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Questionnaire template

Employee Health and Well-being

Measures employees' self-rated health, activity, stressors and emotional well-being, and views on workplace health culture.

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Human Resources · Employee questionnaires. All Human Resources templates

Questions in this template

General Health

  1. This brief survey asks about your health, activity and well-being, and about how the workplace supports them. It will help us plan better wellness support.

  2. How would you rate your health in general?

    A number from 0 to 10:

    • 0
    • 5
    • 10

  3. In the past month, how often have you had health problems?

    Choose one:

    • Never
    • Occasionally
    • Often
    • Very often

  4. How would you describe your usual diet?

    Choose one from a list:

    • Very healthy
    • Fairly healthy
    • Not very healthy
    • Unhealthy

Physical Activity

  1. Which types of physical activity do you do regularly? Select all that apply.

    Choose any that apply:

    • Walking
    • Running
    • Cycling
    • Gym or strength training
    • Team sports
    • Yoga or stretching
    • Other
    • None

  2. Which other activity do you do?

    Asked only when q_activity_types.outcome is not None and (q_activity_types.outcome & 64) != 0

    Open answer

  3. How much do you agree with each statement?

    • I exercise on a regular schedule.
    • My job leaves me enough time to exercise.
    • I am happy with my present level of fitness.

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree

Mental and Emotional Well-being

  1. What, if anything, at work puts a strain on your mental health?

    Open answer

  2. How would you rate your emotional well-being overall?

    A number from 0 to 10:

    • 0
    • 5
    • 10

  3. Does each of these statements apply to you?

    • I can talk about mental health at work without feeling uneasy.
    • I know where to turn for help if work leaves me stressed or anxious.

    For each row: choose one:

    • Yes
    • Not sure
    • No

Workplace Health Culture

  1. Does your workplace encourage a healthy lifestyle?

    Choose one:

    • Yes
    • No
    • Not sure