Work Health SurveyTestQuestionsDemographicInformationYourResults1. My company cares about my personal well-being.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree2. My company provides access to mental health training.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree3. I am aware of what mental health services I can use when I’m struggling at work.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree4. I would be comfortable using my company’s services for a mental health concern.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree5. I would be comfortable asking my manager or HR for an accommodation if I needed it.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree6. My manager cares about my personal well-being.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree7. My company invests in developing supportive managers.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree8. My manager actively encourages me to take time off when I need it.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree9. I am comfortable providing feedback to my manager about their performance.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree10. I can negotiate my responsibilities and workload with my manager.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree11. My company’s leadership (Board, CEO, HR) is invested in their employees’ well-being.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree12. My company’s leadership speaks openly about mental health in my workplace.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree13. If I needed to take leave for a mental health concern, my company would support me.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree14. My company invests in an inclusive environment where employees of all identities feel valued and represented.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree15. The stress from work affects my relationships with friends, family, and coworkers.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree16. The stress from work has led to other mental health concerns (e.g. anxiety, depression, substance use).* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree17. I find it difficult to concentrate at work.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree18. I spend time actively looking for a new position.* Strongly Disagree Disagree Somewhat Disagree Somewhat Agree Agree Strongly Agree19. Tell us how your workplace is supportive and/or unsupportive. (OPTIONAL)Please take a moment to answer the following optional questions. Your answers are totally anonymous—we won't be able to identify you based on this information. Your answers help us provide better information and support for people like you.You can answer as many or as few questions as you would like. When you are done, scroll to the bottom of the survey and click "submit" to receive your screening results.About YouAge Rangeunder-1718-2425-3435-4445-54over-55Race/EthnicityAsian or Pacific IslanderBlack or African-American (non-Hispanic)Hispanic or LatinoNative American or American IndianWhite (non-Hispanic)More than one of the aboveOtherHousehold IncomeLess than $20,000$20,000 - $39,999$40,000 - $59,999$60,000 - $79,999$80,000 - $99,999$100,000 - $149,999$150,000+About Your CompanyWhat industry do you work in?Academic (Professor, Teaching Assistant, Researcher)AutomotiveConstructionEducation (Primary or Secondary School Teacher, Childcare Worker)EnergyFinancial ServicesFood and BeverageHealthcareLegal ServicesManufacturingMarketing and SalesMedia and TelecommunicationsNon-ProfitPublic Sector (Government)Research and DevelopmentSocial ServicesOtherIf "Other"...State (Please select a state or indicate that you live outside the United States.)I live outside the United StatesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificHow many people work for your company? 1-10 11-50 51-250 251-1,000 1,001-5,000 5,001+What is your current employment status?Full-timePart-timeIndependent contractor/Freelance employeeWhich of the following best describes your position?Someone supervises me; I supervise no one.Someone supervises me; I supervise one or more people.I supervise one or more people; no one supervises me.Of the following selections, which does your company currently provide? (Check all that apply.) Competitive salary or wages Insurance benefits that cover mental health Other financial perks (401k, short or long-term disability) Paid time off (vacation, sick, holidays) Paid parental leave Employee Assistance Program (EAP) or similar program Professional development opportunities (conference registration, travel stipends, education/certification reimbursement) Open-door policies or relaxed work environment Flexibility in time off during the workday (breaks, long lunch, time to exercise, relax, take a nap) Remote work options (permanent or semi-permanent remote work, teleworking) Onsite perks (childcare, ability to bring a pet to work, wellness space, gym) Volunteer opportunitiesEmailThis field is for validation purposes and should be left unchanged.
