Slip and Fall Questionnaire
Table of Contents
Did you have sunglasses on or anything to obstruct your view at the time
Do you wear prescription glasses or contacts and were you wearing them at the time
Was the light on in the area where you were at
What type of floor was it
How wet was the floor
What time was it when this incident occurred
Was there a checklist for cleaning
Were there any wet floor signs or caution signs
When was the last time the area was checked prior to the fall
Did you actually fall on the floor
Did you brace yourself and How
What was on the floor
How did the incident happen
What kind of shoes were you wearing
How old or new were your shoes
Do you still have those shoes
Do you know if this spill was reported prior to you falling
Were your clothes wet or damaged after the incident
Was anyone else walking in the area prior to you falling
Did manager and/or employee look at substance after you fell
Was there an incident report done
Who took the report
Were there any witnesses to the incident
What did you do immediately following the incident
Did anyone help you after the incident and who
Did the manager and/or employee acknowledge the spill and incident
If it was a stranger, did you get their contact information
Any prior accidents? Any Injuries
Any prior S&F ? Any Injuries
Any prior injuries such as birth defects or child hood injuries
Did you or anyone else take any pictures
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Presented by:
Rachael
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Views: 16
Uses
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Uses: 2
Tasks
31
Tasks: 31
Who it's for
This Slip and Fall Questionnaire is for teams that want consistent execution, less rework, and clear ownership.
- Standardize quality - run the same Slip and Fall Questionnaire steps every time, regardless of who executes
- Save time - reuse a proven Slip and Fall Questionnaire workflow instead of rebuilding processes from scratch
- Improve accountability - assign owners and see what's done vs. what's pending
- Onboard faster - use the Slip and Fall Questionnaire checklist as the SOP and training guide
- Coordinate across roles - handoffs are clear and everyone works from the same source of truth
How to use it
How to use this Slip and Fall Questionnaire:
- Start by saving it - save as a Template if you'll reuse it, or as a Checklist if it's a one-off project.
- Customize it once for your workflow - remove what doesn't apply and add your team-specific steps.
- Assign ownership and execute - set owners/due dates where needed and track completion as work happens.
- Reuse without rebuilding - when Slip and Fall Questionnaire comes up again, start from your saved version and run it with clear ownership.