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Questionnaire template

Workplace Psychological Well-being

Measures employees' health, stress, emotions, social connection, work-life balance and growth opportunities at work.

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Healthcare · Mental health assessment. All Healthcare templates

Questions in this template

Your General Health

  1. Thank you for taking part. Your answers will help us shape well-being support across the organisation and are reported only in summary form.

  2. In general, how would you describe your health?

    Choose one:

    • Excellent
    • Very good
    • Good
    • Fair
    • Poor

  3. On an ordinary day, how stressed do you feel?

    A number from 1 to 10

How You Feel

  1. Over recent weeks, how often have you felt each of these?

    • Joy
    • Fear
    • Sadness
    • Disgust
    • Anger
    • Surprise
    • Contentment

    For each row: choose one:

    • Never
    • Rarely
    • Sometimes
    • Often
    • Very often

  2. Is there an emotional difficulty that has stayed with you for a while? If so, you can describe it briefly here. (optional)

    Open answer

Social Connection at Work

  1. Which of these are part of your social contact with colleagues? Select all that apply.

    Choose any that apply:

    • Team outings
    • Work meetings
    • Informal breaks such as lunch or coffee
    • Online meetings
    • Socialising after work
    • Networking events
    • None of these

  2. Anything you would like to add about the activities you selected? (optional)

    Condition: Shown when at least one activity was selected

    Open answer

Work-Life Balance

  1. How satisfied are you with the balance between your work and the rest of your life?

    Choose one:

    • Very satisfied
    • Satisfied
    • Neither satisfied nor dissatisfied
    • Dissatisfied
    • Very dissatisfied

  2. What is making your work-life balance difficult? (optional)

    Condition: Only for people dissatisfied with their balance

    Open answer

Growth at Work

  1. Does your work give you each of the following?

    • Chances to develop yourself
    • Recognition when you achieve something
    • Tasks you find personally rewarding

    For each row: choose one:

    • Yes
    • Not sure
    • No

  2. Is there anything else you would like to say about growing and developing here? (optional)

    Open answer