Remote Worker Wellness Health Evaluation Form
Complete this wellness evaluation to help us understand and support your well-being as a remote employee. All questions are non-sensitive and designed to improve your remote work experience.
Overall, how would you rate your current sense of well-being while working remotely?
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1
2
3
4
5
How satisfied are you with your current remote work environment (lighting, seating, equipment)?
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Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
How often do you take breaks to move or stretch during your workday?
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Every hour
Every few hours
Once a day
Rarely
How manageable do you find your current workload?
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Overwhelming
1
2
3
4
Very manageable
5
1 is Overwhelming, 5 is Very manageable
How supported do you feel by your manager or team while working remotely?
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Not supported
1
2
3
4
Very supported
5
1 is Not supported, 5 is Very supported
Which of the following wellness areas would you like more support or resources for?
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Physical activity
Healthy eating
Mental well-being
Work-life balance
Home office ergonomics
Other
How would you describe your typical sleep quality during the workweek?
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Excellent
Good
Fair
Poor
How easy is it for you to disconnect from work at the end of the day?
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Very difficult
1
2
3
4
Very easy
5
1 is Very difficult, 5 is Very easy
What is one thing that helps you maintain your well-being while working remotely?
*
Please share any suggestions or feedback to help improve remote worker wellness support.
Submit Evaluation
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