Employee Welfare Assessment Covid 19

Use this template to perform a welfare assessment of employees especially in the context of the COVID-19 pandemic. ​

Employee Welfare Assessment - COVID-19



General Information

1. Name of Employee


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2. Date of Welfare Check


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3. Welfare Check Conducted By


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4. Position of person carrying out the check


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5. Date of next scheduled Welfare Check


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Employee To Indicate How They Have Been Feeling During The Coronavirus Pandemic

1. I have felt cheerful and in good spirits


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2. I have felt calm and relaxed


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3. I have felt active and vigorous


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4. I woke up feeling fresh and rested


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5. My daily life has been filled with things that interest me


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Wellbeing

1. Have you been worried during the coronavirus pandemic?


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2. Have you suffered from any anxiety during the coronavirus pandemic?


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3. Have you been suffering from a variety of different emotions during the coronavirus pandemic?


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4. Have you suffered from any emotional reactions during the coronavirus pandemic, as listed in Appendix A?


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5. Have you suffered from any social reactions during the coronavirus pandemic, as listed in Appendix A?


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6. Have you suffered from any psycho-social reactions during the coronavirus pandemic, as listed in Appendix A?


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7. Have you suffered from any cognitive reactions during the coronavirus pandemic, as listed in Appendix A?


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8. Have you suffered from any physical reactions during the coronavirus pandemic, as listed in Appendix A?


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9. Have you suffered from any behavioural reactions during the coronavirus pandemic, as listed in Appendix A?


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10. Are you able to exercise regularly to support your mental wellbeing?


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11. Do you look after your own health and wellbeing?


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12. Do you have a regular sleep pattern?


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13. Do you have any dependants at home?


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14. Are you able to balance work life with any dependants you may have?


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15. Have you felt lonely/isolated during the coronavirus pandemic?


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16. Have you suffered any financial difficulties during the coronavirus pandemic?


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17. Are there any other issues or concerns not covered so far that you would like to discuss?


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18. Have you felt supported by in your role during the coronavirus pandemic?


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19. Support Required


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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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