Wellness Program - Employee Survey Sample #7





Surveys 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 Survey. We are on a journey to create a workplace that encourages success! A critical component of creating this culture is building a business you recognize as being a great place to work and one that provides you with challenge and recognition. We want to build a thriving and successful business that provides motivation and satisfaction. In order to do so we need to assess how we are doing and understand your thoughts, views and feelings.

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.

The survey is web-based, quick and simple to complete which allows fast reporting and analysis. To ensure your anonymity, the survey is being hosted by an external organization. You will not be required to identify yourself. We want to be very clear that we will not be able to attribute this data to any specific individual and it is not our intention to do so.

Dimensions Included:
Wellness Program, Corporate Culture, Employee Relations, Job Content and Design, Problem Solving, Training, Department
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





Wellness Program

 Strongly
Disagree		 Disagree Neutral Agree Strongly
Agree		 Not
Applicable
  1. I would encourage others to use the wellness program
    (Click here to add a comment)
  1. The Company is committed to a healthy workforce
    (Click here to add a comment)
  1. I feel the wellness program is an excellent support resource for employees
    (Click here to add a comment)
  1. The wellness program provides a wide array of services to meet my needs
    (Click here to add a comment)
  1. The Company wellness program is personal and confidential
    (Click here to add a comment)
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?

Corporate Culture

 Strongly
Disagree		 Disagree Neutral Agree Strongly
Agree		 Not
Applicable
  1. People enjoy working for the Company
    (Click here to add a comment)
  1. I believe that Company's open door policy is effective.
    (Click here to add a comment)
  1. The Company culture promotes employees to stay within the organization.
    (Click here to add a comment)
  1. The organizational culture enhances employee commitment
    (Click here to add a comment)
  1. CompanyName has an image of a high quality company.
    (Click here to add a comment)
If [Participant Name] were to make improvements in Corporate Culture, 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?

Employee Relations

 Strongly
Disagree		 Disagree Neutral Agree Strongly
Agree		 Not
Applicable
  1. The Company holds quarterly and annual gatherings to keep everyone up-to-date
    (Click here to add a comment)
  1. I can go to My Supervisor if I have a problem
    (Click here to add a comment)
  1. Labor and Management meet regularly to discuss important issues
    (Click here to add a comment)
  1. Workplace issues are resolved fairly and quickly
    (Click here to add a comment)
  1. Employees are able to work independently when necessary
    (Click here to add a comment)
If [Participant Name] were to make improvements in Employee Relations, 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?

Job Content and Design

 Strongly
Disagree		 Disagree Neutral Agree Strongly
Agree		 Not
Applicable
  1. I can adjust my job description as needed
    (Click here to add a comment)
  1. I am clear about the expectations of my role.
    (Click here to add a comment)
  1. My job makes good use of my skills and abilities
    (Click here to add a comment)
  1. The job re-classification process is simple and efficient
    (Click here to add a comment)
  1. I can make positive suggestions and improve how the Company operates
    (Click here to add a comment)
If [Participant Name] were to make improvements in Job Content and Design, 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?

Problem Solving

 Strongly
Disagree		 Disagree Neutral Agree Strongly
Agree		 Not
Applicable
  1. We work together to solve problems
    (Click here to add a comment)
  1. Employees seek to acquire new information and knowledge before deciding on a course of action when problem solving
    (Click here to add a comment)
  1. My Department anticipates and resolves problems
    (Click here to add a comment)
  1. We resolve issues in our organization without resorting to blame, anger, or retribution.
    (Click here to add a comment)
  1. In my job I focus on problem solving instead of fault finding
    (Click here to add a comment)
If [Participant Name] were to make improvements in Problem Solving, 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?

Training

 Strongly
Disagree		 Disagree Neutral Agree Strongly
Agree		 Not
Applicable
  1. I have received good training to do my job
    (Click here to add a comment)
  1. The on-the-job training I received has prepared me for this job
    (Click here to add a comment)
  1. The training I receive is relevant to my job
    (Click here to add a comment)
  1. Training is offered at times convenient to me
    (Click here to add a comment)
  1. The Company supports efforts by employees to obtain training on new skills
    (Click here to add a comment)
If [Participant Name] were to make improvements in Training, 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?

Department

 Strongly
Disagree		 Disagree Neutral Agree Strongly
Agree		 Not
Applicable
  1. My department contributes significantly to the overall production of the organization.
    (Click here to add a comment)
  1. Communication is excellent in our department.
    (Click here to add a comment)
  1. Our department is aligned with the overall goals of the organization.
    (Click here to add a comment)
  1. My department supports diversity initiatives.
    (Click here to add a comment)
  1. Employees communicate freely within our department.
    (Click here to add a comment)
If [Participant Name] were to make improvements in Department, 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: