Employee Benefits Satisfaction Assessment Form
Name
Department
Email
1. Overall Satisfaction with Benefits
1
2
3
4
5
2. Please rate your satisfaction with the following benefits:
Health Insurance
1
2
3
4
5
Retirement Plan
1
2
3
4
5
Paid Time Off
1
2
3
4
5
Other (Specify)
1
2
3
4
5
3. What do you like most about our benefits program?
4. What improvements would you suggest?
5. Additional comments