Staff Survey
Your health and wellbeing at work
Our organisation is committed to improving, promoting and protecting the health and wellbeing of all staff.
This survey is a straightforward check list to find out how our workplace impacts on your health and
wellbeing and what we can do to support you to achieve a healthy working life. This data will help us
identify your needs and suggestions for improvements at work.
The information collected will be used to create a summary report. At no time will you or your individual
responses be identified. All of your answers will remain completely confidential.
Please work through the questions carefully. It will take about 10 minutes to complete.
Name of organisation: _____________________________________________
Date of completion:
__________________________
Q1. How would you describe your health?
□ very good
□ good
□
fair
□
Q2. Do you currently smoke tobacco?
□ yes (go to question 3)
□
no (go to question 4)
Q3. Would you like to stop smoking?
□ yes
□
no
poor
Q4. How often do you have a drink containing alcohol?
□ never (go to question 10)
□ less than monthly
□ 2-4 times a month
□ 2-3 times a week
□ 4 or more times a week
Q5. How many standard drinks* containing alcohol do you have on a typical day when you are drinking?
□ 1 or 2
□ 3 or 4
□ 5 or 6
□ 7 to 9
□ 10 or more
*A standard drink would be a 330ml can of beer (at 4% alcohol) or a 100ml glass of wine (at 12.5% alcohol) or 30ml of straight spirits.
Q6. How often do you have 5 (if you are male) or 4 (if you are female) or more drinks on one occasion?
□ never
□ less than monthly
□ monthly
□ weekly
□ daily or almost daily
Q7. How often during the last year have you found that you were not able to stop drinking once you had
started?
□ never
□ less than monthly
□ monthly
□ weekly
□ daily or almost daily
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Q8. How often in the last year have you failed to do what was normally expected from you because of
drinking?
□ never
□ less than monthly
□ monthly
□ weekly
□ daily or almost daily
Q9. Would you like to reduce the amount of alcohol you drink?
□ yes
□ no
How many hours per day would you usually spend doing each of the following? (tick one per line)
Q10. Seated at a desk or workstation
Q11. Driving a vehicle
Q12. Standing in one location
Q13. Doing light activity around my worksite
Q14. Doing moderate or heavy activity around my
worksite
Rarely
or not
at all
1–2
3–4
5 or more
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Q15. How many hours per day would you usually spend working outside? (tick one only)
□ less than 1 or not at all
□ 1 - 2
□ 3 - 4
□ 5 or more
Q16. Do you have access to protective equipment for the sun (eg sunscreen, sunhats, suitable work
clothing) when working outside?
□ yes
□ no
□ doesn’t apply to me
Q17. How many days per week would you usually do 30 minutes or more of physical activity*? (tick one
only)
rarely or not at all
1–2
3–4
5 or more
*In this case, physical activity means you get short of breath due to the level of exertion.
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Q18. Would you like to increase your physical activity levels?
□ yes
□ no
Q19. What form of transport do you most often use for getting to and from work? (tick one only)
car, as the driver
car, as a passenger
public transport
cycling
walking
other (please state) _____________
Q20. Would you consider more active forms of transport for getting to work (eg walking, cycling, public
transport)?
□ yes
□ no
□ doesn’t apply to me
Please tick one box on each line:
Rarely
or not
at all
1–2
3–4
5 or more
Q21. How many times would you usually eat high sugar
foods (e.g. lollies, chocolate, cakes, biscuits) in a week?
□
□
□
□
Q22. How many times would you usually eat high fat
foods (e.g. meat pies, fried chicken, sausages, chips) in
a week?
□
□
□
□
Q23. How many portions* of fruit and vegetables (fresh,
frozen, tinned or stewed) would you usually eat every
day?
□
□
□
□
Q24. How many times do you usually eat breakfast in a
week?
□
□
□
□
*Portion = 1 medium piece or 2 small pieces of fruit, ½ cup of cooked vegetables or 1 cup of salad vegetables
Q25. Would you like to eat more healthily?
