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Internet Survey
Benbow Environmental Internet Survey

Benbow Environmental Survey will provide your company with information & solutions to environmental or occupational concerns. The information gained by the survey will help manage your company's environmental or safety performance.
* Required Fields
1. Contact Details  
   
First Name *
Last Name *
Company Name *
Postal Address 1 *
Postal Address 2
Postal Town/Suburb *
Postal State *
Postal Postcode *
Postal Country *

Site Address
  
  Tick if same as above
Site Address 1
Site Address 2
Site Town/Suburb
Site State
Site Postcode
Site Country
   
Phone Number *
Mobile Number
Email Address
 
Industry Sector *
 Manufacturing  Primary Industry
 Health  Retail
 Engineering  Consulting
 Food  Government
 IT & Technology  Legal Services
 Major Utility  Mining
 Education
 Other (please specify): 
 
Would you like to receive our newsletter & information brochures
2. General
 
arrow Benbow Environmental service areas or areas you would like to learn more about? *
 Noise
 Water Use
 Waste
 Occupational Hygiene
 Dangerous Goods Training
 Air Pollution (dust, fumes, etc)
 Energy Use
 Stormwater Management
 Cleaner Production
 Risk Management Training
 Odour
 Wastewater Management
 Dangerous Goods & Chemicals
 Risk Management
 Environmental Training
 Other (please specify): 
   
arrow What Occupational Hazards are you possibly exposed to?
 Noise
 Dust
 Explosions
 Fume
 Dangerous Goods & Chemicals
 Physical Injury
 Odour
 Asbestos
 Fire
 Contaminated Materials
 Other Atmospheric Contaminants
 Hazardous Substances
 Other (please specify): 
   
arrow Does your business have any occupational or environmental programs?
 Yes  No  Unsure
If yes, what do you use?
3. Noise
 
arrow What sources of noise are you exposed to in your workplace?


arrow Do you use personal protective equipment such as earplugs to reduce noise levels?
 Yes  No  Unsure
If yes, what do you use?


arrow Has your company ever received complaints regarding noise from neighbours?
 Yes  No  Unsure
 

arrow Does your company hold an environmental protection licence?
 Yes  No  Unsure
If yes, does the licence have noise limits?
 Yes  No  Unsure
 

arrow Have you ever had any noise monitoring undertaken at your site?
 Yes  No  Unsure
If yes, how often is this undertaken?
 One-off
 When a complaint is received
 Every 2 years
 Annually
 2 or more times a year
 4 or more times a year
 Other (please specify): 
4. Air/Odour
 
arrow Does your company produce air pollution or odours from your workplace?
 Yes  No  Unsure
If yes, describe type & from what activity?


arrow Are any personal or company practices in place to reduce impact of air pollution?
 Yes  No  Unsure
If yes, please list:


arrow Do you think your workplace could improve or reduce amount of emitted air from production process?
 Yes  No
 

arrow Does your occupational health & safety workplace network or representative focus on air/odour pollutants?
 Yes  No
5. Environmental Management
 
arrow Does your company have an Environmental Management System or Plan?
 Yes  No

arrow Does your company have documented procedures in relation to the environment?
 Yes  No
If yes, please list:


arrow Has your company had any spill incidences, fines, convictions or pollution notices?
 Yes  No
If yes, please list:
 


arrow Does your company undertake internal environmental auditing or use an external environmental consultant for environmental auditing purposes?
No Auditing undertaken Internal Auditing External Consultant Used
 
arrow Has your company undertaken a cleaner production assessment?
 Yes  No  Unsure
6. Dangerous Goods
 
arrow Does your company store or use chemicals or dangerous goods at the site?
 Yes  No  Unsure
If yes, please list some of the main dangerous goods used:


arrow Has your company undertaken a Dangerous Goods Risk Assessment at your site?
 Yes  No  Unsure
 

arrow Does your company have an Emergency Plan?
 Yes  No  Unsure
If yes, does the emergency plan contain procedures for the following?
 Chemical Spills
 Emergency Response
 Emergency Training
 Fire
 Incident Response
 Incident Reporting
 Evacuation Plan
 
Please click submit button below to submit the survey. Thank You

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