Worksite Wellness – Spring Digital Detox Needs Assessment Survey

Directions: We are looking forward to your visit to Three Otters Eco Retreat for the Spring Digital Detox. In order to provide the best experience possible, we would like to hear from you about your workplace experiences. In addition to worksite wellness, we invite you to share with us any other areas of wellness you are interested in learning more about. Thank you.

About You

	Strongly Disagree	Disagree	Agree	Strongly Agree
a. Welcoming/ comfortable	a. Welcoming/ comfortable Strongly Disagree	a. Welcoming/ comfortable Disagree	a. Welcoming/ comfortable Agree	a. Welcoming/ comfortable Strongly Agree
b. Peaceful/ calm	b. Peaceful/ calm Strongly Disagree	b. Peaceful/ calm Disagree	b. Peaceful/ calm Agree	b. Peaceful/ calm Strongly Agree
c. Accepting/ tolerant of different viewpoints	c. Accepting/ tolerant of different viewpoints Strongly Disagree	c. Accepting/ tolerant of different viewpoints Disagree	c. Accepting/ tolerant of different viewpoints Agree	c. Accepting/ tolerant of different viewpoints Strongly Agree
d. Respectful/ kind	d. Respectful/ kind Strongly Disagree	d. Respectful/ kind Disagree	d. Respectful/ kind Agree	d. Respectful/ kind Strongly Agree
e. Supportive/ encouraging	e. Supportive/ encouraging Strongly Disagree	e. Supportive/ encouraging Disagree	e. Supportive/ encouraging Agree	e. Supportive/ encouraging Strongly Agree
f. Exciting/ fun	f. Exciting/ fun Strongly Disagree	f. Exciting/ fun Disagree	f. Exciting/ fun Agree	f. Exciting/ fun Strongly Agree
g. Energizing/ inspiring	g. Energizing/ inspiring Strongly Disagree	g. Energizing/ inspiring Disagree	g. Energizing/ inspiring Agree	g. Energizing/ inspiring Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

a. Welcoming/ comfortable

a. Welcoming/ comfortable Strongly Disagree

a. Welcoming/ comfortable Disagree

a. Welcoming/ comfortable Agree

a. Welcoming/ comfortable Strongly Agree

b. Peaceful/ calm

b. Peaceful/ calm Strongly Disagree

b. Peaceful/ calm Disagree

b. Peaceful/ calm Agree

b. Peaceful/ calm Strongly Agree

c. Accepting/ tolerant of different viewpoints

c. Accepting/ tolerant of different viewpoints Strongly Disagree

c. Accepting/ tolerant of different viewpoints Disagree

c. Accepting/ tolerant of different viewpoints Agree

c. Accepting/ tolerant of different viewpoints Strongly Agree

d. Respectful/ kind

d. Respectful/ kind Strongly Disagree

d. Respectful/ kind Disagree

d. Respectful/ kind Agree

d. Respectful/ kind Strongly Agree

e. Supportive/ encouraging

e. Supportive/ encouraging Strongly Disagree

e. Supportive/ encouraging Disagree

e. Supportive/ encouraging Agree

e. Supportive/ encouraging Strongly Agree

f. Exciting/ fun

f. Exciting/ fun Strongly Disagree

f. Exciting/ fun Disagree

f. Exciting/ fun Agree

f. Exciting/ fun Strongly Agree

g. Energizing/ inspiring

g. Energizing/ inspiring Strongly Disagree

g. Energizing/ inspiring Disagree

g. Energizing/ inspiring Agree

g. Energizing/ inspiring Strongly Agree

	Strongly Disagree	Disagree	Agree	Strongly Agree
a. Among staff	a. Among staff Strongly Disagree	a. Among staff Disagree	a. Among staff Agree	a. Among staff Strongly Agree
b. Among leadership	b. Among leadership Strongly Disagree	b. Among leadership Disagree	b. Among leadership Agree	b. Among leadership Strongly Agree
c. Between leadership & staff	c. Between leadership & staff Strongly Disagree	c. Between leadership & staff Disagree	c. Between leadership & staff Agree	c. Between leadership & staff Strongly Agree
d. With clients or customers	d. With clients or customers Strongly Disagree	d. With clients or customers Disagree	d. With clients or customers Agree	d. With clients or customers Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

