Mental Health Compliance Questionnaire
First Name
*
Last Name
*
Email Address
*
Mental Health Policy and Programs and Support
*
Nothing in place
Partial action
Implementing
Fully met
Does your company have a written mental health policy?
Nothing in place
Partial action
Implementing
Fully met
Does the policy indicate your commitment to a plan for coordinated management action?
Nothing in place
Partial action
Implementing
Fully met
Does the policy include a commitment to establish measurable objectives and targets to ensure continuous improvement aimed at elimination of work related mental health injury and illness?
Nothing in place
Partial action
Implementing
Fully met
Does the policy contain reference to your health and safety program and the related procedures for implementing your policy objectives?
Nothing in place
Partial action
Implementing
Fully met
Is the policy effectively communicated to every employee in the workplace?
Nothing in place
Partial action
Implementing
Fully met
Is the policy reviewed at least annually?
Nothing in place
Partial action
Implementing
Fully met
Does your company’s Employee Assistance Program offer services that include mental health first aid and selfcare strategies in addition to one on one counselling support?
Nothing in place
Partial action
Implementing
Fully met
Are engagement or satisfaction surveys conducted periodically?
Nothing in place
Partial action
Implementing
Fully met
Do you complete exit-interviews?
Nothing in place
Partial action
Implementing
Fully met
Is training currently provided for mental health awareness for managers and supervisors?
Nothing in place
Partial action
Implementing
Fully met
Do you complete pre-employment or periodic screenings of team members?
Nothing in place
Partial action
Implementing
Fully met
Do pre-employment screens explore resilience, mental health, personality and behavioural skills?
Nothing in place
Partial action
Implementing
Fully met
Do you have a return to work program in place for work and non-work related injuries?
Nothing in place
Partial action
Implementing
Fully met
Do you have an escalation and/or grievance policy?
Nothing in place
Partial action
Implementing
Fully met
Do you employ the use of reasonable adjustment plans for staff with a reported mental health issue/injury?
Nothing in place
Partial action
Implementing
Fully met
Do you employ the use of reasonable adjustment plans for staff with a reported physical health issue/injury?
Nothing in place
Partial action
Implementing
Fully met
Environment
*
Disagree
Neutral
Agree
Completely Agree
Work environment requires good communication skills?
Disagree
Neutral
Agree
Completely Agree
Team members have good work flexibility (i.e. work from home, flexible hours)?
Disagree
Neutral
Agree
Completely Agree
Team members do long hours?
Disagree
Neutral
Agree
Completely Agree
Team members do night shifts or after hours work?
Disagree
Neutral
Agree
Completely Agree
Team members are exposed to hostile environments (i.e. disgruntled customers)?
Disagree
Neutral
Agree
Completely Agree
The workforce culture is highly supportive of mental health and wellbeing?
Disagree
Neutral
Agree
Completely Agree
Mental Health Compliance Score
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