Occupational Safety and Hygiene for Disabled Employees
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Appendix C: Environmental risks survey of for employees with
mental disability
Employees with mental disability – environmental safety and health survey
Job
Name of Employee
Employment Percentage
Yes / No
Shifts
Name of factory assigned escort
Name of Survey operator
Remarks – mark:
1
- in order,
2
- needs to be improved,
3
- problematic
Everything marked 3 requires immediate care, everything marked 2 needs to be taken care
of as well.
1. To what extent can the employee get injured on his way from the parking lot
to the door of his workplace from each of the following?
Unstitched or unglued carpets, unmarked areas, smooth area, beams, trenches, rocks, sharp
slopes, stairways or roads traffic such as fork-lifts. Mark 1-3
Other on the
way outside
the workplace
Road traffic
(different
vehicles)
Stairways
Sharp
slopes
Rocks
Beams /
trenches
Smooth
area
Unmarked
paths
2. To what extent can the employee get injured on his way from the entrance
door to his workstation? (Mark 1-3)
Accessibility
of doors and
emergency exits
Darkened area /
glaring light
Crowded
traffic in
walking path
Sharp
slopes
Smooth
floor
Prominent furniture,
junk, flowerpot,
sculptures
3. To what extent can the employee get injured due to his disability during state
of emergency? (Detail in words)
Familiarity with the protocol for
evacuation in time of emergency
Available support
of contact person in
emergency or panic
Potential deterioration of
symptoms in time of emergency
(panic, confusion, etc)
Remarks
