Workplace Employee Health and Ergonomics Survey Template
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WORKPLACE EMPLOYEE HEALTH AND ERGONOMICS SURVEY
Please take a few minutes to complete this survey to help us understand your experiences and make improvements where needed.
Name: | [Name] | Department: | [Department Name] |
Role/Position: | [Your Job Title] | Date: | [MM/DD/YYYY] |
Health And Wellness
Aspect | Details |
Overall Physical Health | I am in good physical health but I have noticed some stiffness in my lower back. |
Mental Health | |
Work-Life Balance | |
Sleep Quality |
Ergonomics and Workspace
Ergonomic Aspect | Excellent (5) | Good (4) | Neutral (3) | Fair (2) | Poor (1) | Comments |
Chair and Seating | Lower back stiffness due to the office chair. | |||||
Desk and Work Surface | ||||||
Monitor and Display | ||||||
Keyboard and Mouse | ||||||
Lighting | ||||||
Breaks and Movement |
Thank you for taking the time to complete this survey.
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