a. Among staff

a. Among staff Strongly Disagree

a. Among staff Disagree

a. Among staff Agree

a. Among staff Strongly Agree

b. Among leadership

b. Among leadership Strongly Disagree

b. Among leadership Disagree

b. Among leadership Agree

b. Among leadership Strongly Agree

c. Between leadership & staff

c. Between leadership & staff Strongly Disagree

c. Between leadership & staff Disagree

c. Between leadership & staff Agree

c. Between leadership & staff Strongly Agree

d. With clients or customers

d. With clients or customers Strongly Disagree

d. With clients or customers Disagree

d. With clients or customers Agree

d. With clients or customers Strongly Agree

	Not at All	A Little	Quite a Bit	A Great Deal
a. Too much work - long hours	a. Too much work - long hours Not at All	a. Too much work - long hours A Little	a. Too much work - long hours Quite a Bit	a. Too much work - long hours A Great Deal
b. Not enough work - not enough hours	b. Not enough work - not enough hours Not at All	b. Not enough work - not enough hours A Little	b. Not enough work - not enough hours Quite a Bit	b. Not enough work - not enough hours A Great Deal
c. Inequitable distribution of work	c. Inequitable distribution of work Not at All	c. Inequitable distribution of work A Little	c. Inequitable distribution of work Quite a Bit	c. Inequitable distribution of work A Great Deal
d. Staff/colleagues underperforming	d. Staff/colleagues underperforming Not at All	d. Staff/colleagues underperforming A Little	d. Staff/colleagues underperforming Quite a Bit	d. Staff/colleagues underperforming A Great Deal
e. Difficult colleagues, staff members and/or clients	e. Difficult colleagues, staff members and/or clients Not at All	e. Difficult colleagues, staff members and/or clients A Little	e. Difficult colleagues, staff members and/or clients Quite a Bit	e. Difficult colleagues, staff members and/or clients A Great Deal
f. Low or inequitable salaries/benefits	f. Low or inequitable salaries/benefits Not at All	f. Low or inequitable salaries/benefits A Little	f. Low or inequitable salaries/benefits Quite a Bit	f. Low or inequitable salaries/benefits A Great Deal
g. Challenging or inflexible work schedules	g. Challenging or inflexible work schedules Not at All	g. Challenging or inflexible work schedules A Little	g. Challenging or inflexible work schedules Quite a Bit	g. Challenging or inflexible work schedules A Great Deal
h. Poor communication in the workplace	h. Poor communication in the workplace Not at All	h. Poor communication in the workplace A Little	h. Poor communication in the workplace Quite a Bit	h. Poor communication in the workplace A Great Deal

