SAMPLE Health Culture Survey

Transcription

1 SAMPLE Health Culture Survey Workplace culture affects how people feel about work performed on a daily basis, our interactions with each other, and influences our overall health and wellbeing. The following survey measures how this currently works within our organization and offers an opportunity to share ideas for improvement. IMPORTANT: THERE ARE NO RIGHT OR WRONG ANSWERS. We are asking for your opinion.

2 SAMPLE Health Culture Survey GENERAL INFORMATION 1. Which department do you work in? 2. At which division/location do you work? 3. Listed below are the Eight Dimensions of Wellbeing. If you had the opportunity to focus on just one of these dimensions, which ONE would you choose for yourself? EMOTIONAL - Coping effectively with life and creating satisfying relationships. ENVIRONMENTAL - Good health by occupying pleasant, stimulating environments that support wellbeing. FINANCIAL - Satisfaction with current and future financial situations. INTELLECTUAL - Recognizing creative abilities and finding ways to expand knowledge and skills. OCCUPATIONAL/CAREER - Personal satisfaction and enrichment from one's work. PHYSICAL - Recognizing the need for physical activity, healthy foods, and sleep. SOCIAL - Developing a sense of connection, belonging, and a well-developed support system. SPIRITUAL - Expanding a sense of purpose and meaning in life. Other/Comments (please specify)

3 4. DAILY EXPERIENCE: Please indicate your level of agreement with the statements below using the following scale: Undecided/Don't Know Yesterday, I smiled and laughed a lot. Yesterday, I rarely felt worried, sad, stressed or angry. Yesterday, I had enough energy to get things done. I can do the things people in my age range normally do. I schedule time to participate in leisure activities on a regular basis. I seldom feel stressed about my personal finances. During the past 12 months, I never lacked money to buy food, provide adequate shelter or pay for healthcare and/or medicine for me and my family. I volunteer my time and/or donate money on a regular basis to a non-profit organization or some other charity throughout the year. Comments:

4 5. WORKPLACE ENGAGEMENT: Please indicate your level of agreement with the statements below using the following scale: Undecided/Don't Know I am satisfied with the job or work I do. The mission or purpose of my company makes me feel my job is important. My work environment is supportive of adopting healthier lifestyle practices through its use of resources such as time, space and money. At work, I get to use my strengths to do what I do best. At work, my supervisor treats me more like a partner than a boss. My supervisor supports efforts to adopt healthier lifestyle practices. At work, I receive recognition or praise for doing good work on a regular basis. My work environment is trusting and open. I have developed close friendship(s) with people at work. My department supports each others efforts to adopt healthier lifestyle practices. I would refer a good friend or family member for employment. Comments:

5 6. HEALTH AND WELLBEING: Please indicate your level of agreement with the statements below using the following scale: Undecided/Don't Know For 5 of the past 7 days, I exercised 30 minutes or more For the past week, I ate healthy. For the past week, I felt well-rested. I am taking steps to either PREVENT or MANAGE high blood pressure, high cholesterol, diabetes, depression, heart attack, asthma or cancer. I do NOT consider drinking alcoholic beverages and/or smoking to be an important part of my lifestyle.. In the past 12 months, I have NOT had a condition that caused recurring pain (i.e. neck, back, knee, leg, other). I have a personal doctor I see on a regular basis for preventative screenings. Comments: 7. What does a "well workday" mean to you? 8. What causes feelings of fear or anxiety in your current role? 9. What would you do in your current role or career if money was no object and you knew you could not fail? 10. Healthcare often says, "what's the matter with you." Take a moment to write, "what matters to you."

6 11. Who is the individual on your team or within your organization that you interact with on a regular basis and GET INFORMATION from. This is not necessarily a leader, just someone who is "in the know." Please type the name of that individual (FIRST AND LAST) in the box below or type "Unknown." 12. Who is the individual on your team or within your organization that you interact with on a regular basis that you view as setting a POSITIVE EXAMPLE OF HEALTH AND WELLBEING. Please type the name (FIRST AND LAST) of that individual in the box below or type "Unknown." 13. I have the following talents/hobbies/interests that I could share with my team: Reading Writing Gardening Cooking Grilling Yoga or exercise instructor Walking Jogging/Running Hiking Snow Shoeing/Skiing Art/Music/Dance Weight lifting Meditation Spirituality Traveling Volunteer Opportunities Other (please specify)

7 14. What is the best time of the day for you to participate in work-sponsored activities during your non-paid hours? During work hours (i.e. lunch breaks) Mornings before work Afternoons Evenings after work Weekends I am not interested in participating Other (please specify) 15. Please complete this section if you are interested in leading or participating in a peer-led group activity. Your name and contact information will not be associated with your survey answers. Name: Phone: Department: Location: 16. Overall comments: