Benefit Satisfaction

Exit Survey

Are you currently enrolled in the employee health care plan?

Yes

No

If you answered no to question 1, are you:

Covered under spouse’s plan?

Covered under another plan?

Uninsured?

If you do not have health insurance, are you uninsured because of:

Cost

Other - please explain: ________________________________

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Weekly

Monthly

Quarterly

Annually

Which benefits are most important to you? Rank the following benefit plans in order of
importance, with number 1 being most important, and number 6 being least important.

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____ Dental plan

____ Prescription plan

____ Employee Assistance Program

____ Short-term disability plan

____ Long-term disability plan

Which benefits are most important to you? Rank the following benefit plans in order of
importance, with number 1 being most important, and number 6 being least important.

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____ Dental plan

____ Prescription plan

____ Employee Assistance Program

____ Short-term disability plan

____ Long-term disability plan