Employment Health Assessment Questionnaire


An employment health assessment questionnaire is a well framed questionnaire which is adopted by a company to assess the health of its employees so as to know about the overall health state of the employee base. These questionnaires are effective in helping the company know about the limitations of employees as far as health is concerned so that necessary medical attention can be provided when needed.

The following is a sample of one such employment health assessment questionnaire that can be used for reference by anyone:

Sample Employment Health Assessment Questionnaire

Name of employee:

Age of employee:

Gender of employee:

Contact number of employee:

Number of years of job posting:

Please take out a few minutes to answer the following employment health assessment questionnaire:

Q1. Have you ever faced a health issue while at work?

a)      Yes

b)      No

Q2. Do you face any limitations while:

a)      Standing

b)      Walking

c)      Sitting

d)     Balance coordination

(Tick the one which is appropriate)

Q3. Are you waiting for any treatment or investigation of a health check done?

a)      Yes

b)      No

Q4. If yes, then please specify the details of the treatment or test.

___________________________________________________

Q5. Are you suffering from any kind of medical condition about which the company must know?

a)      Yes

b)      No

Q6. If yes, then please specify the medical condition?

______________________________________________________

Q7. Do you wear specs?

a)      Yes

b)      No

Q8. Do you find it difficult to work without specs?

a)      Yes

b)      No

Q9. Do you face a problem in working on a system for a long duration of time?

a)      Yes

b)      Sometimes

c)      No

Q10. Do you get tired easily or lose focus from work often?

a)      Yes

b)      Sometimes

c)      No

Q11. Would you call yourself fit and healthy?

a)      Yes, I feel I am fit and healthy.

b)      No

Category: Employment Questionnaire

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