Q01
Message
All templatesOperations & Data
Workplace Facility Condition & Maintenance Response Survey
Measures employee perceptions of facility cleanliness, environmental comfort, and maintenance responsiveness over a 30-day recall period to help facility and operations teams identify and prioritize improvement areas.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
23 questions · ~10 min
Q02
Multiple Choice
Where do you primarily work?
- HQ or main office
- Regional or satellite office
- Shared or co-working space
- Warehouse or industrial site
- Hybrid across multiple sites
- Remote (no fixed site)
Q03
Opinion Scale
Overall, how would you rate the cleanliness of your workplace facility?
Scale: 1 – 7
Min:Very poorMax:Excellent
Q04
Opinion Scale
How satisfied are you with the temperature and climate control in your workspace?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q05
Multiple Choice
Which of the following issues, if any, did you notice at your workplace? Select all that apply.
- Spill or mess not addressed
- Trash overflow
- Supplies out of stock (e.g., soap, paper towels)
- HVAC issue (too hot or too cold)
- Lighting or electrical issue
- Noise disturbance
- Pest sighting
- Restroom cleanliness issue
- None of the above
Q06
Ranking
Please rank the following improvement areas by priority (1 = highest priority).
- Increase cleaning frequency
- Improve restroom upkeep
- Better restocking of supplies
- Faster maintenance response times
- Improve temperature and climate control
Drag to rank
Q07
AI Interview
Based on your responses in this survey, please share any additional thoughts about your workplace facility experience. What one change would make the biggest difference to your daily comfort?
Q08
Multiple Choice
How long have you worked at the company?
- Less than 6 months
- 6–12 months
- 1–3 years
- 3–5 years
- More than 5 years
- Prefer not to say
Q09
Message
Thank you for completing this survey. Your feedback will be used to prioritize facility improvements over the coming quarter.
Q10
Dropdown
Approximately how many days were you on-site in the past 30 days?
- 0 days
- 1–5 days
- 6–10 days
- 11–15 days
- 16–20 days
- 21–25 days
- 26–30 days
Q11
Opinion Scale
How would you rate the cleanliness of your workstation or desk area?
Scale: 1 – 7
Min:Very poorMax:Excellent
Q12
Opinion Scale
How satisfied are you with the lighting in your workspace?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q13
Multiple Choice
How do you usually report facility or comfort issues?
- Helpdesk or ticketing portal
- Chat (e.g., Slack or Teams)
- Phone
- In person
- I typically do not report issues
Q14
Dropdown
Which department do you primarily work in?
- Operations
- Facilities
- Engineering / IT
- Sales / Marketing
- HR / People
- Finance
- Customer Support
- Other
- Prefer not to say
Q15
Opinion Scale
How would you rate the cleanliness of the restrooms?
Scale: 1 – 7
Min:Very poorMax:Excellent
Q16
Opinion Scale
How satisfied are you with the noise level in your workspace?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q17
Multiple Choice
For the most recent issue you reported, how quickly did you receive an initial response?
- Within 4 hours
- Within 1 business day
- 2–3 business days
- 4–5 business days
- More than 5 business days
- Not resolved yet
- I did not report an issue
Q18
Multiple Choice
Which best describes your role level?
- Individual contributor
- Team lead or supervisor
- Manager or director
- Senior leadership or executive
- Prefer not to say
Q19
Opinion Scale
How would you rate the cleanliness of break rooms or kitchen areas?
Scale: 1 – 7
Min:Very poorMax:Excellent
Q20
Opinion Scale
How satisfied are you with the seating and ergonomic setup at your workstation?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q21
Opinion Scale
Overall, how satisfied are you with how quickly and effectively facility issues are addressed?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q22
Multiple Choice
What is your employment status?
- Full-time
- Part-time
- Contractor
- Intern / Apprentice
- Prefer not to say
Q23
Opinion Scale
How would you rate the cleanliness of meeting rooms and common areas?
Scale: 1 – 7
Min:Very poorMax:Excellent
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
- Covers cleanliness across five distinct zones (workstation, restrooms, break rooms, meeting rooms, overall facility) rather than a single general rating
- Includes a structured maintenance-responsiveness track: how issues are reported, how quickly they were addressed, and satisfaction with resolution speed
- Uses a ranking question to force-prioritize improvement areas, giving facility teams a clear action list instead of just averages
- Closes with an AI follow-up interview that adapts to each respondent's prior answers, surfacing specifics that fixed-choice questions can't capture
Jotform
800+ Facility Management FormsThis is a broad template gallery/category page for facility management forms rather than a single ready-to-field employee perception survey. It's useful as a starting point for building maintenance request or inspection forms, but requires selecting and customizing an individual form to match a structured 30-day employee-experience study.
What it does well
- Large library covering many facility-related use cases (inspections, requests, checklists)
- Drag-and-drop form builder allows quick customization of chosen templates
- Established platform with broad integration and distribution options
Where it falls short
- Static form fields only — no adaptive follow-up questioning to probe vague or negative responses
- No built-in voice AI interview option or automated per-response quality scoring
- As a category page, no single template is purpose-built to measure cleanliness, comfort, and maintenance responsiveness together with department/tenure segmentation
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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