Health Wellbeing Check-In Survey
Please take a moment to reflect on your overall wellbeing. This survey is for general check-in purposes only and does not collect sensitive medical information.
How would you rate your overall wellbeing today?
*
1
2
3
4
5
How would you describe your current mood?
*
Very positive
Somewhat positive
Neutral
Somewhat negative
Very negative
How would you rate your energy levels today?
*
Very low
1
2
3
4
Very high
5
1 is Very low, 5 is Very high
How well did you sleep last night?
Very well
Well
Average
Poorly
Very poorly
How would you rate your stress levels today?
Very low
1
2
3
4
Very high
5
1 is Very low, 5 is Very high
How often have you engaged in physical activity this week?
Every day
Most days
A few days
Rarely
Not at all
How connected do you feel to others right now?
Not at all
1
2
3
4
Very connected
5
1 is Not at all, 5 is Very connected
How satisfied are you with your current work-life balance?
Very dissatisfied
1
2
3
4
Very satisfied
5
1 is Very dissatisfied, 5 is Very satisfied
Is there anything else you would like to share about your wellbeing?
Submit
Should be Empty: