WWKS - Well-Being Assessment

Well-Being Assessment

In developing a comprehensive worksite wellness initiative to address well-being, five strategies need to be employed: information, program, benefit design, policy, and environment.
Your worksite's individual responses to the survey will not be shared with anyone not affiliated with WorkWell KS. This survey will be used as an assessment to provide worksites with information about the steps your worksite can take to establish a worksite wellness initiative. Only aggregated results (with no worksite identifiers) may be published. If you have any questions regarding this survey, please contact Dr. Elizabeth Ablah at 316-293-2627 (eablah@kumc.edu).
Name of worksite*
Primary contact at worksite*
Who will server as WorkWell KS contact person?
Contact email*
example@example.com
County*
Zip*
City*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Approximate number of employees*
Not counting temporary or seasonal
Approximate number of employee dependents*
Spouses and children
What industry type best describes your worksite?*

Agriculture, Forestry, Fishing, and HuntingMining, Quarrying and Oil and Gas ExtractionUtilitiesConstructionManufacturingMachinery, Equipment, and Supplies Merchant WholesalersRetail TradeTransportation and WarehousingInformationFinance and InsuranceReal Estate, Rental, and LeasingProfessional, Scientific, and Technical ServicesEducational ServicesHealthcare and Social AssistanceArts, Entertainment, and RecreationAccommodation and Food ServicesGrant Making and Civic OrganizationsPublic Administration (including health departments)Other
Information
In the last three years, has your worksite administered an assessment that compares employees' current abilities to job demands?*

YesNo
In the last three years, has your worksite assessed work stress (e.g., schedules, workload, relationships with colleagues, satisfaction)?*

YesNo
In the last three years, has your worksite assessed any potential consequences of stress (e.g., absenteeism, disability, illness, productivity, turnover)?*

YesNo
In the last three years, has your worksite conducted a sustained, focused campaign to promote mental health and well-being?*

YesNo
In the last three years, has your worksite provided employees with information addressing the benefits of caring for one's mental health and personal well-being?*

YesNo
In the last three years, has your worksite provided employees information about available services and resources for employee mental health and well-being?*

YesNo
In the last three years, has your worksite provided employees information about coverage for mental health treatment?*

YesNo
1:Calc:Value Scale Total*
1:Calc:Score*
1:Calc Percent *
Program
In the last three years, has your worksite offered any of the following relaxation programs (select all that apply):

Relaxation training, including progressive relaxationMeditationMindfulness classYoga or tai chiOnsite massageOnsite exercise or physical activity program (e.g. classes)Arts activityGroup motivational interviewing to encourage daily physical activity and relaxationRegularly scheduled restorative break programsOther relaxation program
In the last three years, has your worksite offered any of the following professionalism skills programs (select all that apply):

Problem-solving trainingTime-management trainingJob skills trainingResilience trainingConflict resolution trainingPersonal financial planningOther professionalism skills program
In the last three years, has your worksite offered any of the following emotional intelligence programs (select all that apply):

BiofeedbackCognitive-behavioral skills (re-evaluating thoughts, emotions, behaviors)Positive psychologyInterpersonal skills trainingAssertiveness trainingPositive self-talkViewing change and adaptation as positiveOther emotional intelligence program
Does your worksite have any of these stress management programs (select all that apply)?

Cognitive behavioral-based stress managementNature-based stress management courseMindfulness-based stress management programStress support groupOther stress management program
Do upper and middle managers receive annual training on how to reduce employee work stress through professional development training (e.g., assertiveness, time management, conflict resolution, communication)?*

YesNo
Do upper and middle managers receive annual training on how to reduce their own work stress (e.g., assertiveness, time management, conflict resolution, communication)?*

YesNo
Does the worksite offer a participatory action-oriented stress management program (e.g., engaging employees in identifying problems and in the interventions to improve the work environment)?*

YesNo
2:Value Scale - total*
2:Calc:Score*
2:Calc Percent *
Benefit Design
Does your worksite offer paid maternity leave?*

