DANSOON CHEMICALS SDN. BHD.

(288272-U)
NO. 142, JALAN PERMATA 1/5, KAWASAN PERINDUSTRIAN ARAB MALAYSIA
71800 NILAI, NEGERI SEMBILAN

SAFETY & HEALTH SURVEY

Departmen Age
t
Nationality Years of service

Note: Thank you for participating in Dansoon’s HSE Survey of workplace safety and health practices. The company
needs your help to gain a better understanding of current safety and health practices in the workplace. The survey is
anonymous (i.e. we are not asking for your name), CONFIDENTIAL & your participation is voluntary. Your answers will
help pinpoint areas that may need improvement to better protect the health and safety of workers.

No Questions Answer
Does the work area or machine (mixer/forklift) you use can
1
cause an accident? Yes No
Explain:
2 Have you been injured yourself while working here?
Yes No
Explain:
Perform work tasks, or use work methods, that you are not
3
familiar with? Yes No
Explain:
Interact with hazardous substances such as chemicals,
4
flammable liquids and gases? Yes No
Explain:
5 Work in a bent, twisted or awkward work posture?
Yes No
Explain:
Work at a height that is 2 meters or more above the ground
6
or floor? Yes No
Explain:
7 Is the lighting in the work area adequate?
Yes No
Explain:
8 Stand more than 2 hours in a row?
Yes No
Explain:
Has there been a near-miss incident/dangerous
9
occurrence/unsafe condition that you are aware? Yes No
Explain:
10 In your opinion, are the use of forklifts endanger your safety?
Yes No
Explain:
Have you ever been slipped/tripped/fell from slippery floor due
11
to chemical spillage Yes No
Explain:
Does the smell of chemicals (solvents) used to make adhesive
12
disturbs you from working comfortably? Yes No
Explain:
13 Have you ever experienced dizziness/drowsiness Yes No
/giddiness/headache from inhaling chemicals (solvents)?
 DANSOON CHEMICALS SDN. BHD. (288272-U)
NO. 142, JALAN PERMATA 1/5, KAWASAN PERINDUSTRIAN ARAB MALAYSIA
71800 NILAI, NEGERI SEMBILAN
Explain:
Has there been any chemicals splashed on you while making
14
adhesive? Yes No
Explain:
Have you witnessed any products fell from rack in the storage
15
area? Yes No
Explain:
16 Have you attended any safety training related to your work?
Yes No
Explain:
Any hazards/unsafe condition that you would like to share with
17
us? Yes No
Explain:
i.

ii.

iii.

Signature
Designation
Date