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Employee Health & Wellness Survey

2 pages14 fieldsHIPAA-ready
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Employee Health & Wellness Survey

Page 1 of 2

Department / Role
Select an option...
Years at Organization
Select an option...
Overall Physical Health Rating
Option A
Option B
Option C
Overall Mental Health Rating
Option A
Option B
Option C
Stress Level at Work
Option A
Option B
Option C
Average Sleep Quality
Option A
Option B
Option C
Weekly Exercise Frequency
Select frequency...
Musculoskeletal Pain or Discomfort
None (0)
Mild (1-3)
Moderate (4-6)
Severe (7-10)
Work-Life Balance Satisfaction
Very satisfied
Satisfied
Neutral
Dissatisfied
Wellness Program Awareness
EAP / Mental Health Resource Access
Option A
Option B
Option C
Burnout Risk Self-Assessment
Low
Moderate
High
Suggestions for Wellness Improvement
Enter details here...
Contact for Follow-Up
Option A
Option B
Option C
Submit
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The Employee Health & Wellness Survey enables healthcare organizations to proactively assess the physical and mental wellbeing of their workforce. In an industry where burnout rates are among the highest of any profession, understanding employee health status is critical for maintaining a stable, engaged, and high-performing team. This survey covers physical health indicators, stress levels, sleep quality, exercise habits, and nutrition patterns, providing leadership with a holistic view of staff wellness that goes beyond annual physicals and absenteeism data.

The survey includes targeted sections on workplace-specific health concerns such as musculoskeletal strain from prolonged standing or repetitive tasks, exposure concerns, emotional fatigue from patient care, and work-life balance satisfaction. Employees rate their access to and satisfaction with existing wellness programs, employee assistance programs (EAPs), and mental health resources. A confidential open-ended section allows staff to describe health barriers they face and suggest improvements, ensuring that voices across all roles and departments are heard.

Ideal for hospitals, large medical groups, nursing facilities, and any healthcare employer committed to reducing turnover and fostering a culture of wellness. Human resources teams use the aggregated results to design targeted wellness initiatives, allocate benefits budgets more effectively, and track improvement over time. By demonstrating genuine concern for employee health, organizations strengthen loyalty and create a more resilient workforce prepared to deliver excellent patient care.

What's included

  • Department and role identification for segmented analysis
  • Physical and mental health self-assessment rating scales
  • Workplace stress, sleep quality, and exercise habit tracking
  • Musculoskeletal and occupational health concern reporting
  • Wellness program awareness and utilization evaluation
  • Confidential open-ended feedback and follow-up consent

Who uses this template

  • Hospitals assessing workforce burnout risk and mental health needs
  • HR departments designing targeted employee wellness programs
  • Healthcare organizations tracking staff wellbeing metrics over time
  • Nursing facilities identifying ergonomic and occupational health concerns

All form fields

14 fields across 2 pages. Customize any field after signing up.

Department / RoleDropdown
Years at OrganizationDropdown
Overall Physical Health RatingMultiple Choice
Overall Mental Health RatingMultiple Choice
Stress Level at WorkMultiple Choice
Average Sleep QualityMultiple Choice
Weekly Exercise FrequencyDropdown
Musculoskeletal Pain or DiscomfortMultiple Choice
Work-Life Balance SatisfactionMultiple Choice
Wellness Program AwarenessCheckbox
EAP / Mental Health Resource AccessMultiple Choice
Burnout Risk Self-AssessmentMultiple Choice
Suggestions for Wellness ImprovementLong Text
Contact for Follow-UpMultiple Choice

How to use the Employee Health & Wellness Survey

Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Employee Health & Wellness Survey from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.

Setup steps

  1. 1Choose the template. Find the Employee Health & Wellness Survey in the template library and click “Use this template” to add it to your account.
  2. 2Customize fields. Add, remove, or reorder any of the 14 fields. Set fields as required or optional based on your practice needs.
  3. 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
  4. 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
  5. 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.

Frequently asked questions

Is the Employee Health & Wellness Survey HIPAA compliant?

Yes. All Formisoft templates, including the Employee Health & Wellness Survey, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.

Can I customize the fields in this template?

Absolutely. You can add, remove, reorder, or modify any of the 14 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

How do patients fill out this form?

Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.

Can I send this form automatically before appointments?

Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.

Does this template work on mobile devices?

Yes. The Employee Health & Wellness Survey is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.

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