en Occupational and Industrial Health Occupational and Industrial Health پژوهشي Original Article <p><span style="font-size:14px;"><span style="font-family: times new roman;"><strong>Background;</strong> The performance of the HSE units has various dimensions Leading to different performances. Thus, any industry should be capable of evaluating these systems. The aim of this study was to design a standard questionnaire in the field of performance evaluation of HSE management system employing Balanced Score Card model.<br> <strong>Methods; </strong>In this study we, first determined the criteria to be evaluated in the framework of Balanced Score Card model based on the objectives and strategies of HSE Management System and existing standards, and then designed questions on every criterion. We used content validity and Cronbach&#39;s Alpha to determine the reliability and validity of the questionnaire.</span></span><br> <span style="font-size:14px;"><span style="font-family: times new roman;"><strong>Results;</strong> The primary questionnaire was comprised of 126 questions some of which were omitted regarding the results obtained from the CVR and CVI values. We obtained the CVI average of environmental dimension to be 0.75 and its CVI average 0.71.</span></span><br> <span style="font-size:14px;"><span style="font-family: times new roman;"><strong>Conclusion; </strong>With respect to the results of the reliability and validity of this questionnaire,and its standardized design we can suggest using it for evaluation of HSE management system performance in organizations and industries with the mentioned system.</span></span></p> <p dir="rtl"></p> Performance evaluation, HSE management system, Balanced score card, Questionnaire 52 62 http://jhehp.zums.ac.ir/browse.php?a_code=A-10-73-1&slc_lang=en&sid=1 Ali Mohammadi ali@zums.ac.ir 10031947532846009391 10031947532846009391 Yes Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran. Ali Reza Beheshti alirezabeheshti69@yahoo.com 10031947532846009392 10031947532846009392 No Department of Health Safety Environment (HSE) Management, School of Public Health, Zanjan University Of Medical Science, Zanjan, Iran. Koorosh Kamali drkamali@zums.ac.ir 10031947532846009393 10031947532846009393 No Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran. Shirazeh Arghami arghami_sh@yahoo.com 10031947532846009394 10031947532846009394 No Department of Occupational Health Engineering, School of Public Health, Zanjan University of Medical Mehrdad Sazandeh sazandeh.mehrdad@gmail.com 10031947532846009395 10031947532846009395 No Hse Director of Saba Tire Cord Mfg.Complex.