Staff Nutrition Survey Form
Please share your workplace eating habits, food preferences, and support needs so we can better understand staff nutrition needs. Use the exact same title everywhere in the form.
Staff Profile and Work Pattern
Department / Team
*
Typical Work Shift / Schedule
*
Day Shift
Evening Shift
Night Shift
Rotating Shift
Hybrid / Remote
Other
How Often Are You On-Site During Meals or Breaks?
*
Please Select
Always
Often
Sometimes
Rarely
Never
Nutrition Habits and Workplace Food Access
How often do you eat breakfast before work?
*
Always
Often
Sometimes
Rarely
Never
How do you usually get food during your workday?
*
Bring food from home
Buy food at work
Both equally
Do not usually eat during work
Other
How would you rate your access to healthy food options at your workplace?
*
Always available
Usually available
Sometimes available
Rarely available
Not available
Please rate your satisfaction with the following workplace food factors.
*
Rows
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
Food availability
1
2
3
4
5
Food variety
6
7
8
9
10
Food affordability
11
12
13
14
15
Dietary Preferences and Support Needs
Preferred meal and snack options at work
Fresh fruit
Yogurt
Salads
Sandwiches/Wraps
Nuts and trail mix
Whole-grain snacks
Vegetarian options
Vegan options
Protein-rich snacks
Hot meals
Other
General dietary preference for workplace food planning
No specific preference
Vegetarian
Vegan
Pescatarian
Halal
Kosher
High-protein
Lower-sugar
Lower-sodium
Other
Preferred workplace support to encourage healthy eating
Healthier snack options
More fresh fruit and vegetables
Clear labeling of food choices
Refrigerator and microwave access
Healthy meal deals or subsidies
Regular water refills
Nutrition information on menus
Dedicated break time for meals
Other
Submit Survey
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