Survey

Employee Health & Wellness Survey

2 pages14 fieldsHIPAA-ready
Ready to useHIPAA compliantCustomize in minutes

Form preview

formisoft.com/f/employee-health-survey

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
Use this template

Sign up and start customizing in minutes.

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
8 min saved per patient98% patient satisfaction3x faster than paper

Start with this template

Sign up and start customizing the Employee Health & Wellness Survey for your practice. Set up in minutes.

Related templates

Employee Health & Wellness SurveyUse this template