Employee Benefits Satisfaction Survey


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									This Employee Benefits Satisfaction Survey affords employees an opportunity to
provide feedback on the current benefits plan that is being offered by an employer. The
information obtained can help employers identify which components of the plan are
satisfactory, as well as any areas that may need improvement. This template should be
customized accordingly to reflect the specific types of benefits that are offered by the
company. It should be used by the human resources department within a company to
gauge employee satisfaction with a benefits plan.
                Employee Benefits Satisfaction Survey
 [COMPANY] has always been committed to offering employees with great benefit plans that
meet the needs of our employees and their families. To help us evaluate how we're doing, we
would appreciate your honest feedback about the plans offered to you and welcome any
suggestions for possible additional plans or changes to existing ones.

Please complete the following survey questions according to the following rating scale. Circle
the number that best reflects your opinion.

         1                      2                      3                       4                 5
  Very Satisfied          Somewhat                 Neutral                Somewhat        Dissatisfied
                            Satisfied                                     Dissatisfied
No changes to the      Plan is good, but a    The plan requires           Significant     Plan requires
 current plan are      few small changes       changes to be              changes are    major overhaul
     needed                are needed          more effective               needed

Paid-Time-Off (PTO)                                                                      1–2–3–4–5
Holidays (News Years Day, Memorial Day, etc.)                                            1–2–3–4–5
401 (k)                                                                                  1–2–3–4–5
401 (k) match                                                                            1–2–3–4–5
Medical Plan (PPO)                                                                       1–2–3–4–5
Medical Plan (HMO)                                                                       1–2–3–4–5
Medical Plan (HSA)                                                                       1–2–3–4–5
Prescription Drug Plan                                                                   1–2–3–4–5
Dental Plan                                                                              1–2–3–4–5
Life Insurance (Employer Paid)                                                           1–2–3–4–5
Life Insurance (Voluntary)                                                               1–2–3–4–5
Short Term Disability                                                                    1–2–3–4–5
Long Term Disability                                                                     1–2–3–4–5
Vision Benefits                                                                          1–2–3–4–5
Dependent Care Account                                                                   1–2–3–4–5
Employee Stock Purchase Plan                                                             1–2–3–4–5
Tuition Reimbursement Plan                                                               1–2–3–4–5
Stock Options                                                                            1–2–3–4–5
Employee Assistance Plan                                                                 1–2–3–4–5
Employee Meal Plan                                                                       1–2–3–4–5
Legal Assistance Plan                                                                    1–2–3–4–5
Jury Duty Leave                                                                          1–2–3–4–5
Credit Union                                                                             1–2–3–4–5
Discount Entertainment/Sports Tickets                                                    1–2–3–4–5
Employee On-Site Fitness Center                                                          1–2–3–4–5
Overall satisfaction with the company’s benefit plans                                    1–2–3–4–5

© Copyright 2013 Docstoc Inc. registered document proprietary, copy not                      2
What improvements, if any, would you make to our current plans? Are there specific plans you
feel need changes?

 (Area meant for suggestions on how things could be improved. Based on the expected level
 of feedback, this box should be expanded or contracted to accommodate most feedback.
 Additionally, you may suggest employees use the back of the paper if in need of more room.)

List any other benefit plans you would like for us to offer.

 (For Employee to suggest additional plans that could be offered.)

Additional Comments:

 (For employee to comment on anything related to, but not covered by, this survey. I.e.,
 benefit plan administration, annual enrollment, experiences with customer service, benefits
 materials and claim forms, or any other information they feel would be helpful in
 developing future benefit plans.)

                         Thank You For Your Participation.

© Copyright 2013 Docstoc Inc.                                                        3

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