[Your Company Name] is committed to promoting a healthy and safe work environment for all our employees. This survey is designed to understand better the health and wellness needs of our operations team. Your responses will be kept confidential and used solely to improve workplace conditions and health initiatives. Please answer the following questions honestly and to the best of your ability.
1. Name: [Your Name] (Optional)
2. Age Range:
Under 25
25-34
35-44
45-54
55-64
65+
3. Department/Team: ___________________________
1. How do you rate your overall health?
Excellent
Very Good
Good
Fair
Poor
2. In the past 12 months, have you experienced any of the following work-related health issues? (Check all that apply)
Musculoskeletal problems (e.g., back pain, neck pain)
Stress or anxiety
Hearing issues due to noise exposure
Eye strain or vision problems
Respiratory problems
None of the above
1. How comfortable is your workstation? (e.g., desk, chair, computer setup)
Very Comfortable
Somewhat Comfortable
Neutral
Somewhat Uncomfortable
Very Uncomfortable
2. Do you feel you have received adequate training on workplace safety?
Yes
No
3. Have you ever felt at risk of injury while performing your job duties?
Frequently
Sometimes
Rarely
Never
1. How often do you feel stressed at work?
Always
Often
Sometimes
Rarely
Never
2. Does your job negatively affect your mental health?
Yes
No
If yes, please describe: ___________________________
1. How many days per week do you engage in physical activity for at least 30 minutes?
0 days
1-2 days
3-4 days
5+ days
2. Do you use tobacco products?
Yes
No
Templates
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