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