Center for Environmental Health & Safety Program Assessment

Tell Us About Yourself

What is your Vice-Chancellor Area?

What best describes your title? Department Safety Coordinator Lab Manager Manager Principal Investigator Other Other

How often do you contact CEHS?

What do you feel is the primary function of CEHS Service Regulation of the campus Record Keeping Technical Consultation Other Other

Please rate your agreement with the following statements using the following key.
1 - Very Dissatisfied 2 - Dissatisfied 3 - Satisfied 4 - Very Satisfied

CEHS Program Area Satisfaction Level Rating
Did you contact?	CEHS Program Area	Satisfaction Level
	Accident Investigation	1 2 3 4
	Asbestos/Lead Consultation	1 2 3 4
	Biosafety	1 2 3 4
	Chemical Exposure Monitoring	1 2 3 4
	Environmental Programs (air, soil, water pollution control)	1 2 3 4
	Ergonomics	1 2 3 4
	Hearing Conservation	1 2 3 4
	Hazardous Materials (including Chemical Inventory)	1 2 3 4
	Hazardous Waste (chemical, radioactive, etc.)	1 2 3 4
	Indoor Air Quality	1 2 3 4
	Radiation Safety	1 2 3 4
	Respiratory Protection	1 2 3 4
	Lab Safety Consultation	1 2 3 4
	Office Safety Consultation	1 2 3 4
	Shop Safety Consultation	1 2 3 4
	Training Specify:	1 2 3 4
	Other Specify:	1 2 3 4

Please rate your agreement with the following statements using the following key:

1 - Very Dissatisfied 2 - Dissatisfied 3 - Satisfied 4 - Very Satisfied

Agreement Level Rating for CEHS
CEHS is:	Agreement Level
Understanding of my departmental needs and requirements	1 2 3 4
Accessible to me via phone	1 2 3 4
Accessible to me via voice mail	1 2 3 4
Accessible to me via e-mail	1 2 3 4
Responsive within an acceptable time	1 2 3 4
Effective in providing advice/guidance	1 2 3 4
Effective in providing support	1 2 3 4
Effective in providing problem faciliation and resolution	1 2 3 4
Effective in providing accurate, up-to-date information	1 2 3 4
Professional	1 2 3 4
Knowledgeable	1 2 3 4
Courteous	1 2 3 4
Helpful	1 2 3 4
Overall Satisfaction	1 2 3 4

Suggestions for Improvement

General Campus Awareness Survey for Respondants
To be filled out by all survey respondants:	Answer Yes/No
I understand my rights, roles and responsibilities regarding health and safety requirements.	Yes No
Campus requirements are simple and easy to understand.	Yes No
Quality training is readily available for campus requirements.	Yes No
I am familiar with my department's IIPP (Injury Illness Prevention Program)	Yes No
I have been made aware of workplace hazards	Yes No
I know what a Material Safety Data Sheet (MSDS) is	Yes No
I know how to access an MSDS	Yes No
I know what to do when a regulatory agency inspector arrives on-site	Yes No
I know what to do before, during and after a serious injury	Yes No
I know what to do before, during and after an earthquake	Yes No
I know what to do before, during and after a fire	Yes No
I know where the closest fire extinguisher is	Yes No
I know how to use the fire extinguisher	Yes No

General Campus Awareness Survey for Hazardous Material Users
To be filled out by Hazardous Material Users only:	Yes No
I know how to access other hazardous materials information	Yes No
I know how to properly manage hazardous waste	Yes No
I know how to dispose of hazardous waste properly	Yes No
I know what to do in the case of a spill of hazardous material	Yes No
I know what to do if I am contaminated with a hazardous material	Yes No
I am familiar with my site specific laboratory CHP (Chemical Hygiene Plan)	Yes No
I know how to safely work with the hazardous materials	Yes No

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