Form questions
Health risk assessment questions for a wellness program
Ask 12 to 18, all optional and confidential. Never skip the questions on physical activity, smoking and stress, and never leave out the statement that the assessment is not a diagnosis. Activity, smoking and stress are common, changeable risks that a workplace program can actually support.
A health risk assessment asks about lifestyle habits linked to long term health, such as activity, sleep, smoking, alcohol, diet and stress, so a wellness program can offer the right support. These twenty three questions stay with lifestyle and family history, are all optional, and lead to general information rather than any diagnosis.
The questions
About you
Age groupDropdown
Bands rather than a date of birth.
Do you have a health condition a doctor is managing?Single choice
Yes, no, prefer not to say. Used only to suggest speaking to their own doctor.
Activity and sleep
On how many days in a usual week are you active for at least 30 minutes?Number
0 to 7. Australian physical activity guidelines suggest being active on most, preferably all, days.
How many hours do you sit on a usual work day?Number
Do you do muscle strengthening activity on at least two days a week?Single choice
On average, how many hours do you sleep a night?Number
How often do you wake up feeling rested?Single choice
Smoking and alcohol
Do you smoke or vape?Single choice
Never, used to, occasionally, daily.
If you smoke or vape, would you like support to stop?Single choice
On how many days a week do you drink alcohol?Number
On a day you drink, how many standard drinks do you usually have?Number
Eating
How often do you eat each of these?Rating grid
Rows: vegetables, fruit, takeaway or fast food, sugary drinks. Columns never to daily.
Do you usually eat breakfast?Single choice
How much water do you drink on a usual day?Single choice
Stress and wellbeing
How stressed have you felt in the last month?Single choice
A five point scale from not at all to extremely.
What are the main sources of stress for you?Multiple choice
Work load, money, family, health, other.
Do you have someone you can talk to when things are hard?Single choice
Would you like information about the Employee Assistance Program?Single choice
Family history and next steps
Has a parent or sibling had any of these?Multiple choice
Heart disease, type 2 diabetes, high blood pressure, certain cancers. Prefer not to say option.
When did you last have a general health check with a doctor?Single choice
Which program activities interest you?Multiple choice
Walking group, quit support, healthy cooking, sleep workshop.
Would you like a summary of your answers?Single choice
Anything else you would like the program to offer?Long text
Which questions to make required
None are required. A workplace health risk assessment is voluntary, and people should be free to skip anything they would rather not share with an employer funded program. The linked form, a pre exercise screening questionnaire, does require its questions, because there the answers decide whether a person should get medical clearance before exercising, which is a different purpose.
The form built from these questions
A static copy of the finished form, from its own example page.
Three ways to change this bank
For a gym or personal trainer, combine these questions with a pre exercise screening tool and make the screening questions required, since they decide whether training can safely start. For a school staff program, add questions on voice strain and standing time. For a men's shed or community health day, shorten to activity, smoking, alcohol and when they last saw a doctor, and print the form for people who prefer paper. In every version, put the statement that the assessment is not a diagnosis at the top, and end with where to get help, such as a GP or a quit line, so nobody is left with a worrying answer and nowhere to go.
Questions people ask
What is a health risk assessment?
A questionnaire about lifestyle and family history that estimates general health risks and points people to support, such as quit programs or activity groups. It is not a medical test and does not diagnose anything. People with symptoms or concerns should see their own doctor.
Is a workplace health risk assessment confidential?
It should be. Health information is sensitive, and staff need to know who will see their answers. Many programs use an external provider and give the employer only grouped results. Say clearly on the form who sees individual answers and how they are stored.
Should employees be required to complete one?
No. Participation should be voluntary and without penalty, and every question should be optional. Making it compulsory erodes trust and the quality of answers. Encourage participation by explaining what support the program offers, keeping results private and letting people complete it in their own time.
How is this different from a pre exercise screening?
A pre exercise screening, such as the adult pre exercise screening tools used in Australia, asks a few specific questions to decide whether someone needs medical clearance before exercise. A health risk assessment is broader and about lifestyle. The linked form is a screening form, so its questions are required.
What happens with the answers?
Individuals may get a summary with general information and links to services. The program gets grouped results, which show which supports are most needed, such as sleep or stress programs. Nobody should receive advice that sounds like a diagnosis from a form.
How often should a health risk assessment be repeated?
Once a year is common, so the program can see whether habits change over time. Use the same questions each year for comparison. Repeating more often adds little, because lifestyle changes slowly, and frequent surveys tire people who are already busy.
Can the questions use validated tools?
Some programs use established short questionnaires for alcohol, stress or activity, which allows comparison with population data. If you do, keep the wording exactly as published and check any licence conditions. Plain questions like the ones here are fine for planning a program.
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