Wellness in Shift Work Environments Survey
Please provide your feedback on wellness aspects related to shift work.
Full Name
First Name
Last Name
Email Address
example@example.com
How many years have you worked in shift work?
Please Select
Option 1
Option 2
Option 3
How often do you experience fatigue during your shifts?
Option 1
Option 2
Option 3
How would you rate your overall physical health while working shifts?
1
2
3
4
5
How would you rate your overall mental health while working shifts?
1
2
3
4
5
What wellness resources or support would you find most helpful?
Option 1
Option 2
Option 3
Additional comments or suggestions
Submit
Should be Empty: