Workplace Health and Well-being - Sample Workplace Health and Well-being Survey
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What is an example of a workplace health and well-being survey?
Back to topWorkplaces often use a survey to determine interest in the various aspects of a workplace health and well-being program. The following is a sample. You can customize this survey according to the needs of your workplace. See the OSH Answers on Workplace Health and Well-being Program - Getting Started for more information.
Sample Workplace Health and Well-being Survey
[ABC Company] is looking into the need for a workplace health and well-being program. We are interested in learning more about your opinions and interests. Your answers will be used to help plan the program and to decide which types of initiatives to offer.
- Senior management has agreed to let everyone take a few minutes to complete this survey.
- Please do not put your name on the survey because we would like to keep this survey confidential.
- Please complete and submit the survey by [date/month/year]
1. Gender:
Male Female
Non-Binary Prefer not to say
2. Age Group:
under 21 21 - 30 31 - 40
41 - 50 51 - 60
over 60
3. Do you have any health concerns about yourself, your family, or something arising from the workplace? If so, briefly describe your concerns.
4. Would you like [ABC Company] to help with these concerns?
Yes No Not sure
Please explain your answer
5. Indicate how you feel about the following statements:
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Agree Strongly |
Agree |
Neutral |
Disagree |
Disagree Strongly |
On the whole, I like my job. |
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I feel that I am well rewarded for the effort I put in at work. |
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I am happy with my work-life balance. |
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The level of control I have over my work matches the level of responsibly I am assigned. |
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6. Would you participate in the following activities if offered?
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Yes |
No |
Maybe |
Aerobic exercise sessions |
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Walking club |
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Recreational team (e.g., baseball) |
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Other exercise programs. Please specify:___________________________ |
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Tips for healthy backs |
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Tips for healthy eating (general tips, etc.) |
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Tips for weight management |
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Flu shot or other vaccines clinic |
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Blood pressure screening |
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Blood glucose screening |
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Tips for stress management |
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Substance use and abuse education |
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Smoking cessation program |
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Parenting tips |
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Interpersonal skills workshop (such as "Dealing with Difficult People", Conflict Resolution, etc.) |
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Retirement planning workshop |
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Lunch & learn sessions |
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Time management skills workshop |
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Personal finance workshop |
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Tips for work/life balance |
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Other: (please specify) |
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7. When are you most able to participate in activities?
| Day of the Week | Season | Time Period |
|---|---|---|
| Monday |
Spring |
Before work |
| Tuesday |
Summer |
Lunch time |
| Wednesday |
Fall |
After work |
| Thursday |
Winter |
Evenings |
| Friday |
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| Weekends (for family events) |
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Are there other factors that affect participation? Please indicate
8. Where would you prefer to attend activities?
In the workplace
At a private health club
At a local School or facility/hall
Other, please specify:__________________
9. If necessary, would you be willing to share in the cost of a program?
Yes No
Up to a certain amount (please specify _______________)
10. Do you have any additional comments or concerns?
- Fact sheet confirmed current: 2017-05-03
- Fact sheet last revised: 2022-09-29
