Free Employee Benefits Survey
This Employee Benefit Survey Form is a record of how employees feel about a company’s benefits. This form includes the name and job title of the employee, the specific benefits provided (health, financial or others) and a rating system of the benefits (dissatisfied to very satisfied). This Employee Benefit Survey also includes employee’s comments and overall satisfaction about the company’s benefits.
Disclaimer:This was not drafted by an attorney & should not be used as a legal document.
EMPLOYEE BENEFIT SURVEY FORM
PERSONAL INFORMATION
Name: ________________________________ Title: _______________________________
Address: _______________________________ Phone: ______________________________
_______________________________________ Date of Birth: ________________________
Gender: ________________________________
HEALTH BENEFITS
Plan Very Satisfied Satisfied Neutral Dissatisfied
Health Plan
Vision Plan
Life Plan
Short Term Disability
Long Term Disability
Other Plans
FINANCIAL BENEFITS
Benefits Very Satisfied Satisfied Neutral Dissatisfied
Wages
Retirement Benefits
Bonus
Promotions
Stock Purchase
Others
OTHER BENEFITS
Benefits Very Satisfied Satisfied Neutral Dissatisfied
Vacations
Sick Leaves
Personal Leaves
Child Care
Others
COMMENTS
OVERALL RATING
Very Satisfied Satisfied Neutral Dissatisfied
________________________________________
Signature
___________________________
Date
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