Employee Wellness Survey Template

1. Overall, how would you rate your physical health?

The answer should be a single choice:

1. Very Good
2. Good
3. Moderate
4. Poor
5. Very Poor

2. Overall, how would you rate your mental health?

The answer should be a single choice:

1. Very Good
2. Good
3. Moderate
4. Poor
5. Very Poor

3. In the past month, how often have you felt stressed or overwhelmed at work?

The answer should be a single choice:

1. Almost Always
2. Often
3. Sometimes
4. Rarely
5. Never

4. In the past month, how often have you felt able to manage your work-related stress?

The answer should be a single choice:

1. Almost Always
2. Often
3. Sometimes
4. Rarely
5. Never

5. In the past month, how often have you taken breaks during the workday to rest or relax?

The answer should be a single choice:

1. Almost Always
2. Often
3. Sometimes
4. Rarely
5. Never

6. In the past month, how often have you exercised or engaged in physical activity during your leisure time?

The answer should be a single choice:

1. Almost Every Day
2. Several Times a Week
3. Once or Twice a Week
4. A Few Times a Month
5. Almost Never

7. [Company] offers the following wellness resources and benefits. Please rate the usefulness of each one:

The answer should be a single choice per row:

1. [Company] wellness program
2. [Company] gym membership discount
3. [Company] mental health resources and support
4. [Company] healthy eating options (e.g. subsidised fruits and vegetables)

8. Is there anything else you would like to share about your wellness at [Company]? (optional)

The answer should be a multi line text input.