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📊 Assessment Template

Free Employee Burnout Assessment Form Template

Measure employee engagement and burnout risk across 5 key dimensions with an interactive AI form. Upon completion, a personalized PDF wellbeing report is automatically generated — printable for professional delivery, with an embedded QR code that lets respondents chat with an AI consultant about their results.

5 Dimensions
~8 min
AI PDF Report
AI Consultant
Live Preview
Sample Report — Wellbeing Index
WorkloadRecognitionResourcesBurnout RiskCareer Growth 4255683550
50/ 100
Overall Wellbeing Score
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Live Preview

This is the actual running assessment — not a screenshot. Try it yourself.

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Loading burnout assessment form...
This is the actual burnout assessment form your employees will see. Complete it to automatically generate a personalized, printable PDF wellbeing report.
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Loading AI report preview...
Sample AI report with engagement vs burnout visualization and wellbeing state classification. Printable for professional delivery. Each PDF includes a QR code to start an AI consultant chat.
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Loading AI consultant preview...
AI consultant trained on employee wellbeing and burnout prevention. Scan the QR code on your PDF report to start a conversation about your results.
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What's Included

Everything you need to run a professional employee engagement and burnout assessment.

1

Interactive Wellbeing Assessment Form

5-dimension Likert-scale questionnaire — Workload, Recognition, Resources, Burnout Risk, and Career Growth — plus eNPS scoring. Upon completion, a personalized PDF wellbeing report is automatically generated.

2

Printable PDF Wellbeing Report

Professional, print-ready PDF with engagement vs burnout radar chart, wellbeing state classification (Highly Engaged, At Risk of Burnout, or Quiet Quitting), and personalized stress management recommendations. Each PDF includes a QR code.

3

AI Consultant via QR Code

Each PDF report embeds a unique QR code. Scan it with any phone camera to instantly open an AI consultant chat — trained on wellbeing and burnout prevention — where employees can privately discuss their results and get coping strategies.

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Who Is This For

Pick your role — see how the template fits your workflow.

1

HR Teams

Run engagement and burnout assessments with built-in scoring and AI-generated reports. Workflow: Copy template → Customize wellbeing dimensions → Share link with employees → Identify at-risk team members automatically.

2

People Operations

Go beyond annual surveys to continuous wellbeing pulse checks. Workflow: Import template → Adjust for your wellbeing model → Schedule periodic assessments → Track burnout trends over time.

3

Department Heads

Understand your team's engagement drivers and burnout risks. Workflow: Copy template → Customize for your team's context → Share with reports → Get AI-powered recommendations for improving team wellbeing.

Frequently Asked Questions

What is an Employee Burnout Assessment?
An Employee Burnout Assessment measures both engagement levels and burnout risk across key dimensions like workload manageability, recognition, resources, emotional exhaustion, and career growth. It helps HR teams identify at-risk employees early and take proactive steps to improve workplace wellbeing.
How long does it take to complete the burnout assessment form?
The Employee Burnout Assessment form typically takes 6-10 minutes to complete. It covers 5 wellbeing dimensions using Likert-scale questions and an eNPS score. Upon completion, a personalized PDF wellbeing report is automatically generated.
Can I customize this burnout assessment form template for my organization?
Yes. Click "Use This Template" to copy the full assessment into your FormLM workspace. You can then customize dimensions, Likert scales, scoring weights, and report content to match your organization's wellbeing framework.
What does the AI report include?
The AI report includes a dual-axis engagement vs burnout visualization, a wellbeing state classification, and personalized recommendations for stress management and boundary setting. Reports are auto-generated as personalized, printable PDFs — designed for professional delivery. Each PDF includes a QR code that links directly to an AI consultant chat.
What is the QR code on the PDF report for?
The QR code on each PDF report links to an AI consultant chat. Scan it with any phone camera to start a conversation about your wellbeing assessment — discuss burnout risk factors, explore coping strategies, and get personalized advice. No login or app required.
How is this different from Officevibe or Culture Amp?
Unlike Officevibe or Culture Amp that require expensive subscriptions and complex onboarding, this template is free to start and generates personalized, printable PDF wellbeing reports with radar charts and burnout risk indicators. It embeds a QR code in each PDF that links to an AI consultant chat for private, on-demand follow-up. Traditional platforms lock insights behind dashboards; FormLM delivers individual PDF reports and interactive AI-powered support.

Start Your Employee Wellbeing Assessment Today

Copy the Employee Burnout Assessment into your workspace, customize it to your organization's wellbeing framework, and share it with your team. Free to start.