Employee Wellness Program Health Risk Survey

Employee Wellness Program Health Risk Survey — Form Fields

This healthcare template includes 8 fields. Assess employee health risks and wellness needs to personalize workplace wellness program offerings. Free to customize and use on ZenBuild.

• Employee Name (text, optional)
• Department (text, required)
• Age Range (dropdown selection, required) — options: 18-24, 25-34, 35-44, 45-54, 55-64, 65+
• How Would You Rate Your Overall Health? (multiple choice, required) — options: Excellent, Good, Fair, Poor
• Health Conditions You Are Managing (checkboxes, optional) — options: High blood pressure, Diabetes, High cholesterol, Obesity, Anxiety/depression, Back/joint pain, None
• Wellness Topics You Are Interested In (checkboxes, required) — options: Nutrition and diet, Physical activity, Stress management, Sleep improvement, Financial wellness, Smoking cessation, Mental health support
• Do You Currently Exercise Regularly? (multiple choice, required) — options: Yes (3+ times/week), Sometimes (1-2 times/week), Rarely, Never
• What Would Encourage You to Participate More in Wellness Programs? (long text, optional)