Language
- English
- Nederlands
Business
Personal
- Education
- Family
- Food
- Health
- Home
- Money
- Sports
- Technology
- Travel
- All
Pricing
About

Go Pro
- English
- Nederlands

Slip and Fall Questionnaire

By Rachael / Jul 20, 2019 / 32 tasks

4.75 With 88 votes.

Thanks!

Save as Checklist Save as Template

iPhone/ iPad
Android
Kindle

show all hide all

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

Save as Checklist Save as Template

iPhone/ iPad
Android
Kindle

show all hide all

2 checklists

Publish Your Checklist

Share your expertise with the community and publish your checklist templates.

Related Checklists

Child Health Questionnaire Checklist

children

Child Health Questionnaire Checklist

Fall Gardening Checklist

gardening

Fall Gardening Checklist

Baby and Child Development Checklist

children

Baby and Child Development Checklist

Looking for a different template?

Loading Next Checklist...

Find us on

From our blog

Checklist Pro is available!
Turn boring lists into interactive checklists with our WordPress Plugin

Also on

Ⓒ 2011-2019 Checklist.com B.V. All rights reserved.

About Jobs Contact Developers Publishers Help Privacy Terms

Save Template

Why save?

Keep changes you make
Add tasks, reminders, attachments & notes
Share checklists with others
Print
Access your lists anywhere using our mobile apps
100% Free