What is the wellness action plan form template?
Conversations about mental health at work are easier when they happen early and have some structure. A wellness action plan gives an employee a way to tell their manager what keeps them well, what can make things harder and what helps — without needing to share a diagnosis or personal history.
This template follows that approach. The employee chooses who can see the plan, then describes what helps them stay well at work, situations that can affect their mental health, early signs that they may not be coping and how this might affect their work. On the support page they say what their manager can do, what isn't helpful, adjustments that might help — flexible hours, working from home, extra breaks, workload reviews, a quieter space, written instructions or time for appointments — and steps they'll take themselves.
The plan ends with how often to check in, the preferred format, a review date, an agreement on confidentiality and signatures, with a reminder about emergency help. Each plan is saved as a PDF in your FileIt vault, shared only as agreed.
- Best for
- Employees, line managers and HR teams supporting wellbeing
- Filled in by
- The employee, with their manager
- Time to complete
- About 15 minutes, best done together
- Includes
- Visibility choice, triggers and early signs, adjustments checklist, check-ins and review date
Who uses a wellness action plan form?
- Any employee who wants to set up support proactively
- A return to work after time off for mental health reasons
- A new starter sharing how they work best
- Supporting someone through a stressful period such as a reorganisation
- A manager offering plans to their whole team as standard
- Recording adjustments agreed during a wellbeing conversation
Questions on this wellness action plan form
23 questions over 4 pages · includes signature, conditional questions, multiple pages, consent checkbox.
1 About this plan
- Your name*
- Your email*
- Manager*
- Date agreed*
- Who can see this plan?* Me and my manager only · Me, my manager and HR
2 What keeps you well
- What helps you stay well at work?*
- Situations at work that can affect your mental health
- Early signs that you may not be coping
- How might this affect your work?
3 Support
- What can your manager do if they notice these signs?*
- What isn't helpful
- Adjustments that might help Flexible start and finish times · Working from home on some days · Extra or longer breaks · Regular workload reviews · A quieter place to work · Instructions in writing · Time off for appointments
- Details of adjustments agreed asked only when it applies
- Steps you'll take to look after yourself
- Have you been given details of the employee assistance programme or other support?
- Who should we contact if you're unwell at work? (optional)
4 Check-ins
- How often would you like to check in?* Weekly · Every two weeks · Monthly · When I ask
- Preferred format Face to face · Video call · Phone · Written
- Review this plan on*
- Anything else you'd like your manager to know?
- Agreement*
- Your signature*
- Manager's signature
The wellness action plan form, page by page
1 About this plan
A note explains the plan is voluntary and confidential. The employee gives Your name, Your email (for their copy), Manager and Date agreed, and chooses who can see the plan: just themselves and their manager, or HR as well.
2 What keeps you well
Four boxes ask what helps the employee stay well at work, situations that can affect their mental health, early signs that they may not be coping, and how this might affect their work. Only the first is required.
3 Support
The employee describes what their manager can do if they notice the signs and what isn't helpful, then ticks adjustments that might help, with a box for the details agreed. Steps they'll take themselves, whether they've been given employee assistance details and an optional contact if they're unwell at work complete the page.
4 Check-ins
The plan sets how often to check in (weekly to only when asked), the preferred format and a review date, with room for anything else. They agree to the confidentiality statement, the employee signs and the manager can sign too, and a final note points to emergency services or a crisis helpline in a crisis.
Make the template yours
- Add your employee assistance programme's contact details to the support page
- Add your local crisis helpline number to the closing note
- Edit the adjustments list to reflect what your workplace can offer
- File plans into a restricted folder that only HR can open
- Turn off owner notifications if plans should stay between employee and manager
- Send personal links so each employee's plan is pre-filled with their name
Tips for a better wellness action plan form
- Offer plans to everyone, not only to people who seem to be struggling
- Let the employee lead and decide what to write
- Never pressure anyone to share a diagnosis or medical details
- Keep check-in dates — a plan that's never reviewed loses trust
- Store plans securely and share them only as the employee chose
- Consider getting advice on adjustments where a health condition may be involved
Every response becomes a PDF in your vault
The plan is saved as a PDF in the vault folder you choose and the employee gets an emailed copy. Keep the folder restricted so only the people the employee chose can see it.
At the review date, the employee and manager can complete a new plan, keeping earlier versions in the vault for continuity.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Wellness action plan form: frequently asked questions
Is this wellness action plan template free?
Yes. It's included in the FileIt Forms app on every plan, including the free plan.
Does the employee have to share a diagnosis?
No. The plan focuses on what helps and what to look out for at work, and the employee chooses what to share.
Who can see the plan?
The employee chooses who can see it, and access depends on who can open the form's responses and the vault folder — so keep that folder restricted.
Is this a medical or clinical document?
No. It's a workplace support plan agreed between an employee and their manager. It isn't medical advice or a substitute for professional help.
What if someone is in crisis?
The form reminds people to contact emergency services or a crisis helpline. Add your local numbers to the closing note.
How often should it be reviewed?
The plan sets a review date and a check-in frequency, and either person can ask for a review sooner.