Employee Wellness Survey
Dear Ma'am/Sir,

Good day!

This survey form is designed to determine your health and wellness interests/needs. Your response in this form shall serve as our basis in the design & development of appropriate HR Welfare programs, activities and/or services.

Thank you in advance for your cooperation. We look forward in creating a more positive health-conscious workplace environment with you!

Email address *
INSTRUCTION
Kindly mark your corresponding response and provide other details, if necessary. THIS SURVEY WILL ONLY TAKE 3 - 5 MINUTES of your time. Every information typed herein shall be treated with utmost confidentiality.
I. Personal Information/Demographics
Full Name: *
Your answer
Employment Status *
Place of Assignment/Official Station *
Section/Unit/Program *
If working in the Extension/Center/Satellite Offices/Municipal Offices, kindly specify (eg., POO1, SWAD Quirino, RRCY)
Your answer
SEX *
AGE *
Medical/Health History ( as diagnosed by a Medical Health Practitioner in the past 12 months). *
(Please note that this shall be treated with full confidentiality. This is included for establishment and maintenance of an Employee Health Database only)
Required
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