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Worksite Wellness – Spring Digital Detox 
Needs Assessment Survey

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

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
1.What is your name?
2.How long have you been with your organization? 
3.What is your title?
About your workplace 
4.To what extent do the following characteristics describe your workplace?  

My workspace is ....
Strongly Disagree
Disagree
Agree
Strongly Agree
a. Welcoming/ comfortable
b. Peaceful/ calm
c. Accepting/ tolerant of different viewpoints
d. Respectful/ kind
e. Supportive/ encouraging
f. Exciting/ fun
g. Energizing/ inspiring
5.In my workplace there is strong communication ...
Strongly Disagree
Disagree
Agree
Strongly Agree
a. Among staff
b. Among leadership
c. Between leadership & staff
d. With clients or customers
6.To what extent do the following challenges impact your workplace? 

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

Extent to which ________is/are a workplace asset/strength…. 
Not At All
A Little 
Quite A Bit 
A Great Deal
a. Worksite wellness offerings - nutrition, exercise
b. Staff retention - happy, satisfied staff
c. Highly productive worksite
d. Flexible work schedules
e. Family friendly environment
f. Clear job descriptions
g. Opportunities for professional development
h. Opportunities for growth within the company
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….
Strongly Disagree
Disagree
Agree
Strongly Agree
a. Wellness - nutrition, exercise
b. Stress management
c. Communication
d. Strategic planning
e. Team building
f Leadership training
9.What do you like most about your job? What about your job is most gratifying?  
10.What about your job creates stress for you? What about your job is most stressful? 
11.Anything else you would like to see us cover in the retreat that would help to create/enhance your sense of wellness?
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