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Primary Trauma Exposure & Workplace Support Survey

For organizations in high-risk professions (first responders, healthcare, social services, journalism) to understand how often staff are directly exposed to traumatic events on the job and whether current support systems actually help. An AI follow-up interview explores what support was present or missing after a recent difficult incident, without asking anyone to relive graphic details.

Sample questions

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

14 questions · ~7 min
Q01
Message

Thank you for taking part in this workplace wellbeing check-in. It asks about how often you're exposed to difficult events on the job and whether the support around you is working — not the details of any specific incident. It's confidential, not a clinical assessment, and takes about 8 minutes. Skip anything you'd rather not answer, and if you need support right now, please use (Replace with your organization's EAP/crisis line).

Q02
Multiple ChoiceRequired

In the last 12 months, how often have you been directly exposed to a potentially traumatic event as part of your role (for example, witnessing death, serious injury, or violence)?

  • Never
  • Once or twice
  • About monthly
  • About weekly
  • Almost daily
Q03
Multiple ChoiceRequired

Which of these, if any, have you experienced directly in your role in the last 12 months? Select all that apply — no details needed.

  • Death or serious injury
  • Physical violence or threats to you
  • Sustained verbal abuse or hostility
  • A mass-casualty or large-scale disaster event
  • Other
Q04
Opinion ScaleRequired

Lately, how much has this kind of exposure affected your ability to do your job effectively?

Scale: 17
Min:Not at allMax:Significantly
Q05
MatrixRequired

How much do you agree with each statement about support in your workplace?

4 rows × 5 columns
  • I have someone I can talk to after a difficult incident
  • My supervisor checks in with me after critical incidents
  • I know how to access mental health support through my employer
  • I feel safe telling someone when an incident has affected me
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q06
Rating Scale

Thinking about the most recent difficult incident you experienced at work, how would you rate the support you received afterward?

Range: 15
Min:PoorMax:Excellent
Q07
Multiple Choice

Which of these support resources have you actually used in the last 12 months?

  • Employee assistance program / counseling benefit
  • Peer support team
  • Manager or supervisor check-ins
  • External therapist or counselor
  • Chaplaincy or spiritual care
Q08
AI Interview

Without asking for graphic details of the incident itself, explore what happened around the most recent difficult event the respondent flagged: who reached out afterward, what support (if any) actually helped, and what was missing or came too late. If they say support was good, probe what specifically made it work so it can be repeated elsewhere. If they say they've had no support, gently ask what would have made it easier to reach out, and remind them support resources are available without pressing further.

Q09
Opinion ScaleRequired

How confident do you feel in your ability to cope with future difficult events in this role?

Scale: 17
Min:Not at all confidentMax:Extremely confident
Q10
Multiple ChoiceRequired

Are you currently considering leaving this role or profession because of its emotional demands?

  • Not at all
  • Occasionally think about it
  • Frequently think about it
  • I've already decided to leave
Q11
Long Text

What one change would most improve support for people in your role after a difficult incident?

Q12
Multiple Choice

How long have you been in a role with this kind of exposure?

  • Less than 1 year
  • 1-3 years
  • 4-9 years
  • 10+ years
  • Prefer not to say
Q13
Multiple Choice

Which age range do you fall into?

  • Under 25
  • 25-34
  • 35-44
  • 45-54
  • 55+
  • Prefer not to say
Q14
Message

Thank you for sharing this with us. Responses are combined into an aggregate report used to strengthen critical-incident support and staffing decisions — no individual answers are shared with your direct manager. If anything came up for you while answering, (Replace with your organization's EAP/crisis line) is available any time.

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

  • Includes an adaptive AI follow-up interview that explores what support was present or missing after a recent difficult incident, without requiring anyone to describe graphic details
  • Combines structured exposure-frequency and support-usage questions (multiple-choice, matrix, rating, rating-scale) with open-ended follow-up so both patterns and lived experience are captured
  • Directly asks about retention risk (considering leaving the role) and gathers a concrete improvement suggestion via long-text, giving organizations actionable output
  • Closes with a transparent message explaining that responses are aggregated into a report, and is built for organizations to run themselves with automated per-response quality scoring rather than requiring a research team to hand-code results

QuestionPro

Primary Trauma Survey Questions + Sample Questionnaire Template

This is a sample questionnaire and question bank for primary trauma exposure rather than a ready-to-field adaptive instrument. It's useful as a reference for question wording but appears to be a static list to copy into QuestionPro's survey builder. No mention of built-in interview-style follow-up on individual incidents.

What it does well

  • Established survey platform with broad question-type library and reporting tools
  • Provides sample question wording specific to primary trauma exposure, saving drafting time
  • Likely supports standard skip logic and quantitative analysis dashboards

Where it falls short

  • No adaptive AI follow-up interview to probe what support was present or missing after a specific incident
  • Static question set means every respondent gets the same fixed items regardless of their answers
  • No indication of per-response quality scoring or transparent AI prompt methodology

Jotform

Psychological Trauma Questionnaire Form Template

A general psychological trauma intake form, more clinical/individual-assessment in framing than a workplace wellbeing check-in for high-risk professions. It's a form template built on Jotform's drag-and-drop builder, not a research instrument designed for organizational reporting. Good for basic intake but not tailored to occupational exposure or support-system evaluation.

What it does well

  • Easy drag-and-drop customization within Jotform's form builder
  • Free-form template lowers the barrier to quickly assembling a basic trauma-related form
  • Can integrate with Jotform's broader form ecosystem (notifications, storage, etc.)

Where it falls short

  • No adaptive or voice AI interview component to explore incident context conversationally
  • Not built specifically for high-risk occupational exposure or workplace support evaluation
  • No automated aggregate reporting or per-response quality scoring geared toward organizational decision-making

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.