A Sample Check-in Survey for Wellness

Photo by National Cancer Institute on Unsplash

I started putting out a weekly pulse survey at the beginning of the pandemic.

I lead a community of 60 school administrators. A year ago when the pandemic hit, I saw them over-extending themselves more than usual. My worry was that before long they would be exhausted with nothing left to give. The problem is that I knew we were in this for the long haul. Before there were any covid cases in the USA, I noticed that some leaders didn’t even think it would impact their community. I asked them to prepare for being remote for a year or longer. I’m married to an epidemiologist so I felt that I had better information than many people.

I wanted to have a sense of how everyone was doing and what I found that depended on the week. The highs and lows were experienced by all. The survey I created was simple and was designed to help me identify if any of the leaders I support were in crisis. It was mostly a reflective tool for the survey respondents.

The first two questions:

  • Name
  • How are you right now? This question is a Lickert style 1–10 continuum with 1 being “I’m in a crisis” and 10 being “Everything is great.”

Self-care reflection questions:

  • Are you intentionally planning “buffer-time,” “white space,” or time for mindfulness to recenter each day?
  • Are you intentionally planning “turn off time” (limiting screen time, news, email)?
  • Are you intentionally planning physical time (stretching, walking, working out, etc.)?
  • Are you intentionally planning time in nature?
  • Are you intentionally planning balance time (time dedicated just for you or with friends/family)?
  • Are you getting enough sleep?
  • Are you eating a healthy diet?
  • Are you saying “No” and honoring your needed boundaries?
  • Are you practicing gratitude?

Two questions where leaders I serve could ask for help:

  • Do you have a problem?
  • What do you need?

Host of the Better Leaders Better Schools podcast with over one million downloads 🚀