Health Risk Assessment Template

Use this Health Risk Assessment Template to design a structured self-report flow that routes people toward the right education, benefits, or clinical follow-up—while staying explicit about limits.

It fits benefits and wellness teams, care navigators, population health coordinators, and clinic operations leads who need repeatable intake, not ad hoc Google Forms with unclear ownership.

Important: This template supports screening, reflection, documentation, or process improvement. It does not replace qualified medical, legal, benefits, or privacy review where your program or jurisdiction requires it.

What a health risk assessment usually covers

Tune modules to your program goals; do not collect fields you cannot act on:

• Eligibility and context: age band, plan membership, pregnancy status, or work role—only if each item changes the next safe question or resource.
• Self-reported biometrics in bands: height and weight for BMI category, blood pressure awareness, glucose or cholesterol awareness—prefer ranges over exact values when possible.
• Lifestyle: tobacco, physical activity, sleep, nutrition patterns at a high level.
• Family or personal history flags where they change prevention messaging—not exhaustive genealogy in a web form.
• Functional and symptom screens only when a clinician or triage protocol will review results on a defined schedule.

Use skip logic so pregnancy-related items, cancer survivorship prompts, or occupational exposures appear only when relevant.

Consent and plain-language framing

Open with: who operates the assessment, whether answers sync to a medical record, who can see responses, how long data is kept, and how to withdraw. Avoid burying material information below the submit button.

Scoring and “risk tiers”

If you publish green, yellow, or red style tiers:

• Define thresholds with clinical or actuarial input—not guesswork from marketing.
• Explain what each tier triggers: general education only, nurse call, provider visit, or nothing—honesty reduces harm and complaints.
• Retest cadence: annual HRAs are common for wellness; clinical monitoring follows different rules.

Distribution and accessibility

• Mobile-first layouts and large tap targets for older adults.
• Multilingual surveys when your population requires them; translate clinical concepts carefully, not only UI chrome.
• Offer save-and-continue or short sessions if literacy or fatigue is a concern.

Analysis and follow-through

Use survey data analysis only within policies your legal and privacy teams approve—health data needs purpose limitation, access controls, and retention rules, not ad hoc spreadsheets.

• Aggregate de-identified trends for program design; route identifiable risk flags only through approved clinical or care-management channels.
• Pair quantitative flags with a short optional open text for barriers such as cost, transportation, or shift work—then assign owners who can actually remove those barriers.

Employer wellness versus clinical intake (use case)

Employer wellness: keep the HRA voluntary, disclose incentives and alternatives, and separate general education from any clinical pathway. Risk tiers should map to benefits resources or coaching—not surprise medical decisions from HR.

Clinical or care navigation: align fields with the record system and triage protocol your clinicians use; avoid duplicate questions patients already answered elsewhere, and ensure escalation matches coverage and licensure.

Program governance KPIs to monitor

• Completion rate among invited participants (and opt-out reasons if you track them ethically).
• Time from high-priority flag to human review, against your SLA.
• Data access audit compliance (who viewed identifiable responses, when).
• Program satisfaction or trust signals where appropriate—without turning the HRA into marketing noise.

Common mistakes to avoid

• Mixing wellness gamification with questions that belong in a confidential medical encounter without clear separation.
• Required answers on stigmatized behaviors that increase abandonment or dishonesty.
• No audit trail of who accessed individual health responses.
• Promising anonymity while collecting employee ID in the same row.
• Using HRAs as a substitute for occupational safety assessments governed by different regulations.

Helpful resources

Use create survey, make your questions required, e-mail notifications for triage queues your staff monitors, and save responses to Google Sheets only if your security review approves that destination.

Then read survey design guide, close ended questions, and open ended questions to balance structured risk flags with optional context you can interpret responsibly.

Deploy safer, consent-first health intake

Publish this flow in Responsly with skip logic for sensitive modules, multilingual support where needed, and notifications or integrations only to destinations your security review approves—so intake stays structured, consented, and aligned with how your team actually follows up.