Purpose:

Use some or all of the below questions to create an employee wellness needs assessment. Please feel free to include additional questions that aren’t included in this sample survey.

Notes for Wellness Team:

  • The sample questions listed below are arranged by category relating to mental health. They are intended as a starting place for your inquiry. You do not need to use all of the questions in your survey; select what best fits your needs.
  • The questions follow a pattern of asking about self-perception/organization/perception/wellness input.
  • Your team may want to add an introduction to:
    • Briefly describe existing wellness programs.
    • Describe the purpose of the survey and how the information will be used.
    • Provide a due date.
    • Clarify confidentiality of the data.
    • Plan how to share results and feedback to the survey respondents.
  • The survey could be shortened by asking only once at the end for feedback on all sections.

Sample Survey Questions

Section 1: Physical Health

  1. How many of hours of sleep, on average, do you get in 24 hours?
  2. Does your work interfere with getting as much sleep as you need?
  3. Please provide any suggestions you have for the wellness team to consider to help optimize your sleep.
  4. How many days per week do you exercise?
  5. Do you feel that your city supports you in staying fit for your work?
  6. Please provide any suggestions you have for the wellness team to consider to help        optimize your exercise.
  7. Do you generally eat a nutritionally balanced diet?
  8. Are you able to eat a nutritionally balanced meal during work hours?
  9. Please provide any suggestions you have for the wellness team to consider to help optimize your nutrition.

Section 2: Work/Life Balance

  1. On a scale of 1 to 5, with “1” being “do not agree at all,” and “5” being “agree wholeheartedly,” how much do you agree with the following: “I enjoy an optimal work-life balance at my current job?”
  2. On a scale of 1 to 5, with “1” being “do not agree at all,” and “5” being “agree wholeheartedly,” how well do you think our organization supports employees in achieving a better balance between work and other responsibilities?
  3. Please provide any suggestions for workplace initiatives, wellness programs, or policies that could improve employees’ work-life balance.

Section 3: Work-Related Burnout

  1. On a scale of 1 to 5, with “1” being “very low,” and “5” being “very high,” please rate your degree of work-related burnout.
  2. On a scale of 1 to 5, with “1” being “do not agree at all,” and “5” being “agree wholeheartedly,” how much do you agree with the following: “I have a reasonable workload?”
  3. Please provide any suggestions for ways our organizations could help manage work-related burnout.

Section 4: Job Satisfaction

  1. Does your work give you a sense of purpose?
  2. In the past 6 months have you considered quitting your job?
  3. Would you recommend our city as a positive place to work?
  4. Please provide any suggestions on ways our organization could improve employee job satisfaction.

Section 5: Leadership

  1. Does our organization’s leadership do enough to remind you of the importance of our work?
  2. Do you feel you can communicate openly with your supervisor about workloads and performance expectations?
  3. Do you feel you can communicate openly always, sometimes, or never?
  4. Please provide any additional suggestions on our organization’s leadership.

Section 6: Peer Support

  1. On a scale of 1 to 5, with “1” being “do not agree at all,” and “5” being “agree wholeheartedly,” how much do you agree with the following: My coworkers are friendly and supportive”
  2. Is there a person within the organization you feel you can speak to about stress and other factors that influence your work performance?
  3. Please provide any additional feedback about peer support within our organization.

Section 7: Stress Management

  1. Do you have access to resources that address stress, depression, anxiety, and other mental health issues?
  2. On a scale of 1 to 5, with “1” being “totally unimportant,” and “5” being “very important,” how much importance does your city place on public safety employee wellness?
  3. Please provide any suggestions for programs or initiatives that could help address stress or other mental health issues.

Section 8: Intellectual

  1. Do you actively seek to learn new skills at work and away from work?
  2. Does your workload leave you with enough time to pursue hobbies, personal activities, and/or career development?
  3.  Please provide any suggestions for how our organization can better support learning.

Section 9: Financial

  1. Do you have a long term financial plan in place?
  2. Does our organization support employees’ financial literacy?
  3. Please provide any suggestions for how our organization can support employees’ financial well-being.

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