Employee Mental Health Screening Form
Personal Information
Full Name
Email
Department
Date
Mental Health Screening
1. How often have you felt stressed at work recently?
Never
Rarely
Sometimes
Often
Always
2. In the past two weeks, have you experienced any of the following? (Select all that apply)
Anxiety
Low Mood
Sleep Issues
Fatigue
None
3. Do you feel comfortable discussing mental health concerns at work?
Yes
No
Unsure
4. Is there anything else you would like to share about your mental well-being?