Healthy People Survey
Welcome to the Healthy People Survey.
This survey will ask you about your:
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Health behaviours (e.g. if you smoke and how much physical activity you do).
General health and wellbeing (e.g. how well you manage your work-life balance).
Background and work situation (e.g. how old you are and if you work full or part-time).
The survey will take approximately 20 minutes, so try to find a space in the day where you will not be interrupted.
When completing the survey:
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Read the instructions above each question carefully before answering, as different questions may ask you
to recall your behaviour for different time frames (for example, what you did yesterday, last week, or
what you would usually do).
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Tick one answer unless otherwise specified..
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Answer all questions as accurately as you can.
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For questions that ask you to select one answer from a range of options, choose the option that best
describes your situation.
Note: An online version of the survey can be found on https://workplacesforwellness.qld.gov.au/member-home/
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Nutrition
How many serves of vegetables (including fresh, dried, frozen and tinned vegetables) do you usually eat each day?
(1 serve of vegetables is a cup of salad, half a cup of cooked vegetables or a medium-sized potato excluding chips)
(Mark one only)
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





None
Less than 1 serve
1 serve
2 serves
3 serves
4 serves
5 serves
6+ serves
How many serves of fruit (including fresh, dried, frozen and tinned fruit) do you usually eat each day?
(1 serve of fruit is 1 medium-sized piece (or 2 smaller-sized pieces) of fresh fruit, 1 cup of canned or chopped fruit, half a cup of fruit juice, or 1½
tablespoons of dried fruit)
(Mark one only)








None
Less than 1 serve
1 serve
2 serves
3 serves
4 serves
5 serves
6+ serves
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Alcohol
Have you had an alcoholic drink of any kind in the last twelve months? Yes/No
On a day that you have an alcoholic drink, how many standard drinks do you usually have?
 1-2
 3-4
 5 or more
In the last 12 months, how often do you have more than 4 drinks on one occasion?
 Never
 Less than monthly
 Monthly
 Weekly
 Daily or almost daily
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Smoking
Which of the following is applicable to you:
 You have never smoked cigarettes, cigars, pipes or other tobacco products (Go to Physical Activity Section)
 You are an ex-smoker
 You currently smoke cigarettes, cigars, pipes or other tobacco products
Do you smoke regularly, that is, at least once a day?
 Yes
 No
If you smoke daily, on average how many cigarettes do you smoke each day?
_____
If you smoke, but not daily, on average, how many cigarettes do you smoke per week?
_____
In the last 12 months, have you successfully given up smoking for more than a month?
 Yes
 No
In the last 12 months, have you tried to give up smoking but been unsuccessful?
 Yes
 No
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Physical Activity
In the last week, how many times have you walked continuously, for at least 10 minutes, for recreation/exercise
or to get to or from places? Number
What do you estimate was the TOTAL TIME that you spent walking in this way IN THE LAST WEEK? Hours/Minutes
How many of these walks that lasted at least 10 minutes were specifically to get to or from places rather than for
recreation or exercise? Number/week
What do you estimate was the TOTAL TIME you spent walking this way IN THE LAST WEEK? Hours/Minutes
In the last week, how many times did you do any vigorous gardening or heavy work around the yard, which made
you breathe harder or puff and pant? Number
What do you estimate was the TOTAL TIME that you spent doing vigorous gardening or heavy work around the
yard IN THE LAST WEEK? Hours/Minutes
The next question excludes household chores or gardening or yard work.
IN THE LAST WEEK, how many times did you do any vigorous physical activity which made you breathe harder or
puff and pant? (E.g. jogging, cycling, aerobics, competitive tennis)? Number
What do you estimate was the TOTAL TIME that you spent doing this vigorous physical activity IN THE LAST
WEEK? Hours/Minutes
IN THE LAST WEEK, how many times did you do any other more moderate physical activity that you haven't
already mentioned? (E.g. gentle swimming, social tennis, golf, lawn bowls) Number
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What do you estimate was the TOTAL TIME that you spent doing these activities IN THE LAST WEEK?
Hours/Minutes
Including any activities already mentioned, in the last week did you do any strength or toning activities? Yes/No
On how many days did you do any strength or toning activities in the last week? Number
Sitting
What is the total time you spend sitting at work on a typical day? Hours/Minutes
What is the total time you spend sitting on a non-work day? Hours/Minutes
Change
Which one of the following behaviours would you most like to change in the next 6-months? (Please tick one box)
I would like to:
 Eat more fruits and vegetables
 Reduce my alcohol intake
 Quit smoking
 Increase my physical activity
 Reduce the amount of time I spend sitting
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Wellbeing
This section asks some general questions about how you feel about your health and your level of satisfaction with
your life and your work. Most answers are rated on a scale of 1 to 10 and choosing from a set of descriptions by
ticking a box.
In general, would you say your health is:

Excellent

Very good

Good

Fair

Poor
If you are pregnant or have a pre-existing medical condition (e.g. heart disease or diabetes), please tick this box.

