Wellness Survey Template
A careful check on how work is affecting sleep, stress, and life outside — anonymous, non-clinical, and built to change workload decisions.
An anonymous check on how work is affecting your life lately. This is not a clinical assessment and nothing here is tracked to you — it exists so workload decisions can meet reality.
Up to three.
A wellness survey walks a line: ask too clinically and you are playing doctor without a license; ask too softly and you get smiley-face data that changes nothing. This template holds the line by measuring one thing precisely — how work is affecting life — and staying scrupulously out of diagnosis. Every question is about work's footprint, not anyone's mental health status.
The impact matrix is the core. Instead of "are you burned out?" (a label people resist), it asks how often work has affected sleep, stress, physical activity, and time with people — concrete, observable, answerable without self-labeling. Frequency columns ("never" to "constantly") make the results quantifiable: the share of people answering "often" or "constantly" on sleep is a number leadership cannot wave away. The stress-source checklist then points at causes the company controls — deadlines, meetings, unclear priorities — which is what makes this actionable rather than merely sympathetic. The switch-off question measures boundary erosion, the quiet precursor to the rest.
The benefits-usage question is the audit. Companies buy wellness perks and assume the job is done; asking which benefits people have actually used exposes the gap between the benefits page and reality. "None of these" scoring high next to a low wellbeing score is a budget-reallocation memo written by your own team.
One number up front, one field at the end. The 1–10 wellbeing rating opens the survey because it is the trend anchor — coarse on purpose, comparable wave over wave, the line leadership watches while the matrix explains its movements. The closing idea field asks for realistic over aspirational because grand wellness visions stall in committees; the suggestions that actually ship are small and workload-shaped, like protected focus mornings.
What this survey refuses to do. No depression screeners, no health questions, no crisis language — a workplace form is the wrong instrument for clinical assessment, and collecting health data casually creates obligations most teams should not take on. The ending instead signposts real support channels, which is the responsible pattern: measure the workload, point to the help.
Who runs this. People teams after a crunch period, founders who suspect the pace is borrowing from next year, and managers of on-call or shift teams where the work-life boundary is structurally thin.
Make it yours. Swap the benefits list for what you actually offer, and put your real support resources in the ending text before publishing. Keep it anonymous — no identity fields, distribution via a shared channel — and run it at most quarterly; wellbeing surveys lose credibility faster than any other kind when nothing visibly changes between waves. Export the CSV, lead with the sleep and switch-off numbers, and pair every result you publish with one concrete workload decision.
Frequently asked questions
Is this survey a mental-health screening?
No — deliberately. It measures work’s impact on sleep, stress, and time, and avoids clinical territory. The ending signposts real support channels, which you should localize before sharing.
How is anonymity protected?
The form collects no name, email, or department. Responses arrive as answers only; share the link in a group channel rather than individually addressed messages to reinforce it.
What results should leadership look at first?
The share answering "often" or "constantly" on the sleep and stress rows, and the switch-off distribution. Those three numbers, trended, are the honest workload dashboard.
How often should a wellness check run?
Quarterly at most, always followed by a visible decision. More frequent runs without action teach people the survey is decorative.