Q01
Message
All templatesIndustry-Specific
Workplace Culture Health Assessment
Measures how employees actually experience company culture — psychological safety, values alignment, manager reinforcement, and day-to-day behavior — not just stated policy. An AI follow-up interview digs into the story behind the most telling rating, surfacing specific moments that a scale alone can't capture.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Opinion ScaleRequired
How likely are you to recommend this company to a friend as a great place to work?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q03
MatrixRequired
How much do you agree with each statement about your day-to-day experience here?
5 rows × 5 columns
- I feel safe raising concerns or disagreeing with my manager
- Leaders here model the values they say they hold
- My team collaborates effectively across departments
- Good work gets noticed and recognized
- Decisions that affect me are made transparently
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q04
Multiple ChoiceRequired
In the last 3 months, how often have you seen someone's behavior clash with a value the company claims to hold, with no visible consequence?
- Never
- Once
- A few times
- Regularly
- I'm not sure
Q05
Best–Worst Trade-off (MaxDiff)Required
From this list of things our company says it values, pick the one you see lived out most in practice, and the one you see least.
- Transparency in decision-making
- Work-life balance
- Innovation and risk-taking
- Customer obsession
- Collaboration over internal competition
- Accountability for mistakes
- Recognition of good work
- Diversity and inclusion
Pick best & worst per setBest:Most lived outWorst:Least lived out
Q06
Multiple ChoiceRequired
When there's disagreement or conflict on your team, how is it typically handled?
- Addressed directly and openly in the moment
- Escalated to a manager to resolve
- Avoided or smoothed over without real resolution
- Left to fester until it becomes a bigger issue
- Varies too much to say
Q07
Rating ScaleRequired
How would you rate your direct manager's ability to build a healthy team culture (trust, fairness, communication)?
Range: 1 – 5
Min:Very poorMax:Excellent
Q08
Multiple ChoiceRequired
How comfortable would you feel giving honest, critical feedback directly to senior leadership?
- Very uncomfortable
- Somewhat uncomfortable
- Neutral
- Somewhat comfortable
- Very comfortable
Q09
AI Interview
Probe the reasoning behind the respondent's recommendation likelihood score and their psychological safety rating. Ask for a specific recent example — a moment they felt genuinely supported or unsupported, or a time they held back from speaking up — and what happened as a result. If they flagged a values-behavior gap or picked a least-lived-out value, ask what a leader could concretely do differently. If everything scored very positively with no specifics, probe gently for anything that felt 'off' recently.
Q10
Dropdown
Which department or team are you part of? (Optional — helps us spot team-level patterns.)
- Engineering / Product
- Sales
- Marketing
- Customer Support
- Operations
- Finance / Legal
- People / HR
- Other
- Prefer not to say
Q11
Multiple Choice
How long have you been with the company?
- Less than 6 months
- 6 months to 2 years
- 2-5 years
- More than 5 years
- Prefer not to say
Q12
Multiple Choice
Which best describes your role level?
- Individual contributor
- People manager
- Senior leader / executive
- Prefer not to say
Q13
Message
That's everything — thank you for the honesty. Responses are aggregated into a culture health report shared with leadership so specific, fixable issues (not just vibes) get acted on.
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 AI follow-up interview that probes the reasoning behind the recommendation-likelihood score, surfacing specific stories a scale alone can't capture
- Combines quantitative measures (opinion scale, matrix, rating, max-diff) with qualitative depth in a single flow, so you get both the 'what' and the 'why'
- Asks concrete, behavior-based questions (value-clash frequency, conflict handling, comfort giving feedback to senior leaders) rather than only abstract policy statements
- Segments by department, tenure, and role level so you can spot where culture breaks down, then auto-generates a report from aggregated responses
Jotform
Business Health Assessment Survey Form TemplateA general business-health form that touches on organizational and operational wellbeing rather than being purpose-built for culture diagnostics. It's a ready-to-field static form builder template, useful as a starting point but not tailored to psychological safety or manager-culture dynamics. Best suited to teams wanting a broad health check rather than a deep culture read.
What it does well
- Ready-to-use, fieldable form template with Jotform's drag-and-drop builder
- Broad business-health framing that could appeal to non-HR stakeholders
- Easy to embed and customize like other Jotform templates
Where it falls short
- Static question set with no adaptive follow-up to dig into a specific low or high rating
- No voice AI interview option or guided screen-share tasks
- No automated per-response quality scoring or transparent prompt methodology
Typeform
Business Culture Survey FormA conversational-style form focused on business culture, leveraging Typeform's one-question-at-a-time UX to keep completion friendly. It's a fielding-ready static template, not an AI-driven interview, so it collects self-reported ratings without probing further. Good for lightweight pulse checks but limited for uncovering the story behind an answer.
What it does well
- Polished, conversational one-question-at-a-time interface that boosts completion rates
- Fieldable out of the box with Typeform's known design quality
- Simple sharing and embedding across channels
Where it falls short
- No adaptive AI follow-up questioning — every respondent sees the same fixed question sequence
- No voice interview or guided task capability
- No built-in automated quality scoring of open-ended responses
QuestionPro
Organizational Culture Assessment Survey TemplateA dedicated organizational culture template covering standard dimensions like values, leadership, and engagement, positioned as a ready-to-use survey. It relies on fixed rating and multiple-choice items rather than dynamic probing, so nuance behind any given score has to be inferred rather than asked for directly. Solid for benchmarking but static by design.
What it does well
- Purpose-built for organizational culture assessment, so question coverage is topically relevant
- Ready-to-field template within QuestionPro's established survey platform
- Likely includes standard reporting/analytics dashboards typical of QuestionPro
Where it falls short
- No adaptive AI follow-up interview to explore the reasoning behind a specific rating
- No voice AI interview or guided screen-share task option
- No transparent, published prompt methodology or automated response-quality scoring
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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