HR Survey Work Order Form

HR SURVEY WORK ORDER FORM

Requestor Name:   Date Requested:   Work Order No.:

Personal Information

Position Information

Reporting Manager:   Requested Start Date:   Expected Completion:

Survey Scope and Objectives

Provide a concise statement of the survey objectives, the business questions to be answered, and the intended use of results. Be specific about populations, subgroups, and any required demographic cross-tabs.

Survey Type and Methodology

Select all survey methods and types required for this work order.

Employee Engagement    Exit Survey    360 Evaluation    Compensation Benchmark    Job Analysis    Custom

Online survey    Paper survey    Interviews    Focus groups

Deliverables and Timeline

Milestone 1:   Due:

Milestone 2:   Due:

Budget and Billing

Confidentiality and Data Handling

The survey and all associated data are governed by the following terms. Data provided to HR or third-party analysts must be treated as confidential. All personally identifiable information shall be retained only as necessary, anonymized in delivered reports unless explicit written consent is provided, and stored using administrative, technical, and physical safeguards appropriate to the sensitivity of the data.

Data Ownership: The requesting department and the organization retain ownership of raw personnel data. HR retains the right to use aggregate results for enterprise reporting with removal of individual identifiers. Any request to publish or share identifiable results outside the organization requires explicit written authorization.

Yes — deliver only anonymized, aggregate results    No — identifiable results required (must attach justification)

By submitting this work order, the requester authorizes HR to distribute the survey to the identified employee population and to access personnel records strictly as required for validation and analysis.

Authorize distribution to employees    Authorize access to personnel records for validation

Applicant Certification & Authorizations

I certify that all information provided on this form is true and complete to the best of my knowledge. I understand that submitting false or misleading information may result in denial of the work order or administrative action. I further authorize HR and its designated agents to perform any necessary actions to execute this survey, including contacting employees and using internal records where permitted by policy.

I certify the above statement

Employment History (Requester)

Company:   Title:   Dates:

Company:   Title:   Dates:

Education

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures

At-Will Employment Statement: Nothing in this work order alters the at-will employment relationship between the organization and its employees. The issuance or execution of this form does not create a contract of employment for any specified term.

Equal Opportunity Statement: All survey administration, participant selection, and reporting must comply with applicable nondiscrimination policies. Survey use for adverse employment actions is prohibited unless explicitly authorized in writing by Human Resources in accordance with policy.

Authorization to Contact Previous Employers and Background Checks

Where the survey scope requires verification of employment history, reference checks, or background validation to ensure sample integrity, the requester authorizes HR to contact previous employers and to request such checks consistent with organizational policy and applicable law. Such checks are limited in scope to employment verification and role-relevant validation unless separate written consent is provided.

Authorize HR to contact previous employers for verification    Authorize background checks if required

Additional Notes / Attachments

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