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Wellness Program Engagement & Barriers Survey

Measures employee participation patterns, motivational drivers, and barriers to workplace wellness engagement. Designed for HR and wellness teams seeking actionable data to improve program design, communication, and uptake.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

24 questions · ~11 min
Q01
Message

Welcome to the Employee Wellness Engagement Survey. This survey explores your experiences with workplace wellness programs to help us improve future offerings. Your participation is completely voluntary, and you may stop at any time. There are no right or wrong answers—we are interested in your honest opinions. All responses are confidential and will be reported only in aggregate. No individual responses will be shared with managers or leadership. The survey takes approximately 6–8 minutes to complete. Thank you for your time.

Q02
Multiple Choice

In the past 90 days, how often did you participate in any workplace wellness program or activity?

  • Weekly or more
  • 2–3 times per month
  • About once per month
  • One time
  • Not at all
Q03
Multiple Choice

What motivates you to participate in wellness programs? Select all that apply.

  • Improve health or energy
  • Reduce stress
  • Fun or friendly competition
  • Connect with coworkers
  • Rewards or incentives
  • Manager encouragement
  • Supportive company culture
  • Convenient scheduling
  • Expert-led, high-quality content
  • Ability to track progress or data
  • Confidence in privacy and confidentiality
  • Other (please specify)
Q04
Opinion Scale

How likely are you to participate in a wellness program in the next 3 months?

Scale: 1 – 7
Min:Very unlikelyMax:Very likely
Q05
Multiple Choice

How do you prefer to participate in wellness activities? Choose up to three.

  • In-person at the workplace
  • Live virtual sessions
  • Self-paced digital modules
  • Hybrid (mix of in-person and virtual)
  • Team-based challenges
  • 1:1 coaching
Q06
Long Text

If you could change one thing about your organization's wellness programs to increase your participation, what would it be?

Q07
Multiple Choice

What is your primary work arrangement?

  • Onsite
  • Hybrid
  • Fully remote
  • Prefer not to say
Q08
Message

Thank you for completing the survey. Your feedback will directly inform improvements to our wellness programs.

Q09
Multiple Choice

Which types of wellness activities have you participated in during the last 6 months? Select all that apply.

  • Step or activity challenges
  • Mindfulness or meditation
  • Nutrition or healthy eating
  • Sleep improvement
  • Financial well-being
  • Health screenings or assessments
  • Mental health group sessions
  • Volunteering or social impact
  • Ergonomics or stretch breaks
  • Other
  • None of the above
Q10
Multiple Choice

Which factors, if any, made it difficult to participate in wellness programs in the past 90 days? Select all that apply.

  • Not enough time due to workload
  • Schedule conflicts or time zone differences
  • Wasn't aware of offerings
  • Programs not relevant to my needs
  • Limited manager support
  • Privacy or data concerns
  • Technical or access issues
  • Not available in my location
  • Prefer to do wellness on my own
  • Too many simultaneous initiatives
  • Other (please specify)
  • Nothing prevented me
Q11
Dropdown

Realistically, how many wellness activities do you expect to participate in over the next 3 months?

  • 0
  • 1
  • 2–3
  • 4–5
  • 6 or more
Q12
Multiple Choice

Which communication channels would most likely prompt you to participate? Select all that apply.

  • Email newsletter
  • Direct email invite
  • Slack or Teams message
  • Intranet homepage
  • Manager mention in team meeting
  • Calendar invite or hold
  • Onsite posters or digital signage
  • Mobile app push notification
  • Other (please specify)
Q13
AI Interview

Based on your survey responses, we'd like to explore your wellness experience in a bit more depth. Please share your thoughts and our AI moderator will ask a couple of brief follow-up questions.

Q14
Multiple Choice

Which best describes your role level?

  • Individual contributor
  • People manager
  • Senior leader
  • Prefer not to say
Q15
Opinion Scale

How clear are you about the wellness programs currently available to you?

Scale: 1 – 5
Min:Not at all clearMax:Extremely clear
Q16
Opinion Scale

How important is it that wellness programs fit into your existing work schedule?

Scale: 1 – 5
Min:Not at all importantMax:Extremely important
Q17
Ranking

Rank the following incentives from most motivating to least motivating.

  1. Gift cards or cash rewards
  2. Public recognition or leaderboards
  3. Charitable donation on my behalf
  4. Extra time off or flexible hours
  5. Health insurance premium discounts
  6. Wellness merchandise or swag
Drag to rank
Q18
Multiple Choice

How long have you been with your organization?

  • Less than 6 months
  • 6–12 months
  • 1–3 years
  • 3–5 years
  • 5+ years
  • Prefer not to say
Q19
Opinion Scale

How important is it that wellness program content is relevant to your personal health goals?

Scale: 1 – 5
Min:Not at all importantMax:Extremely important
Q20
Dropdown

When do you most prefer to participate in wellness activities?

  • Before work
  • During lunch
  • Mid-afternoon
  • End of day
  • Evenings
  • Weekends
  • Varies / no preference
Q21
Dropdown

Where are you primarily located?

  • Americas
  • EMEA
  • APAC
  • Other / Prefer not to say
Q22
Opinion Scale

How important is it that your manager supports your participation in wellness programs?

