Please enter your full name 
 
  The information for the following four fields that has been provided by your Coordinator
 
Personal ID Code
 
Company Name
 
Coordinator's Number

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Simply read each statement and decide whether you agree or disagree and by how much -
strongly, moderately or slightly (pick the answer closest to what you think).

For each statement choose the one answer that best reflects your own view.

 

     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
1.
I have read the instructions and am willing to answer each question as truthfully as possible.
 
2.
I enjoy having a good time at all costs.
 
3.
I feel I am living the right kind of life.
 
4.
I feel full of energy most of the time.
 
5.
I sometimes feel resentful when I do not get my way.
 
6.
Whether I get injured at work or not is a matter of fate, chance or luck.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
7.
Most on-the-job accidents can be avoided.
 
8.
My life and career have been one crises after another for me.
 
9.
I prefer to have an exciting, unpredictable life.
 
10.
I am stricter about "right" and "wrong" than most people I know.
 
11.
I am happy with my life and career.
 
12.
I am always a good listener, no matter with whom I am talking.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
13.
I am easily distracted when working.
 
14.
I seem to have fewer accidents than most people I know.
 
15.
Thinking about everything that might happen to me at work makes me nervous.
 
16.
I prefer to have new and exciting experiences even if they are frightening or dangerous.
 
17.
There are too many unfair laws that people must follow.
 
18.
I sometimes feel that life is too troublesome.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
19.
I feel capable of handling almost any situation.
 
20.
On occasion I have taken advantage of someone.
 
21.
Drivers can prevent nearly all motor vehicle accidents by being careful and following all traffic regulations.
 
22.
People are victims of misfortune whenever they have an accident.
 
23.
I enjoy taking risks in life.
 
24.
I occasionally like to do my own thing at work instead of always following company rules.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
25.
I probably like to fight more than others.
 
26.
I am always willing to admit it when I make a mistake.
 
27.
There are so many dangers in this world, that people never know how or when they might be in an accident.
 
28.
When I am angry about something, it usually is not long before I am in a good mood again.
 
29.
Experienced workers do not need safety training.
 
30.
I have sometimes done dangerous things just for the thrill of it.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
31.
I always stop and think things over before I do something that could get me into trouble with the law.
 
32.
I am not the type to let troubles keep me down for very long.
 
33.
I sometimes go weeks where I do not care about anything at work.
 
34.
I am always courteous, even to people who are disagreeable.
 
35.
I can avoid getting injured at work if I am careful and avoid potential dangers.
 
36.
For me, avoiding accidents is a matter of luck.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
37.
I like "wild" parties where people will do anything to have a good time.
 
38.
Typically, I do not let myself get too worried over how things are going.
 
39.
In the past, I have been tempted to break a law that I did not really believe in.
 
40.
I never have difficulty controlling my temper.
 
41.
There have been times when I was jealous of the good fortunes of others.
 
42.
I often cannot sleep because there are too many things on my mind.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
43.
Some jobs are so dangerous that there is no way to avoid accidents.
 
44.
WIth my luck, I will probably have an accident in the near future.
 
45.
I like to do things that shock or scare others.
 
46.
I sometimes act without thinking, even though I tend to get into trouble later.
 
47.
I am happier than most people I know.
 
48.
I am sometimes irritated by people who ask favors of me.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
49.
If I get really upset, I cannot just forget about the problem and go on with other things like some people.
 
50.
People who think they know everything really make me mad.
 
51.
I feel unmotivated to work much of the time.
 
52.
For me, staying healthy is a matter of good luck.
 
53.
I rarely have problems that keep me awake when I want to sleep.
 
54.
I sometimes enjoy being with fun-loving people who engage in risky activities.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
55.
I have sometimes been tempted to break a law that I thought was unfair.
 
56.
Lately, my outlook on life and work has changed for the worse.
 
57.
I have never deliberately said somehting to hurt someone's feelings.
 
58.
When drivers are involved in motor vehicle accidents, it is usually because they are not concentrating on their driving.
 
