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Human ResourcesWork From Home

Mental Wellness Self-Check Form

Confidential self-check to identify stress, burnout risk and support needs for remote employees.

Updated 26d ago
wellnessmental-healthburnoutself-check

Document Control

FieldValue
Document TitleMental Wellness Self-Check Form
Document OwnerHuman Resources
Version1.0
Effective Date{{effective_date}}
Review CycleAnnual
ClassificationInternal Use

Purpose & Scope

Provide a private, structured way for employees to reflect on wellbeing and identify support needs early.

How are you feeling?

DimensionScore (1–5)
Energy
Sleep Quality
Mood
Focus
Connection with Team
Workload Manageability

Signals to Watch

What would help?

Resources

  • Employee Assistance Programme: {{eap_contact}}
  • Mental Health First Aiders: {{mhfa_list}}
  • Crisis lines: {{crisis_lines}}

Confidentiality & Data Protection

All personal data captured under this document is processed in accordance with {{company_name}}'s Data Protection & Privacy Policy and applicable data-protection legislation (including GDPR/UK GDPR where relevant). Records are retained for {{retention_period}} and accessed only on a need-to-know basis.

Notes

Use this space to capture additional context, attachments referenced, or any deviations from standard process. All notes form part of the official record.

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