Health Risk Assessment  ·  Popular

Annual Employee Health Risk Assessment Form

Collect vital employee health data—medical history, lifestyle habits, and wellness indicators—with this easy-to-use annual health risk assessment form.

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Aura theme
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Annual Employee Health Risk Assessment Questionnaire
Full Name
· · ·
Work Email Address
· · ·
Phone Number
· · ·
Submit

The Annual Employee Health Risk Assessment Questionnaire is a structured form designed to help HR teams and occupational health professionals gather essential health information from employees on a yearly basis. It covers personal details, medical history, current medications, family health background, and key lifestyle habits such as exercise frequency, tobacco use, alcohol consumption, and sleep patterns.

This template is ideal for corporate wellness programs, human resources departments, and occupational health practitioners who want to proactively identify health risks in their workforce. By collecting standardized data annually, organizations can spot trends, tailor wellness initiatives, and support employees in achieving better health outcomes.

Using this ready-made form saves time and ensures consistent data collection across your entire organization. It is fully customizable, HIPAA-conscious in its approach, and can be deployed online in minutes—making it the smart choice for any business committed to employee well-being and preventive health management.

4 Pages
25 Questions
~8min To complete
Free No credit card needed
Field types Dropdown ×4 Yes / No ×3 Likert Scale ×3 Date ×2 Single Choice ×2 Multiple Choice ×2 Long Text ×2 Full Name Email Phone Short Text Range Slider termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Employee Information 7 questions
Employee Information
1 Full Name * Full Name
2 Work Email Address * Email
3 Phone Number Phone
4 Date of Birth * Date
5 Department * Dropdown
6 Employee ID Number * Short Text
7 Gender Dropdown
Page 2 General Health & Medical History 6 questions
General Health & Medical History
1 How would you rate your overall health? * Single Choice
2 Have you ever been diagnosed with any of the following conditions? (Select all that apply) * Multiple Choice
3 Are you currently taking any prescription medications? * Yes / No
4 If yes, please list current medications and dosages Long Text
5 Do you have a family history of heart disease, diabetes, or cancer? * Yes / No
6 Date of your last physical examination Date
Page 3 Lifestyle & Wellness Habits 7 questions
Lifestyle & Wellness Habits
1 How often do you engage in physical exercise (30+ minutes)? * Dropdown
2 Do you currently smoke or use tobacco products? * Single Choice
3 How many alcoholic drinks do you consume per week on average? * Dropdown
4 I get adequate sleep (7-9 hours) most nights * Likert Scale
5 I manage my stress levels effectively * Likert Scale
6 I maintain a balanced and nutritious diet * Likert Scale
7 On a scale of 1-10, how would you rate your current mental well-being? * Range Slider
Page 4 Workplace Health & Consent 5 questions
Workplace Health & Ergonomics
1 Do you experience any of the following work-related health concerns? (Select all that apply) * Multiple Choice
2 Are you interested in participating in company wellness programs? * Yes / No
3 Please share any additional health concerns or accommodations you would like us to be aware of Long Text
Confidentiality & Consent
All information provided in this questionnaire is strictly confidential and will be used solely for the purpose of identifying workplace health risks and improving employee wellness programs. Your responses will be reviewed only by authorized health and HR personnel.
4 I confirm that the information provided is accurate to the best of my knowledge, and I consent to its use for health risk assessment purposes. * termsandconditions
5 Employee Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.

  • Ready-to-use structure — pre-configured fields out of the box
  • Applied "Aura" theme — fonts, colors, and layout already set
  • Mobile-responsive — works on every device without extra configuration
  • Fully editable with drag-and-drop — change anything in seconds
  • Free to use on any plan, no credit card required

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Free to use. Open in the editor, customize, and publish in minutes.

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Category Evaluation & Assessment
Subcategory Health Risk Assessment
Theme Aura
Badge Popular
Price Free
Coding required None
Tags
Healthcare Employee Data Collection

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