How satisfied are you with your life as a whole? (Please tick one box)
0
Completely
dissatisfied
1
2
3
4
5
Neutral
6
7
8
9
10
Completely
satisfied
7
8
9
10
Completely
satisfied
How satisfied are you with your work life as a whole? (Please tick one box)
0
Completely
dissatisfied
1
2
3
4
5
Neutral
6
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How would you describe the level of stress in your job during the past six months? (Please tick one box)
1
Very low
stress
2
3
4
5
6
7
8
9
10
Very high
stress
Overall, how would you describe your relationship with your supervisor?
 Excellent
 Very Good,
 Good,
 Fair
 Poor
Overall, how would you describe your relationship with your immediate co-workers?
 Excellent
 Very Good
 Good
 Fair
 Poor
Managing time is often difficult. How often do you feel: (Please tick one)
Every day
(5)
A few times a
week
(4)
About once a
week
(3)
About once a
month
(2)
Never (1)
That you are rushed, pressured, too
busy?
That you have time on your hands
that you don't know what to do
with?
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Please indicate how often you have felt each of the following in the past six months (where 1 is not at all, 4 is
sometimes and 7 is all the time): (Please tick one box)
1
2
3
4
5
6
7
My personal life suffers because of
work
My job makes my personal life difficult
I neglect personal needs because of
work
I put my personal life on hold for work
I miss personal activities because of
work
I struggle to juggle work and nonwork
I am happy with the amount of time
for non-work activities
My personal life drains me of energy
for work
I am too tired to be effective at work
My work suffers because of my
personal life
I find it hard to work because of
personal matters
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In the last 6 months, how often has your work been affected by your (Please tick one box):
A lot of the time
(3)
Some of the time
(2)
A little of the time (1)
None of the time
(0)
Physical health?
Emotional or
psychological
wellbeing?
About you
Are you….
 male
 female
What is your current age? _________
How much do you weigh (wearing light clothing and no shoes)? _____kilograms
How tall are you (wearing no shoes)? ______centimetres
In which country were you born?
 Australia
 Other English-speaking country (e.g. UK, New Zealand, USA, Canada, South Africa)
 Non-English speaking country in Europe
 Non-English speaking country in Africa
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 Non-English speaking country in Asia
 Non-English speaking country in South America
 Other
Which language do you mainly speak at home?
 English
 Other
Are you of Aboriginal or Torres Strait Islander origin?
 No
 Aboriginal
 Torres Strait Islander
 Both
What is the postcode where you live?
____
Which of the following best describes your household type?
 Person living alone
 Married or defacto couple only
 Married or defacto couple living with children
 One person living with children
 Shared household
 All other households
What
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is the highest qualification you have ever COMPLETED?
No formal education
Primary school only
Year 10 or equivalent
Year 12 or equivalent
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How
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Technical or trade certificate
Diploma or advanced diploma
Bachelor degree
Graduate diploma or graduate certificate
Postgraduate degree
do you manage on the income you have available?
It is difficult all of the time
It is difficult some of the time
It is not too bad
It is easy
How would you describe your work?
 Manager (e.g., chief executive, general manager, legislator, farm manager, sales manager, service
manager)
 Professional (e.g., journalist, accountant, engineer, scientist, teacher, nurse or allied health professional, IT
worker, solicitor, social worker)
 Technician or trades worker (e.g., electrician, mechanic, carpenter, butcher, chef, horticulturalist,
hairdresser)
 Community or personal service worker (e.g., health support worker, child care worker, teacher aide, waiter,
security officer, personal trainer)
 Clerical or administrative worker (e.g., secretary, receptionist, book keeper, administrative assistant)
 Sales worker (e.g., real estate agent, retail sales assistant, checkout operator)
 Machinery operator or driver (e.g., plant operator, delivery driver, bus driver, store person, truck or fork lift
operators)
 Labourer (e.g., cleaner, laundry worker, construction worker, gardener, food preparation assistant)
Do you work...
 Full time
 Part time
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 Casual
In a usual week, how much time in total do you spend at work in paid employment?
____ hours and ____ minutes
Do you normally do any of the following kinds of paid work?
(Tick all that apply)
 Paid shift work
 Paid work with irregular hours
 Paid work on short-term contract (less than one year)
 Paid work in more than one job
 Paid work at night
 Paid work from home
 None of the above
Thank you for your time.
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