Wilkinson Foy, LLC

This survey will assess your knowledge and beliefs of safety and harassment, intimidation, retaliation, and discrimination (HIRD) policies. The survey is divided into multiple sections. Please read each set of instructions carefully and choose the best response to each question.

For the purposes of the survey, safety culture is defined as that assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, safety issues (process, industrial, environmental, etc) receive the attention warranted by their significance.

Part I: Questions about knowledge of policies (Objective 1) and training (Objective 2).
1.	How would you rate the safety culture of your site or organization?
	Not existent Poor Fair Good Excellent
2.	How would you rate the safety culture of your department?
	Not existent Poor Fair Good Excellent
3.	My organization has a policy prohibiting Harassment, Intimidation, Retaliation, and Discrimination (HIRD).
	Yes No
4.	In the last year, I have received training on my role in preventing HIRD.
	Yes No
5.	As a result of the training, what specific change(s) did you make as a supervisor?

Please answer the questions below using the following definition of a Safety Conscious Work Environment: a work environment where employees are encouraged to raise safety concerns (process, industrial, environmental, etc) and where concerns are promptly reviewed, given the proper priority based on their potential safety significance, and appropriately resolved with timely feedback to the originator of the concerns and to other employees.
6.	On a scale of 1 to 5 ranging from worst to best, how do you rate your site’s safety conscious work environment?
	1 2 3 4 5
	Using the same scale,
	A. How do you rate your fellow supervisors’ knowledge and practices related to a safety conscious work environment?
	1 2 3 4 5
	B. How do you rate middle management’s knowledge and practices related to a safety conscious work environment?
	1 2 3 4 5
	C. How do you rate your executives’ knowledge and practices related to a safety conscious work environment?
	1 2 3 4 5
Part II: Assessment of Organizational Trust (Objective 5) Please choose the number on the scale (1-5) that best represents your views on the work environment of your organization. 1 = Strongly Disagree 2 = Disagree 3 = Mixed Feelings 4 = Agree 5 = Strongly Agree
1.	Employee input is encouraged.
	1 2 3 4 5
2.	I can trust that the information communicated to me by my supervisors is true.
	1 2 3 4 5
3.	I can voice my opinion without fear.
	1 2 3 4 5
4.	The information that I receive from my superiors is always in sufficient detail.
	1 2 3 4 5
5.	I always receive information from my superiors is a timely fashion.
	1 2 3 4 5
6.	When things go wrong, we focus on the fixing the problem instead of blaming people.
	1 2 3 4 5
7.	The atmosphere in our department is highly cooperative.
	1 2 3 4 5
8.	Our department atmosphere is consistently one of trust.
	1 2 3 4 5
Part III: Management’s values towards HIRD (Objective 4). Please choose the number on the scale (1-3) that best represents your experiences with HIRD policies. 1 = Not Important 2 = Somewhat Important 3 = Very Important
1.	What value does upper management put on managing HIRD?
	1 2 3
2.	What value do your supervisory peers put on managing HIRD?
	1 2 3
3.	What value do you put on managing HIRD?
	1 2 3
Part IV: Beliefs, Attitudes, and Experiences (Objectives 3 and 4) Please choose the number on the scale (1-5) that best represents your beliefs about safety issues other than nuclear such as industrial, environmental, radiological, process and health. 1 = Strongly Disagree 2 = Disagree 3 = Mixed Feelings 4 = Agree 5 = Strongly Agree
1.	My organization encourages employees to raise safety issues
	1 2 3 4 5
2.	I encourage the people who report to me to raise safety issues.
	1 2 3 4 5
3.	I have experienced negative consequences for raising safety issues to my management.
	1 2 3 4 5
4.	I know of employees in other parts of the organization who have experienced negative consequences for raising safety issues
	1 2 3 4 5
5.	I know of supervisors in other parts of the organization who have experienced negative consequences for raising safety issues.
	1 2 3 4 5
Part V. Practices (Objectives 4 and 5). Please choose the number on the scale (1-5) that best represents your practices. 1 = Never 2 = Seldom 3 = Sometimes 4 = Frequently 5 = Always
1.	I make personnel decisions (promotions, assignments, etc) with an awareness of the potential for perceptions of HIRD.
	1 2 3 4 5
2.	I make discipline decisions (time off, demotion, etc) with an awareness of the potential for perceptions of HIRD.
	1 2 3 4 5
3.	I get advice from upper management and/or HR when I make discipline decisions.
	1 2 3 4 5
4.	Managing HIRD interferes with production.
	1 2 3 4 5
5.	Upper management makes discipline decisions with an awareness of the potential for perceptions of HIRD.
	1 2 3 4 5
6.	Our organization tries to mitigate the perception of HIRD in the workforce whenever controversial decisions are made.
	1 2 3 4 5
7.	Our organization periodically surveys employees to determine their level of trust in management.
	1 2 3 4 5
VII: SES/demos (Objective 5):
1.	What is your age?
	Under 20 20 – 29 30 – 39 40 – 49 50 – 59 60 or over
2.	What is your gender?
	Male Female
3.	What is your position with the company?
	Front-line supervisor Temporary front-line supervisor
4.	How long have you worked in the nuclear industry?
	less than 5 years between 5 and 9 years between 10 and 19 years between 20 and 29 years more than 30 years
5.	How long have you been employed by this particular organization?
	less than 1 year between 1 and 4 years between 5 and 9 years between 10 and 19 years more than 20 years
6.	What are your total work hours (number of hours) for a typical work week?

Projects of Wilkinson Foy, LLC.

Alyeska Pipeline, Anchorage, AK – Assess & Revitalize Open Work Environment & Employee Concerns Programs
Optometry Association of Louisiana - Manage all public relations and educational programs for the Association
PSE&G @ Salem/Hope Creek Nuclear Power Generating Station, Hancocks Creek, NJ - Safety Culture Assessment: preparation for NRC inspection to obtain Confirmatory Order closure.
@#!*# of Louisiana - Provide partnership development for the company with organizations and groups serving the senior population.
Arizona Public Service @ Palo Verde Nuclear Generating Station, Phoenix, AZ - Acting Department Leader, Employee Concerns Program
Louisiana Health Care Review - Currently working on a CMS directive to assist the state in rebuilding the health care system
Nuclear Fuel Services, Erwin, TN - Safety Culture Assessment in response to NRC Confirmatory Order
Louisiana Primary Care Association – Plan and conduct community meetings to formulate disaster plans for healthcare providers
BWXT Pantex, Amarillo, TX – Develop employee engagement programs to supplement site Strategic Plan
Louisiana Rural Ambulance Alliance – Strategic Planning
Resource Environmental – Strategic Planning
Louisiana Office of Public Health – Strategic Planning
American Institute of Architects, Louisiana Chapter – Teambuilding and Communication Skills Workshop
Constellation Energy, Nine Mile Nuclear Generating Plant – Focused SCWE assessment