In order for a wellness program to become effective and promote employee buy-in and interest throughout the agency, all employees’ input must be solicited. The most effective wellness initiatives, however, are ideas from frontline employees. This anonymous survey can be used by any agency that is initiating a wellness program or that wants to gauge the effectiveness of its current wellness program.
1. How long have you been an emergency first responder?
A. 0–5 years
B. 6–10 years
C. 11–20 years
D. 20+ years
2. Are you a sworn or a nonsworn employee?
3. What was the primary reason you wanted a career as an emergency first responder?
4. Do you feel that the job currently fulfills that goal?
Yes No
Why or why not?
5. Do you believe the job has adversely affected you, your outlook on life, your emotional wellness, or your relationships away from work?
Yes No
If yes, in what way(s)?
6. Has your family or someone else close to you told you that you have changed since you began your emergency-first-responder career?
Yes No
If yes, in what way(s)?
7. Name any specific issues or circumstances related to your job that adversely affect your general wellness.
8. List any specific habits, hobbies, or interests that you enjoyed and regularly participated in before you began your emergency-first-responder career, and that you either no longer enjoy or no longer participate in to the same level.
9. What coping mechanisms, if any, do you regularly rely on to deal with stress and issues from work?
A. None
B. Exercise/group sports
C. Vacation/time off
D. Meditation
E. Faith-based activities
F. Hobbies
G. Self-medication (alcohol or drugs)
H. Spending time with family
I. Counseling
J. Talking with friends
K. Gambling
L. Promiscuity or other reckless or dangerous behavior
M. Shopping/buying things
N. Extreme sports or other high-risk activities
O. Other (please describe):
10. Which personal issues listed below directly impact you, those close to you, or your job performance?
A. Finances/bankruptcy/foreclosure
B. Divorce
C. Troubled relationships
D. Depression
E. Suicidal thoughts (current or formerly)
F. Alcohol
G. Prescription medications
H. Anger
I. Sleep deprivation/sleep problems
J. Domestic violence
K. Organizational stress from the agency/command staff/supervisors
L. PTSD/issues related to a critical incident(s) at work
M. Other (please list):
11. How much does the agency promote or train individuals in emotional-survival and wellness issues?
A. Not at all
B. Very little
C. Very little, and I would like to see more
D. Moderate level
E. Moderate level, and I would like to see more
F. High level
G. High level, and I would like to see more
H. Too much
12. Is there emotional-survival/wellness training you would like to see?
Yes No
Please list any training you would like to see.