Health & Safety Survey – COVID19 - Pennine Acute Health Branch

UNISON - Pennine Acute Health Branch

During this extremely difficult time your UNISON branch is ensuring that all Health & Safety issues are raised with the Trust. Our representatives are aware of the immense pressures on your role at the moment and are committed to campaigning for your safety and security in all aspects of your employment. The information you provide in this questionnaire is vital and will aid us in our role of raising issues with the Trust in order to protect your employment rights at work.

Section 1 - Personal Details

1. Full Name

2. Membership Number

3. Mobile Telephone Number

4. Email Address This question requires a valid email address.

Section 2 – Employment Details

5. Job Title

6. Department / Ward

7. Hospital / Base

Section 3 – Current Status

8. Are you currently working within the workplace? If yes please move to section 4

9. b) If no please provide details with dates where possible, of your current status. For example:

Working from home - with or without an underlying health condition
Shielding, Shielding with disabled/vulnerable dependants
Sick Leave
Unpaid Leave
Carers Leave

10. Did you feel that you were pressured to take the option that you have stated in question 9? Please provide as much detail as possible

11. If you are working from home have you had a Risk Assessment carried out? If yes were you provided with a copy of it? If no please give details as to why.

Section 4 - Coronavirus Testing

12. Has the Trust offered you a Coronavirus test? If yes please provide the date & result of the test.

13. If you answered no to question 12 please give details. e.g. you have not been contacted, you have requested one but not had a response

Section 5 - Health & Safety within the workplace

14. How are you currently travelling to work?

15. Is the Trust providing you with the correct PPE? If no please provide details

16. Has a Risk Assessment on your role/work area been carried out? If yes have you been provided with a copy, if not have you requested one?

17. Are you aware of any Health & safety inspections taking place within your department?

18. Are your shifts running on time and are you able to take adequate breaks? If not please provide details.

19. Have you raised any concerns with management regarding health & safety? If so please provide details including whether they have been resolved.

20. What are your current concerns about Health & Safety at work? Please provide as much detail as possible.

Health & Safety Survey – COVID19 - Pennine Acute Health Branch - copy

UNISON - Pennine Acute Health Branch