YesNo
Does your worksite offer paid paternity leave?*

YesNo
What benefits are available at your worksite (select all that apply):

Separate sick leave from vacation time offChildcare or daycare facility on siteInfants up to 6 months can be brought to work
Does your worksite offer (select all that apply):

Meaningful annual employee recognitionsInternal promotionsFinancial rewards (e.g. bonus, raise)
Does your basic benefit package for employees include a benefit (e.g., premium reduction, deposit in HSA) for participation in a well-being program (e.g., mindfulness class, financial planning)?*

YesNo
3:Calc:Value Scale Total*
3:Calc:Score*
3:Calc Percent *
Policy
Does the worksite have a written policy allowing employees to take 10 to 15 minute "rest" or "booster" breaks to engage in healthy non-work activities?*

YesNo
Does the worksite have a written policy for minimum staffing levels (a sufficient number of staff in proportion to the required work)?*

YesNo

Does the worksite have any of the following written policies (not just practices):*

Rows	Yes	No
Self-scheduling (e.g. employees schedule own hours but must work at least minimum hours each week; detailed definition)
Flex-time (e.g. employees able to vary their arrival and/or departure times; detailed definition)
Stable shifts (employees stay on same shift) Teleworking (e.g. work offsite)
Gradual retirement (e.g. progressive reduction in hours)
Voluntary overtime
A ban on mandatory overtime
Job sharing (e.g. two or more employees sharing job duties of one employee)

Does the worksite have a written policy supporting time and accommodations for mental health and/or stress management?*

YesNo
Does the worksite have a written policy to prevent and address sexual harassment?*

YesNo
Does the worksite have a written policy to prevent and address bullying?*

YesNo
4:CalcValue Scale Total*
4:Calc:Score*
4:Calc Percent *
Environment
Does your worksite have at least one "Zen," comfort, or relaxation room where employees feel comfortable to relax in a quiet space?*

YesNo

7. What percent of employees have access at their workspace to:*

Rows	0-25%	26-50%	51-75%	76-100%
Sunlight, natural light
Windows
Nature outside (e.g., trees, vegetation)
Nature inside (e.g., plants)
Garden (can step away from work environment)
Personal, private space (e.g. locker, office)

In their workspace, what percent of employees have:*

Rows	0-25%	26-50%	51-75%	76-100%
Adequate or good ventilation
Non-fluorescent lighting
Tobacco and smoke-free environment
Moderate temperatures
Adequate office cleaning

Do employees have opportunities to listen to their choice of music in their workspace?*

YesNoN/A (not appropriate for the type of work we do)
Are employees able to personalize their workspace?*

YesNoN/A (employees do not have their own workspaces)
Does the worksite have at least one sports team for employee participation?*

YesNo
Does the worksite sponsor or organize regular (annual) social events (e.g., company picnic)?*

YesNo

What percent of employees:*

Rows	0-25%	26-50%	51-75%	76-100%
Have the opportunity to take uninterrupted meal breaks?
Take uninterrupted meal breaks?

To what extent do you agree with the following statements:*

Rows	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
Employees report having meaningful and/or stimulating work
Employees do not have repetitive work
Employees know what is expected of them in their roles
Employees have career development opportunities (career and promotion opportunities)
Employees participate in and have some control in decision-making that affects their jobs
The demands of the work (work load and pace) match employees' abilities
The culture values two-way organizational communication
Co-workers respect and support one another
Supervisors support their employees
The worksite fosters social support or social capital (networks of relationships that enable co-workers to function effectively)
Managers are willing to redesign employee job description to improve fit
Worksite accommodates non-work demands (e.g., leaving to pick up kids from school)
Employees report feeling supported by their employer
Employees are committed to the worksite
The worksite encourages employees to volunteer in the community

5:Calc Value Scale - Total*
5:Calc NA questions - Total*
5:Calc:Score*
5:Calc:Score for pdf*
5:Calc:Scale Adjusted*
5:Calc Percent *
Should be Empty:

Well-Being Assessment

Information

Program

Benefit Design

Policy

Environment