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A health and wellness assessment questionnaire is a short set of questions that helps an employer check how staff are feeling. It can cover physical symptoms, energy, stress and workload, so that problems are picked up early and support can be planned. This page keeps the screening form BOTI published during the COVID-19 pandemic. It also explains how to build a broader wellness questionnaire and where training fits in, using BOTI’s health, safety and wellness training courses.
Fighting COVID 19 – Wellness Assessment Questionnaire
Signing this form indicates that you confirm that you are feeling well and that you do not have any of the following symptoms: Headache / high temperature/fever / cough / sore throat / loss of smell / loss of taste. Should you be suffering from any of these symptoms please either self-isolate at home or seek medical attention.
Signing this form also indicates that you confirm that you have not recently been in contact with anyone who has tested positive for COVID-19.
| Temperature | Passed test? | Feeling Well? | |||||
| Date | Name | Temperature Reading | Yes | No | Yes | No | Signature |
Disclaimer: Use of this form is at your own risk including the addition and modification of any fields where necessary.
A note on this form
BOTI created the screening register above in 2020, when many workplaces checked staff and visitors for COVID-19 symptoms every day. Rules and health guidance have changed since then. Before you use the form, check current guidance from the national health authorities and your own occupational health and safety advice, and adapt the fields to what your workplace actually needs.
What a health and wellness assessment questionnaire covers
A symptom check asks one narrow question: is this person well enough to be here today? A broader wellness assessment questionnaire looks at how people are coping over time. It gives managers and HR a clearer picture of the pressures in a team, so they can act before problems turn into absenteeism, mistakes or resignations.
Most workplace wellness questionnaires cover some or all of these areas:
- Physical health: energy levels, sleep, aches and strain linked to the job, and whether the person feels fit for their duties.
- Stress and workload: how manageable the workload feels, deadlines, overtime and the ability to switch off after work.
- Mental and emotional wellbeing: mood, worry, frustration and whether the person knows where to get support.
- Work environment: safety, equipment, lighting, noise and ergonomics at the desk or on site.
- Relationships at work: support from the manager, teamwork and any conflict or unfair treatment.
- Work-life balance: travel time, family responsibilities and flexibility.
Questions you can include
Keep the questionnaire short enough to finish in a few minutes. A rating scale (for example 1 to 5) makes answers easy to compare over time, and one or two open questions let people say what the scale misses. Examples:
- How would you rate your energy levels during a normal working day?
- How manageable is your current workload?
- How often do you feel stressed or anxious about work?
- Do you have the equipment and space you need to work safely and comfortably?
- Do you feel you can raise a concern with your manager?
- How well are you able to balance work and personal responsibilities?
- What one change would most improve your wellbeing at work?
Avoid questions that ask for a diagnosis or detailed medical history. A wellness questionnaire is a conversation starter, not a medical assessment. Anyone with a health concern should be referred to a medical professional or your employee support programme.
How to run the questionnaire fairly and privately
People answer honestly only when they trust how the answers will be used. A few practical steps help:
- Explain why you are asking, who will see the answers and what you will do with the results.
- Make participation voluntary and, where possible, anonymous. Report results for teams, not individuals.
- Store completed forms securely and limit access. Health details are sensitive personal information, so handle them in line with POPIA. The POPIA for Every Employee masterclass covers the basics of handling personal information safely.
- Repeat the questionnaire at regular intervals, such as every six or twelve months, so you can see whether things are improving.
Turning the results into action
A questionnaire only helps if something changes afterwards. Share a short summary of what you found, choose two or three priorities, and tell staff what will happen next. Common responses include adjusting workloads, fixing equipment or safety issues, training managers to spot early signs of strain, and giving staff practical tools for managing stress.
Training is often the quickest way to act on the results. Depending on what your questionnaire shows, teams may benefit from Stress Management Training, the Work-Life Balance Course or the Managing Workplace Anxiety Course. Where the answers point to safety concerns, the Occupational Health and Safety (OHS) Course helps supervisors understand their responsibilities. For more ideas, read BOTI’s article on wellness in the workplace and building more resilient teams.
If you would like to adapt the screening form above or design a wellness questionnaire for your organisation, ask BOTI to help you plan it alongside your training, or request a quote.
Frequently asked questions
What is a health and wellness assessment questionnaire?
It is a short set of questions that helps an employer understand how staff are feeling, covering areas such as physical health, stress, workload, the work environment and work-life balance. It is used to spot problems early and plan support, not to diagnose medical conditions.
What questions should a workplace wellness questionnaire include?
Include rating questions on energy levels, workload, stress, safety and equipment, support from the manager and work-life balance, plus one or two open questions asking what would improve wellbeing at work. Keep it short and avoid asking for medical history.
Should wellness assessment questionnaires be anonymous?
Anonymous questionnaires usually get more honest answers. Report results for teams rather than individuals, store forms securely and handle any health details in line with POPIA.
Is the COVID-19 screening form still needed?
The form on this page was created in 2020 for daily COVID-19 symptom screening. Check current guidance from the health authorities and your occupational health and safety advice before using it, and adapt the fields to your workplace.
Wellness training for your team
If your wellness assessment shows that staff are tired, stressed or struggling to balance work and home, BOTI’s Health and Wellness at Work Training is a practical one-day course that helps employees and managers build healthier habits and a more supportive workplace. Training runs in-house at your premises, at BOTI’s venue in Sunningdale, Johannesburg, or live online. This course is not accredited. It is delivered as a professional skills programme, and delegates receive a BOTI certificate of attendance. Call BOTI on 011 882 8853 or email [email protected].