Scale: 1 – 5
Min:Not at all importantMax:Extremely important
Q23
Ranking

Rank the following wellness topics by your level of interest (top = most interested).

  1. Physical activity and fitness
  2. Stress management and mindfulness
  3. Nutrition and healthy eating
  4. Sleep health
  5. Financial well-being
  6. Ergonomics and posture
  7. Social connection and volunteering
Drag to rank
Q24
Opinion Scale

How important is it that your participation data and health information remain private?

Scale: 1 – 5
Min:Not at all importantMax:Extremely important

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • AI interviews dynamically adapt based on whether respondents are early adopters, skeptics, or non-users—capturing qualitative depth at quantitative scale
  • A generous free tier and affordable plans fit university research budgets, unlike enterprise-locked Qualtrics
  • Every AI parameter is logged for replication—critical for the peer-reviewed AI adoption research that competitors' tools cannot support
  • AI follow-up questions probe beyond surface-level Likert ratings to uncover root causes of disengagement—something no static survey can do
  • Full transparency: every prompt, model, and logic flow is visible to HR researchers, unlike competitor 'black box' AI features

SurveyMonkey

AI Readiness Assessment Template

SurveyMonkey's AI Readiness Assessment is the closest match—evaluating employee AI awareness, training needs, and current tool usage. Solid for organizational readiness but doesn't specifically measure feature-level adoption, trust, or perceived value of AI capabilities.

What it does well

  • Covers employee awareness, comfort levels, and perceived impacts of AI
  • Includes risk, compliance, and ethical considerations alongside adoption questions
  • Fully customizable with branding, and AI-powered analysis suite for open-ended responses

Where it falls short

  • Focused on organizational readiness, not specific AI feature adoption or value perception
  • No conversational AI follow-ups to explore trust barriers or adoption hesitancy in depth
  • SurveyMonkey's own AI tools (Build with AI, analysis) operate as black boxes—no prompt or model transparency
  • No validated trust measurement scales—uses general readiness questions rather than academic trust constructs

Qualtrics

Qualtrics XM for Strategy + Research

Qualtrics publishes extensive research on AI trust gaps (e.g., their State of AI in Employee Experience report analyzing 35,000+ employees) but doesn't offer this as a self-serve template. Their conversational feedback feature is the most competitive AI-interview capability in the market.

What it does well

  • Conversational feedback uses generative AI to generate follow-up questions during live surveys—respondents contribute 40% more information
  • Own research demonstrates deep expertise in AI trust measurement at organizational scale
  • 23 question types including video/audio responses with advanced logic branching

Where it falls short

  • No public pre-built AI feature adoption or trust survey template—requires custom building
  • Pricing starts at $420/month, making it inaccessible for academic researchers and small teams
  • Conversational feedback AI is not researcher-configurable—no access to prompts, no model selection, no parameter logging
  • Enterprise-focused platform creates unnecessary complexity for straightforward adoption studies

Jotform

Technology Surveys

Jotform offers 100+ technology survey templates including some AI-adjacent ones (AI-Augmented Learning Perception, Healthcare AI Bias Awareness, Public Perception of Health AI Tools), but none specifically targeting AI feature adoption and trust in a product or workplace context.

What it does well

  • Largest volume of AI-adjacent survey templates among competitors (100+ technology surveys)
  • Free plan available with drag-and-drop customization and conditional logic
  • Separate AI Agents product offers conversational survey experiences with NLP

Where it falls short

  • No dedicated AI feature adoption or trust survey template—closest options are domain-specific (healthcare, education)
  • AI Agents are a separate product from form templates—not integrated into survey methodology
  • No academic methodology validation, no rubric checking, no scale construction guidance
  • AI Agent training is opaque—no visibility into prompts, models, or reasoning logic for researchers

SurveyMonkey

Employee Engagement Survey Template

Well-established template with benchmarking capabilities and expert-written questions across motivation, leadership, growth, recognition, and culture themes. Strong analytics with filters and crosstabs, but fundamentally limited to static question-and-answer format.

What it does well

  • Industry benchmarking data to compare scores against other organizations
  • Standardized 5-point Likert scale with built-in scoring methodology
  • Extensive customization and segmentation by team or location

Where it falls short

  • No AI-powered follow-up questions to explore the 'why' behind low scores
  • Static survey format cannot adapt to individual employee responses in real-time
  • AI features limited to survey creation assistance, not actual respondent interaction

Typeform

Employee Engagement Survey Template

Visually appealing one-question-at-a-time conversational format that improves completion rates. Strong UX and branding customization, but the 'conversational' experience is still pre-scripted—it doesn't actually listen and adapt like AI.

What it does well

  • Beautiful, conversational one-question-at-a-time interface that feels less like a survey
  • Strong integrations with Slack, Microsoft Teams, and 300+ tools
  • Excellent mobile experience with no app downloads required

Where it falls short

  • No AI follow-up probes—conversational format is just UX, not intelligent adaptation
  • No transparent AI methodology—no visible prompts or logic for researchers to audit
  • Limited survey methodology rigor—focuses on design over academic-grade question construction

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