□ yes
□ no
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Regarding the following, please tick the box that best describes your experience of the following
over the last two weeksi:
All of
Often
Some of the Rarely None of
the
time
the
time
time
Q26. I’ve been feeling optimistic about the future
□
□
□
□
□
Q27. I’ve been feeling useful
□
□
□
□
□
Q28. I’ve been feeling relaxed
□
□
□
□
□
Q29. I’ve been feeling interested in other people
□
□
□
□
□
Q30. I’ve had energy to spare
□
□
□
□
□
Q31. I’ve been dealing with problems well
□
□
□
□
□
Q32. I’ve been thinking clearly
□
□
□
□
□
Q33. I’ve been feeling good about myself
□
□
□
□
□
Q34. I’ve been feeling close to other people
□
□
□
□
□
Q35. I’ve been feeling confident
□
□
□
□
□
Q36. I’ve been able to make up my own mind
about things
□
□
□
□
□
Q37. I’ve been feeling loved
□
□
□
□
□
Q38. I’ve been interested in new things
□
□
□
□
□
Q39. I’ve been feeling cheerful
□
□
□
□
□
Q40. Have you had the influenza vaccination in the last 12 months?
□ yes
□ no
Q41. If female, have you recently returned to work from parental leave? (if male or no is selected, go to
question 44)
□ yes
□ no
□ i’m male
Q42. If yes, did you intend to continue breastfeeding after returning to work?
□ yes
□ no
Q43. If yes, did you feel supported to continue to breastfeed while at work?
□ yes
□ no
If no, please comment: ______________________________________________________________
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Regarding your workplace rank the following: (tick one box on each line)
Very Good
Good
Fair
Poor
Q44. General workplace safety
□
□
□
□
Q45. Workplace road safety
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
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□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Q46. Quantity of general workplace safety training
Q47. Quality of general workplace safety training
Q48. Access for people with disabilities
Q49. Air quality
Q50. Air temperature
Q51. Noise level
Q52. Work space
Q53. Toilet facilities
Q54. Hand washing facilities
Q55. Food preparation areas
Q56. General workplace cleanliness
Q57. What organisational policies does your workplace currently have? (tick all that apply)
Employee Assistance Programme (EAP)
Mental health and wellbeing (eg stress
management)
Induction or orientation programme for new
employees
Alcohol
Employee relations
Smokefree
Equal opportunities
Other drugs
Job sizing/workload balance
Healthy eating
Performance review
Breastfeeding
Flexible work hours
Physical activity
Alternative work arrangements (eg return to work
after injury)
Waste management (eg recycling)
Pollution (eg air, water, noise)
Health and Safety
Sickness and absence (ensuring sick/infectious
employees are not at work)
Occupational health services
Sun safety
Business continuity during times of emergency
None of the above
Q58. Thinking about your workplace and all of the questions you have just answered, do you have any
further comments relating to your health and wellbeing at work?
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Please provide the following demographics for statistical purposes
Q59. To which ethnic group(s) do you belong? (tick all that apply)
□ New Zealand European
□ Maori
□ Samoan
□ Cook Island Maori
□ Tongan
□ Niuean
□ Chinese
□ Indian
□ other (please state):______________
Q60. Are you:
□ male
□ female
Q61. To which age bracket do you belong?
□ 15 - 19
□ 50 - 59
□ 20 - 29
□ 60 - 64
□ 30 - 39
□ 65 +
□ 40 - 49
Q62. Which best describes the type of work you do?
□ manager
□ professional
□ technician or trade worker
□ community or personal service worker
□ clerical or administration worker
□
□
□
□
sales worker
machinery operator or driver
labourer
other (please state):
Q63. Did you complete the last WorkWell Staff Survey?
□ yes
□ no
Thank you for completing this questionnaire.
i
(Q26-39) The Warwick-Edinburgh Mental Well-being Scale was funded by the Scottish Executive National Programme for
improving mental health and well-being, commissioned by NHS Health Scotland, developed by the University of Warwick and the
University of Edinburgh, and is jointly owned by NHS Health Scotland, the University of Warwick and the University of Edinburgh.
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