (if applicable)

19. A suitable follow-up action timescale was agreed
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
20. Follow-up action was completed within timescale
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
21. The follow-up action answered all questions
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
22. Contact details were provided for further queries
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
23. Visit report was provided in a suitable timescale
  1 (strongly agree)   2   3 (neutral)   4   5 (strongly disagree)  
             
24.

And overall

25. Please rate the service on this occasion
  N/A   Excellent   Good   Average   Poor   Very Poor  
               
26. Please rate the service provided overall
  N/A   Excellent   Good   Average   Poor   Very Poor  
               
27.