Not at All

A Little

Quite a Bit

A Great Deal

a. Too much work - long hours

a. Too much work - long hours Not at All

a. Too much work - long hours A Little

a. Too much work - long hours Quite a Bit

a. Too much work - long hours A Great Deal

b. Not enough work - not enough hours

b. Not enough work - not enough hours Not at All

b. Not enough work - not enough hours A Little

b. Not enough work - not enough hours Quite a Bit

b. Not enough work - not enough hours A Great Deal

c. Inequitable distribution of work

c. Inequitable distribution of work Not at All

c. Inequitable distribution of work A Little

c. Inequitable distribution of work Quite a Bit

c. Inequitable distribution of work A Great Deal

d. Staff/colleagues underperforming

d. Staff/colleagues underperforming Not at All

d. Staff/colleagues underperforming A Little

d. Staff/colleagues underperforming Quite a Bit

d. Staff/colleagues underperforming A Great Deal

e. Difficult colleagues, staff members and/or clients

e. Difficult colleagues, staff members and/or clients Not at All

e. Difficult colleagues, staff members and/or clients A Little

e. Difficult colleagues, staff members and/or clients Quite a Bit

e. Difficult colleagues, staff members and/or clients A Great Deal

f. Low or inequitable salaries/benefits

f. Low or inequitable salaries/benefits Not at All

f. Low or inequitable salaries/benefits A Little

f. Low or inequitable salaries/benefits Quite a Bit

f. Low or inequitable salaries/benefits A Great Deal

g. Challenging or inflexible work schedules

g. Challenging or inflexible work schedules Not at All

g. Challenging or inflexible work schedules A Little

g. Challenging or inflexible work schedules Quite a Bit

g. Challenging or inflexible work schedules A Great Deal

h. Poor communication in the workplace

h. Poor communication in the workplace Not at All

h. Poor communication in the workplace A Little

h. Poor communication in the workplace Quite a Bit

h. Poor communication in the workplace A Great Deal

	Not At All	A Little	Quite A Bit	A Great Deal
a. Worksite wellness offerings - nutrition, exercise	a. Worksite wellness offerings - nutrition, exercise Not At All	a. Worksite wellness offerings - nutrition, exercise A Little	a. Worksite wellness offerings - nutrition, exercise Quite A Bit	a. Worksite wellness offerings - nutrition, exercise A Great Deal
b. Staff retention - happy, satisfied staff	b. Staff retention - happy, satisfied staff Not At All	b. Staff retention - happy, satisfied staff A Little	b. Staff retention - happy, satisfied staff Quite A Bit	b. Staff retention - happy, satisfied staff A Great Deal
c. Highly productive worksite	c. Highly productive worksite Not At All	c. Highly productive worksite A Little	c. Highly productive worksite Quite A Bit	c. Highly productive worksite A Great Deal
d. Flexible work schedules	d. Flexible work schedules Not At All	d. Flexible work schedules A Little	d. Flexible work schedules Quite A Bit	d. Flexible work schedules A Great Deal
e. Family friendly environment	e. Family friendly environment Not At All	e. Family friendly environment A Little	e. Family friendly environment Quite A Bit	e. Family friendly environment A Great Deal
f. Clear job descriptions	f. Clear job descriptions Not At All	f. Clear job descriptions A Little	f. Clear job descriptions Quite A Bit	f. Clear job descriptions A Great Deal
g. Opportunities for professional development	g. Opportunities for professional development Not At All	g. Opportunities for professional development A Little	g. Opportunities for professional development Quite A Bit	g. Opportunities for professional development A Great Deal
h. Opportunities for growth within the company	h. Opportunities for growth within the company Not At All	h. Opportunities for growth within the company A Little	h. Opportunities for growth within the company Quite A Bit	h. Opportunities for growth within the company A Great Deal

Not At All

A Little

Quite A Bit

A Great Deal

a. Worksite wellness offerings - nutrition, exercise

a. Worksite wellness offerings - nutrition, exercise Not At All

a. Worksite wellness offerings - nutrition, exercise A Little

a. Worksite wellness offerings - nutrition, exercise Quite A Bit

a. Worksite wellness offerings - nutrition, exercise A Great Deal

b. Staff retention - happy, satisfied staff

b. Staff retention - happy, satisfied staff Not At All

b. Staff retention - happy, satisfied staff A Little

b. Staff retention - happy, satisfied staff Quite A Bit

b. Staff retention - happy, satisfied staff A Great Deal

c. Highly productive worksite

c. Highly productive worksite Not At All

c. Highly productive worksite A Little

c. Highly productive worksite Quite A Bit

c. Highly productive worksite A Great Deal

d. Flexible work schedules

d. Flexible work schedules Not At All

d. Flexible work schedules A Little

d. Flexible work schedules Quite A Bit

d. Flexible work schedules A Great Deal

e. Family friendly environment

e. Family friendly environment Not At All

e. Family friendly environment A Little

e. Family friendly environment Quite A Bit

e. Family friendly environment A Great Deal

f. Clear job descriptions

f. Clear job descriptions Not At All

f. Clear job descriptions A Little

f. Clear job descriptions Quite A Bit

f. Clear job descriptions A Great Deal

g. Opportunities for professional development

g. Opportunities for professional development Not At All

g. Opportunities for professional development A Little

g. Opportunities for professional development Quite A Bit

g. Opportunities for professional development A Great Deal

h. Opportunities for growth within the company

h. Opportunities for growth within the company Not At All

h. Opportunities for growth within the company A Little

h. Opportunities for growth within the company Quite A Bit

h. Opportunities for growth within the company A Great Deal

	Strongly Disagree	Disagree	Agree	Strongly Agree
a. Wellness - nutrition, exercise	a. Wellness - nutrition, exercise Strongly Disagree	a. Wellness - nutrition, exercise Disagree	a. Wellness - nutrition, exercise Agree	a. Wellness - nutrition, exercise Strongly Agree
b. Stress management	b. Stress management Strongly Disagree	b. Stress management Disagree	b. Stress management Agree	b. Stress management Strongly Agree
c. Communication	c. Communication Strongly Disagree	c. Communication Disagree	c. Communication Agree	c. Communication Strongly Agree
d. Strategic planning	d. Strategic planning Strongly Disagree	d. Strategic planning Disagree	d. Strategic planning Agree	d. Strategic planning Strongly Agree
e. Team building	e. Team building Strongly Disagree	e. Team building Disagree	e. Team building Agree	e. Team building Strongly Agree
f Leadership training	f Leadership training Strongly Disagree	f Leadership training Disagree	f Leadership training Agree	f Leadership training Strongly Agree