59.
It is very frustrating when things happen that slow me down, even briefly.
 
60.
Employees who get injured at work are just plain unlucky.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
61.
It is nearly impossible to prevent an accident at work.
 
62.
I prefer to stay home for the evening than to go to "wild" parties.
 
63.
Unfortunately, most things that are enjoyable are also illegal or immoral.
 
64.
I guess I have a "short fuse" when other people do something that annoys me.
 
65.
I sometimes think of hitting someone who really deserves it.
 
66.
I sometimes try to get even, rather than forgive and forget.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
67.
Workers can avoid on-the-job injuries if they use proper lifiting techniques.
 
68.
Most employees, including myself, will never be involved in on-the-job accidents.
 
69.
Maybe I overreact sometimes, but little things at work can really get on my nerves.
 
70.
Most motor vehicle accidents involve drivers who have not learned to drive carefully enough.
 
71.
I always try to think things through carefully before I act.
 
72.
I do not care what happens to me at work or in life.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
73.
I have never been annoyed when people expressed ideas different from my own.
 
74.
Usually it takes a lot of hassles before I lose my temper.
 
75.
The odds are in favor of me having an accident at work in the near future.
 
76.
I usually get headaches from stress and worries.
 
77.
Drivers who are on the road a lot and have no accidents are just plain lucky.
 
78.
I often get into trouble since I am "in the wrong place at the wrong time."
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
79.
I am a confident person.
 
80.
Work stress often makes me feel tense.
 
81.
I often worry about getting hurt or injured in an accident at work.
 
82.
I sometimes do dangerous things that might cause injury to myself or another.
 
83.
I firmly believe that life is too short to worry about minor setbacks.
 
84.
If I follow all company safety regulations, I can avoid on-the-job accidents.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
85.
I try at all costs to keep out of trouble.
 
86.
Most drivers, including myself, will someday be involved in a traffic accident.
 
87.
Dealing with all the things I have to do at work really wears me out.
 
88.
There is nothing I can do to keep from getting injured in an accident.
 
89.
When I get angry I might break things.
 
90.
Sometimes I wonder what else could go wrong with my life or career.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
91.
A careful employee can prevent any accident from happening.
 
92.
Accidents usually happen because of events you cannot predict.
 
93.
When a motor vehicle accident occurs, the driver is almost always to be blamed.
 
94.
I have plenty of energy to handle the daily problems in life and work.
 
95.
I am a relaxed person.
 
96.
When another person is angry with me, I usually get mad right back.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
97.
It is impossible to provide error-free products and services to customers at all times.
 
98.
I double-check my work before I turn it in to my supervisor.
 
99.
When working, I seem to make fewer errors than most people I know.
 
100.
Employees who make costly mistakes at work are just plain unlucky.
 
101.
I do not worry about doing a project right the first time since I know my supervisor will probably ask me to redo it anyway.
 
102.
I continuously try to improve my work skills and abilities.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
103.
I am good at identifying and correcting the root causes of problems.
 
104.
Some problems at work are so small that it is a waste of time to try to correct them.
 
105.
It is unrealistic for a supervisor to expect employees to always complete their jobs in an accurate and error-free manner.
 
106.
I never settle for second best.
 
107.
I try to continuously improve the projects I work on.
 
108.
I prefer jobs where I have to pay close attention to details.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
109.
I am very skilled at quickly spotting, then correcting, any defects in the projects I am working on.
 
110.
It is impossible to avoid making errors when working since most employees are overworked.
 
111.
It is almost impossible to prevent costly mistakes at work before they happen.
 
112.
Most employees do not care about improving the quality of a company's products or services.
 
113.
I would get upset if someone regularly monitored the day-to-day quality of my work.
 
114.
At school or work, I was always the person who improved the way things were done.
     
Strongly
Agree
Moderately
Agree
Slightly
Agree
Slightly
Disagree
Moderately
Disagree
Strongly
Disagree
 
115.
I find it helps to talk about the problem and work things out if someone is mad at me.
 
116.
I answered all items truthfully.
 
 
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117.
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