Employee Check-In Self-Assessment Form
Please complete the Employee Check-In Self-Assessment Form to reflect on your current work experience and well-being.
Your Name
*
First Name
Last Name
How satisfied are you with your current role?
*
1
2
3
4
5
How would you rate your current workload?
*
Very light
1
2
3
4
Very heavy
5
1 is Very light, 5 is Very heavy
How supported do you feel by your manager and team?
*
Not supported
1
2
3
4
Very supported
5
1 is Not supported, 5 is Very supported
What is your current energy and motivation level at work?
*
Very high
High
Moderate
Low
Very low
Have you encountered any significant challenges recently?
*
Yes
No
Please describe any recent achievements or successes.
What support or resources would help you perform better?
How likely are you to recommend your workplace to others?
*
Not likely
1
2
3
4
Extremely likely
5
1 is Not likely, 5 is Extremely likely
Any additional comments or feedback?
Submit
Should be Empty: