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Workplace Wellness Inventory

We would like your help in assessing your workplace environment as you see it. Read over the complete form first, then go back and fill in your answers. Answers will be confidentially compiled to facilitate problem solving and assess training needs. Please put your completed form in a sealed envelope and give to the designated person.

1. I look forward to coming to work ____days out of five.

2. The best things that happen at work are:

3. The most challenging situations for me at work are:

4. Please rate the following from 0 to 3 by the challenge they give you.
( 0– no problem, 1- an occasional problem, 2-often a problem; 3- A definite challenge for me)
___Interoffice relationships/teamwork
___Interoffice communication
___Developing & maintaining customer rapport
___Dealing with angry people
___Lack of communication from others
___Dealing with difficult mindsets
___Find change difficult or disruptive
___Find it hard to express ideas, feelings
___Often feel no one listens to me
___My ability to communicate needs
___Dressing better for less money
___Stress caused at work
___Stress caused at home
___Sometimes I feel unappreciated
___Unclear about department objectives
___My understanding of other’s actions
___My ability to make a positive difference at work
___Speaking with power and persuasion
___My image compliments company goals
___Bridging generational differences
___There is pettiness, gossip & blaming

5. What I feel I(we) need to learn more about to be more effective:
(ie. Balancing work/personal issues, personality conflict, communication skills, dealing with change, procedural clarifications, etc. Please be specific)

6. Other comments you feel are important: