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Worker interest survey template
How to use this template
Read step three of the Work Health Planning Guide: Needs assessment.
The following template is a starting point for you to gain an understanding of the health and wellbeing interests of your workers.
Remember to ensure the confidentiality and privacy of your workers. See the tip sheet Protecting employee privacy and confidentiality.
Included in the survey are prompts to {insert} information. Simply replace the bracketed words with the information requested.
Note: This survey template can be branded, changed or manipulated to cater for the individual needs of your workplace.
You can use either a paper-based version of this survey, or you can consider offering the survey as an online version, depending on the capabilities of your workforce (i.e. if they have access to a computer, the online survey may be more appropriate). For some workplaces, you may need a mix of both survey formats to cover all employees.
To create an online version of the survey, tools as SurveyMonkey www.surveymonkey.com or People Pulse www.peoplepulse.com.au can assist you.
{insert organisation name/logo}
Worker interest survey
1. What are the top 5 unhealthy lifestyle behaviours you would like to change to enhance your health and wellbeing? (Please tick five boxes only)
q Eating unhealthy meals or snacks at work
q Eating unhealthy meals or snacks at home
q Unhealthy weight
q Not meeting the recommended guidelines of eating 5 serves of vegetables and 2 serves of fruit a day
q Not meeting the recommended guidelines of at least 30 minutes of moderate-intensity physical activity a day (moderate-intensity will cause a slight, noticeable increase in your breathing and heart rate)
q Spending a lot of time sitting at work
q Smoking
q Consuming alcohol on a daily basis
q Consuming large amounts of alcohol on any one occasion (e.g. binge drinking)
q Not being sun safe
q Prolonged or excessive stress responses at work or outside of work
q Other (e.g. sun safety, fatigue, work-life balance) Please list suggestions:
______
______
2. What wellness activities interest you? Note: it will not be possible to implement all chosen activities but your response will help identify areas of interest.
q Information sessions on healthy eating
q Information sessions on physical activity
q Information sessions on social and emotional health and wellbeing
q Healthy cooking demonstrations
q Joining a weight management group
q Company sponsorship and involvement in charity events (fun runs etc.)
q Subsidised membership to gym facilities
q Onsite facilities to help support physical activity (e.g. showers, bike racks)
q Flexible time to participate in exercise
q Receiving healthy lifestyle tips via emails or newsletters
q Workplace health assessments
q Other suggestion: Please specify
______
3. What is your commitment to participating in wellness activities at work (e.g. attending lunchtime seminars, walking before or after work, bringing in healthy food for morning teas/celebrations (please circle your answer below)
q Very committed
q Somewhat committed
q Not committed at all
q I prefer to undertake healthy activities in my own time
4. If you are committed to participating in workplace wellness activities, when would you prefer these activities to occur?
q Before work
q During lunch time
q After work
q During tool box talks/staff meetings
5. What items or systems in the workplace could be used or modified that would support healthy behaviours at work? (e.g. policies, culture, physical infrastructure)
______
______
______
6. Are there any barriers in the workplace that you think prevents you or your work colleagues from undertaking healthy behaviours?
______
______
______
7. Would you be willing to contribute to workplace wellness activities?
r Yes
r No
If YES, how could you contribute? (e.g. paying for activity sessions, volunteering time, have a special skill etc.)
______
Thank you for your time.
© Queensland Government 2015
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