Night Shift Health Awareness Survey Form
Help us understand the health and wellness challenges faced by night shift workers. Your responses are anonymous and will be used to improve workplace support.
Which best describes your current night shift schedule?
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Permanent night shifts
Rotating shifts (including nights)
Occasional night shifts
Other
On average, how many hours of sleep do you get in a 24-hour period?
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Less than 5 hours
5–6 hours
6–7 hours
7–8 hours
More than 8 hours
How would you rate your overall sleep quality during night shift periods?
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1
2
3
4
5
How often do you feel fatigued or drowsy during your night shift?
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Never
Rarely
Sometimes
Often
Always
When do you typically have your main meal during a night shift?
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Before shift starts
During the shift (early hours)
During the shift (late hours)
After shift ends
No main meal during shift
How many caffeinated beverages (coffee, tea, energy drinks) do you typically consume during a night shift?
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None
1–2
3–4
5 or more
How would you rate your hydration during night shifts?
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Very poor
1
2
3
4
Excellent
5
1 is Very poor, 5 is Excellent
How often do you engage in physical activity (e.g., walking, exercise) outside of work?
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Never
Less than once a week
1–2 times per week
3 or more times per week
Do you have any current wellness concerns related to working night shifts? (Select all that apply)
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Difficulty sleeping
Frequent fatigue
Digestive issues
Mood changes
None
Other
Please share any additional comments or suggestions about your night shift health and wellness.
Submit Survey
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