Wellness Program - Employee Opinion Survey Sample #1





Survey Measuring Wellness Program:
Example 1 (5-point scale; numbers; NA)
Example 2 (7-point scale; radio buttons)
Example 3 (4-point scale; radio buttons)
Example 4 (5-point scale; radio buttons)
Example 5 (5-point scale; words)
Example 6 (Pulse Survey)
Example 7 (5-point scale; item comments)
Example 8 (3-point scale; words; N/A)
Example 9 (4-point scale; numbers)
Example 10 (Comment boxes only)
Example 11 (Single rating per dimension)
Example 12 (Slide-bar scale)
Dear Employee:


Welcome to the Employee Opinion Survey. We recognize that our employees are our biggest asset and we are committed to continuing to ensure that the [Company] is considered a great place to work. We would like to hear from you as your opinions will help to guide our objectives.

We have developed this survey with questions tailored for our staff and business to provide you with an opportunity to anonymously rate many facets of the business. The survey will assess what you value most in your employment and allow you to make positive suggestions for improvement.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Dimensions Included:
Wellness Program, Hiring, Equality, Management, Feedback/Guidance, Flexibility, Pride/Loyalty, Respect for Others, Teamwork


Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.




Wellness Program

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. I feel the wellness program is an excellent support resource for employees
  1. The Company wellness program is personal and confidential
  1. I would encourage others to use the wellness program
  1. The wellness program provides a wide array of services to meet my needs
  1. The Company is committed to a healthy workforce
If [Participant Name] were to make improvements in Wellness Program, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?

Hiring

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. The Company is good at finding the right talent for current and future work.
  1. Managers follow the hiring procedures
  1. Hiring procedures are clearly defined
  1. The hiring process is fair and unbiased
  1. The Company is successful in recruiting to fill both long-term and short-term positions
If [Participant Name] were to make improvements in Hiring, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?

Equality

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. Employees have equal resources available to them to perform their jobs
  1. Employees have equal access to resources used at the Company
  1. Our department is an inclusive environment
  1. All leaders are trained to better understand the issues facing some employees
  1. The contributions of all employees are valued and recognized
If [Participant Name] were to make improvements in Equality, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?

Management

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. Managers are effective in putting the right people in the right places
  1. The managers involve us in decisions affecting our work
  1. Managers are held accountable for achieving results
  1. Managers encourage initiative
  1. I have enough resources and support to adequately manage my department.
If [Participant Name] were to make improvements in Management, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?

Feedback/Guidance

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. I receive mentoring and coaching from my superior.
  1. I receive adequate feedback and guidance.
  1. I am comfortable giving feedback to others.
  1. I actively seek feedback from colleagues and customers about my work.
  1. I see my role to include mentoring and coaching others.
If [Participant Name] were to make improvements in Feedback/Guidance, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?

Flexibility

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. In our department, we seeks opportunities to improve processes and procedures to benefit the company overall.
  1. Our department swiftly adapts to changes, anticipates challenges and takes preemptive actions.
  1. Our department leader can easily accommodate changes in personnel of the department.
  1. Coworkers are willing to try new approaches to solving problems if the current solution isn't working.
  1. I can handle external information requests efficiently without disrupting workflow.
If [Participant Name] were to make improvements in Flexibility, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?

Pride/Loyalty

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. I feel this is a good place to work.
  1. This organization actively contributes to the community.
  1. I feel like I am able to help my department.
  1. The Company is a good employer to work for.
  1. I feel like I contribute to the Company.
If [Participant Name] were to make improvements in Pride/Loyalty, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?

Respect for Others

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. At this company, my suggestions are given serious consideration.
  1. Co-workers respect each others' opinions
  1. Individual differences are seen as strengths.
  1. I feel I am valued at work.
  1. I am treated with respect by others with whom I work.
If [Participant Name] were to make improvements in Respect for Others, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?

Teamwork

Strongly
Disagree
1
2
Neutral
3
4
Strongly
Agree
5
Not
Applicable
  1. Our team builds consensus and shares relevant information.
  1. Team members share pertinent information with all members of the team
  1. Our team is able to make decisions that positively impact performance
  1. The team leader takes the time to actively listen to other team member's perspectives
  1. There are strong relationships between team members
If [Participant Name] were to make improvements in Teamwork, which item do you think should be emphasized most over the next two years in order to make us a more effective organization. Type the number here: What are your suggestions for how we can improve this?




  1. What changes would you like to see in your benefit plans? Please note that some of these may increase premium rates. Please check all that apply.
    Add a higher deductible plan ($1,000 - $2,500)
    Increase vision care
    Increase dental care
    Add wellness program (weight loss, nutrition, smoking cessation programs, etc.)
    Add a Medical Spending Account (MSA) (allows employees to enroll in a high deductible health plan,
    spacer and then [Company] and the employee contribute on a pre-tax basis to an account used for eligible medical expenses)


  2. What changes would you be willing to accept in order to help hold down premium increases? Please check all that apply.
    Higher annual deductibles (the amount you pay out-of-pocket before benefits begin)
    Higher office visit co pays (the dollar amount you pay for office visits)
    Higher prescription drug co pays (the dollar amount you pay for prescription drugs)
    More network restrictions (smaller group of doctors and specialists to choose from)
    No dental coverage
    Other, please specify


  3. How often would you like to participate in after hours company event?






  4. How would you rate your satisfaction with the communication between you and [Company]?







  5. What would you change about your current job or position?


  6. Please identify factors that would improve your job performance in the coming year.


  7. When your performance was discussed with you in the past,
    how often did you receive practical suggestions for improving your work?






  8. How would you rate your overall satisfaction with the company in the past year?






  9. Please give any comments or suggestions on how the company can be improved in the coming year: