This survey aims to gather information about your health and well-being in relation to your office environment. Your honest responses will help us identify potential health hazards and implement necessary improvements. All information provided will be treated confidentially and used for internal purposes only.
Age
Gender
Job Title/Role
Length of time in current role
Department
How often do you experience discomfort or pain in the following areas while working?
Neck:
Never
Rarely
Sometimes
Often
Very Often
Shoulder:
Never
Rarely
Sometimes
Often
Very Often
Back (upper, middle, lower):
Never
Rarely
Sometimes
Often
Very Often
Wrists/Hands:
Never
Rarely
Sometimes
Often
Very Often
Eyes:
Never
Rarely
Sometimes
Often
Very Often
Legs/Feet:
Never
Rarely
Sometimes
Often
Very Often
Describe your workstation setup: (e.g., adjustable chair, monitor height, keyboard placement).
Do you use any ergonomic aids (e.g., wrist rest, lumbar support)?
If yes, please specify:
Do you feel your workstation is adequately designed for your comfort and health?
Yes
No
Somewhat
How many days a week do you engage in at least 30 minutes of moderate-intensity physical activity?
Do you feel you have adequate opportunities for physical activity during your workday?
Yes
No
Somewhat
Do you take breaks to stretch or walk around during your workday?
Yes
No
Somewhat
How often do you consume the following at work?
Fresh fruits and vegetables:
Very Often
Often
Sometimes
Rarely
Never
Processed snacks (e.g., chips, candy):
Very Often
Often
Sometimes
Rarely
Never
Sugary drinks:
Very Often
Often
Sometimes
Rarely
Never
Water:
Very Often
Often
Sometimes
Rarely
Never
Do you have access to healthy food options at or near your workplace?
Yes
No
Somewhat
On average, how many hours of sleep do you get per night?
Do you feel rested when you wake up in the morning?
Yes
No
Somewhat
Do you believe your work schedule or environment affects your sleep quality?
Yes
No
Somewhat
Do you have any pre-existing medical conditions that may be affected by your work environment?
If yes, please specify:
How often do you feel stressed or overwhelmed at work?
Very Often
Often
Sometimes
Rarely
Never
What are the primary sources of stress in your work environment? (e.g., workload, deadlines, interpersonal relationships, lack of control).
Do you feel your workplace provides adequate resources for stress management?
Yes
No
Somewhat
Do you feel you have a healthy work-life balance?
Yes
No
Somewhat
Do you feel your work interferes with your personal life?
Yes
No
Somewhat
Do you feel supported by your manager and colleagues in maintaining a healthy work-life balance?
Yes
No
Somewhat
How satisfied are you with your job overall?
Very satisfied
Satisfied
Neither
Dissatisfied
Very dissatisfied
What aspects of your job do you find most satisfying?
What aspects of your job do you find least satisfying?
Do you feel comfortable and supported by your colleagues?
Yes
No
Somewhat
Do you feel there is open communication and trust within your team?
Yes
No
Somewhat
Do you feel your workplace promotes a positive and inclusive environment?
Yes
No
Somewhat
How would you rate the air quality in your office?
Excellent
Good
Fair
Poor
Do you experience any symptoms that you believe are related to air quality (e.g., headaches, allergies, dry eyes)?
If yes, please specify:
How would you rate the lighting in your office?
Excellent
Good
Fair
Poor
Do you experience any eye strain or headaches due to lighting?
Yes
No
Somewhat
How would you rate the noise levels in your office?
Excessive
Moderate
Quiet
Do you find noise to be a distraction or source of stress?
Yes
No
Somewhat
How would you rate the cleanliness of your office?
Excellent
Good
Fair
Poor
Do you find the office temperature comfortable?
Yes
No
Somewhat
Do you have any control over the temperature in your workspace?
Yes
No
Somewhat
Do you feel safe in your work environment?
Yes
No
Somewhat
Are you aware of emergency procedures and safety protocols?
Have you received adequate safety training?
What other factors, if any, do you believe are impacting your health and well-being in the office environment?
What suggestions do you have for improving the health and well-being of employees in the office?
Thank you for completing this survey!
Survey Template Insight
Please remove this survey template insight section before publishing.
This survey is designed to be comprehensive, covering a wide range of factors that can impact employee health and well-being in an office environment. It goes beyond simply asking about physical discomfort and delves into mental and emotional health, workplace environment, and even lifestyle factors.
Here are some key insights about the survey:
1. Holistic Approach: The survey recognizes that health is multifaceted and includes physical, mental, and emotional well-being. It acknowledges the interconnectedness of these aspects by asking questions about stress, work-life balance, and job satisfaction alongside questions about ergonomics and physical activity.
2. Focus on Prevention: By identifying potential hazards and areas for improvement, the survey aims to prevent health issues before they arise. This proactive approach can lead to a healthier and more productive workforce.
3. Employee-Centric: The survey prioritizes the employee experience by asking for their opinions and suggestions. This shows a commitment to creating a workplace that supports employee well-being and values their input.
4. Actionable Data: The survey collects data that can be used to make informed decisions about workplace improvements. This could include changes to workstation setups, lighting, temperature, or even company policies related to work-life balance and stress management.
5. Confidentiality: The emphasis on confidentiality encourages honest responses, which is crucial for obtaining accurate data and identifying areas that need attention.
Overall, this survey demonstrates a strong commitment to employee health and well-being. By gathering comprehensive data and taking action based on the results, organizations can create a work environment that supports both individual and organizational success.
To configure an element, select it on the form.