Nursing Home Employee Satisfaction Form

Date: [Month Day, Year]

Please answer all questions honestly. No personal information will be disclosed.

Full Name:	[Name]
Department:
Email Address:
Phone Number:

Survey Questions

Please rate the following statements on a scale from 1 (Strongly Disagree) to 5 (Strongly Agree).

Statement	1	2	3	4	5
I feel welcomed and valued in my workplace.					✔
My workplace promotes a culture of respect.
I have the resources needed to perform my job.
My job responsibilities are clear and manageable.
I receive recognition for my work.
My work gives me a sense of accomplishment.
I trust my supervisor/manager.
Communication from management is clear.
There are opportunities for professional growth.
I am encouraged to pursue further training.
Feedback provided to me is constructive.

Open-Ended Questions:

1. What do you enjoy most about working at [Your Company Name]?

   I am satisfied with the balance between my work and personal life.

2. What changes would you suggest to improve the workplace?

3. Any additional comments or concerns you would like to share?

Employee Signature:

[Name]

[Job Title]

[Month Day, Year]

Thank you for participating. Your feedback is invaluable and will be used to improve our workplace.

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