Return to Work Template - view only

	A	B	C	D
1		Preparing to Return to the Workplace
2	Survey Section	Survey Factor	Question Text	Notes
3	Return Readiness	Return Readiness	I am confident I can make an effective transition back to the workplace
4	Return Readiness	Return Readiness	I am looking forward to returning to the workplace
5	Return Readiness	Return Readiness	I will feel safe being in the workplace when COVID-19 restrictions are lifted
6	Support	Support	I am able to transition back to the workplace with minimal disruption to my usual routine/personal life
7	Support	Support	I am able to manage any caring responsibilities while transitioning back to work (e.g. child care, looking after dependents)
8	Support	Support	I feel confident that I would receive support from coworkers if I needed it
9	Support	Support	I have been appropriately involved in my return to work plan
10	Manager support	Manager support	Are you a people manager? Yes/No	Used to create branching for remaining questions in the section
11	Manager support	Manager support	I am confident I can support my direct report(s) in a successful transition back to the workplace
12	Manager support	Manager support	I have been provided with the resources I need to support my direct report(s) when they return to the workplace
13	Manager support	Manager support	I have been informed on the health and safety precautions my direct report(s) will need to follow
14	Manager support	Manager support	I feel equipped to have difficult conversations with my direct report(s) on their return to the workplace
15	Manager support	Manager support	I have the support I need to manage a phased return of my direct report(s)
16	My Role	My Role	I have been informed on whether there will be any changes to my role responsibilities when I return to the workplace
17	My Role	My Role	I have been informed of the responsibilities of my role as I return to the workplace
18	My Role	My Role	I feel capable to successfully carry out the responsibilities of my role as I return to the workplace
19	My Role	My Role	I know how my role contributes to the organization's success as I return to the workplace
20	Wellbeing	Wellbeing	I am feeling energized about returning to the workplace
21	Wellbeing	Wellbeing	I believe I will be treated fairly by my coworkers as I transition back to the workplace
22	Wellbeing	Wellbeing	I feel confident that any changes to my personal circumstances will not impact my ability to do my job effectively
23	Wellbeing	Employee Assistance	I know how to access %ACCOUNT_NAME%'s Employee Assistance Program [other employee support program]
24	Wellbeing	Employee Assistance	I believe %ACCOUNT_NAME%'s Employee Assistance Program [other employee support program] will meet any needs I may have
25	Wellbeing	Employee Assistance	I know how to get access to %ACCOUNT_NAME%'s mental health resources
26	Wellbeing	Employee Assistance	I believe %ACCOUNT_NAME% are providing employees with the mental health resources they need
27	Wellbeing	Wellbeing	I have been able to maintain my physical health during COVID-19
28	Safety	Travel	I would feel safe traveling to the workplace when COVID-19 restrictions are lifted
29	Safety	Travel	I would feel comfortable traveling for work related purposes (e.g. attending offsite meetings) when COVID-19 restrictions are lifted
30	Safety	Knowledge of Safety Measures	I have been informed of the safety measures being put in place when I return to the workplace
31	Safety	Knowledge of Safety Measures	I have been informed of what workplace facilities will be available (e.g. gym, cafeteria, social areas) when I return to the workplace
32	Safety	Knowledge of Safety Measures	I have been informed of what social distancing measures will be in place when I return to the workplace
33	Safety	Knowledge of Safety Measures	I have been informed of what personal protective equipment will be available to me when I return to the workplace
34	Safety	Comfort with Safety Measures	I would feel comfortable being in the workplace if [safety protocol e.g. wearing a mask / temperature check / social distancing ] is in place	Create additional questions for each safety measure
35	Concerns	Concerns	I know where to raise concerns about transitioning back to the workplace
36	Concerns	Concerns	I would feel comfortable raising concerns about transitioning back to the workplace
37	Concerns	Concerns	What (if any) are your biggest concerns about returning to the workplace?
38	Comments	Free text	What can %ACCOUNT_NAME% do to support you as you make the transition back to the workplace?
39	Comments	Free text	What has %ACCOUNT_NAME% implemented in response to the COVID-19 pandemic that could help working life in the future? (Flexible work hours, daily stand-ups, project teams)
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41		Demographics	What are your caregiving responsibilities? Children (part- or full-time) Other adults Children and other adults No caregiving responsibilities
42			What is your living status? Living alone Living with family Living with other people
43			Where are you currently living? In usual residence In other residence (same state/county) In other residence (different state/county) In other residence (abroad)
44			How do you usually travel to work? Walk Cycle Drive Taxi Public Transport Other, please specify...
45			How do you plan to travel to work once the COVID-19 restrictions are lifted? Walk Cycle Drive Taxi Public Transport Other, please specify...
46			Are there any travel restrictions in place that could prevent you from returning to the workplace from your current residence? Yes - legal restrictions Yes - public transport restrictions Unsure No
47			Prior to COVID-19 did you work remote? Always Sometimes Never
48			Are you a people manager? Yes No
49			Are you returning from furlough? Yes No
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