Employee Welfare Assessment - COVID-19

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

Download as free PDF

GET A DEMO
SIGN UP TO USE TEMPLATE
SIGN UP

Employee Welfare Assessment - COVID-19



General Information

1. Name of Employee


Photo Comment

2. Date of Welfare Check


Photo Comment

3. Welfare Check Conducted By


Photo Comment

4. Position of person carrying out the check


Photo Comment

5. Date of next scheduled Welfare Check


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

1. I have felt cheerful and in good spirits


Photo Comment

2. I have felt calm and relaxed


Photo Comment

3. I have felt active and vigorous


Photo Comment

4. I woke up feeling fresh and rested


Photo Comment

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


Photo Comment
Wellbeing

1. Have you been worried during the coronavirus pandemic?


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

12. Do you have a regular sleep pattern?


Photo Comment

13. Do you have any dependants at home?


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

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


Photo Comment

19. Support Required


Photo Comment

Is this sample what you are looking for?
Sign up to use & customise this template, or create your own custom checklist:

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.

Seeing is Believing

Get a live demo customized to your unique needs, or get started with a 14-day FREE trial.

GET A DEMO
START FREE TRIAL
  • No credit card, no commitment.