Strongly Disagree

Disagree

Agree

Strongly Agree

a. Wellness - nutrition, exercise

a. Wellness - nutrition, exercise Strongly Disagree

a. Wellness - nutrition, exercise Disagree

a. Wellness - nutrition, exercise Agree

a. Wellness - nutrition, exercise Strongly Agree

b. Stress management

b. Stress management Strongly Disagree

b. Stress management Disagree

b. Stress management Agree

b. Stress management Strongly Agree

c. Communication

c. Communication Strongly Disagree

c. Communication Disagree

c. Communication Agree

c. Communication Strongly Agree

d. Strategic planning

d. Strategic planning Strongly Disagree

d. Strategic planning Disagree

d. Strategic planning Agree

d. Strategic planning Strongly Agree

e. Team building

e. Team building Strongly Disagree

e. Team building Disagree

e. Team building Agree

e. Team building Strongly Agree

f Leadership training

f Leadership training Strongly Disagree

f Leadership training Disagree

f Leadership training Agree

f Leadership training Strongly Agree

Worksite Wellness – Spring Digital Detox
Needs Assessment Survey

Prepared for You in Partnership by Fit.Active.Toned. and Three Otters Eco Retreat, LLC

Question Title

* 1. What is your name?

Question Title

* 2. How long have you been with your organization?

Question Title

* 3. What is your title?

Question Title

* 4. To what extent do the following characteristics describe your workplace?

My workspace is ....

Question Title

* 5. In my workplace there is strong communication ...

Question Title

* 6. To what extent do the following challenges impact your workplace?

The following impact my workplace....

Question Title

* 7. To what extent are the following assets/strengths in your workplace?

Extent to which ________is/are a workplace asset/strength….

Question Title

* 8. What are you looking for in a wellness retreat to enhance your work experience?

To enhance my experience with work, I would most benefit from a retreat/workshop addressing….

Question Title

* 9. What do you like most about your job? What about your job is most gratifying?

Question Title

* 10. What about your job creates stress for you? What about your job is most stressful?

Question Title

* 11. Anything else you would like to see us cover in the retreat that would help to create/enhance your sense of wellness?

Worksite Wellness – Spring Digital Detox Needs Assessment Survey

Prepared for You in Partnership by Fit.Active.Toned. and Three Otters Eco Retreat, LLC

Question Title

* 1. What is your name?

Question Title

* 2. How long have you been with your organization?

Question Title

* 3. What is your title?

Question Title

* 4. To what extent do the following characteristics describe your workplace? My workspace is ....

Question Title

* 5. In my workplace there is strong communication ...

Question Title

* 6. To what extent do the following challenges impact your workplace? The following impact my workplace....

Question Title

* 7. To what extent are the following assets/strengths in your workplace? Extent to which ________is/are a workplace asset/strength….

Question Title

* 8. What are you looking for in a wellness retreat to enhance your work experience? To enhance my experience with work, I would most benefit from a retreat/workshop addressing….

Question Title

* 9. What do you like most about your job? What about your job is most gratifying?

Question Title

* 10. What about your job creates stress for you? What about your job is most stressful?

Question Title

* 11. Anything else you would like to see us cover in the retreat that would help to create/enhance your sense of wellness?

Worksite Wellness – Spring Digital Detox
Needs Assessment Survey

* 4. To what extent do the following characteristics describe your workplace?

My workspace is ....

* 6. To what extent do the following challenges impact your workplace?

The following impact my workplace....

* 7. To what extent are the following assets/strengths in your workplace?

Extent to which ________is/are a workplace asset/strength….

* 8. What are you looking for in a wellness retreat to enhance your work experience?

To enhance my experience with work, I would most benefit from a retreat/workshop addressing….