🏆 Launched at the 1st National Sustainability Convention 2025  |  The Institution of Engineers (India), Bihar State Centre & IEI SDF Forum  |  askravi.org
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Nationwide NCD Health Survey 2025 — Fit India @ Work

Non-Communicable Disease Risk Assessment & Screening Form  ·  Aligned with UN SDG 3.4

Launched by Hon'ble Shri Nitin Nabin Ji (National Working President, BJP)  ·  Guest of Honour: Shri Deepak Kumar Singh, IAS, Additional Chief Secretary, Govt. of Bihar  ·  askravi.org

👤 Bact to Hmoe 👤 Personal 🌿 Lifestyle 🎗️ Cancer 🧠 Mental Health ❤️ Cardiovascular 🫁 Respiratory 🩸 Diabetes 💊 Hypertension
🎉 Official Launch Announcement
Fit India @ Work & Nationwide NCD Health Survey 2025
We are delighted to inform you that our flagship initiative Fit India @ Work, along with the Nationwide NCD Health Survey 2025 — aligned with UN SDG 3.4 to reduce premature mortality from Non-Communicable Diseases — was officially launched at the 1st National Sustainability Convention 2025, organized by The Institution of Engineers (India), Bihar State Centre & IEI SDF Forum.
🎤 Chief Guest
Hon'ble Shri Nitin Nabin Ji
National Working President, BJP
🏅 Guest of Honour
Shri Deepak Kumar Singh, IAS
Additional Chief Secretary, Govt. of Bihar
🚀 The survey is now actively underway and gaining tremendous momentum, with the goal of reaching millions of employees across the nation to promote workplace wellness and early detection of NCD risks.
📋 Instructions: This survey is completely confidential. Please answer all questions honestly to the best of your knowledge. Data collected will be used solely for health planning, workplace wellness promotion, and early detection of NCD risks. Fields marked * are mandatory. For any assistance, contact: info@askravi.org
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Section A — Personal & Demographic Details
Basic information about the employee
1. Full Name *
2. Employee ID / Service Number *
3. Age (years) *
4. Date of Birth
5. Gender *
6. Department / Ministry *
7. Designation / Grade
8. District of Posting *
9. Contact Number
10. Height (cm)
11. Weight (kg)
12. Educational Qualification
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Section B — Lifestyle & General Risk Factors
Habits and behaviours that influence NCD risk (WHO STEPS-aligned)
13. Do you currently use any tobacco products (cigarettes, bidi, gutka, khaini, hookah, etc.)? *
14. Do you consume alcohol? *
15. How many servings of fruits and vegetables do you eat per day on average?
16. How physically active are you? (Vigorous/moderate exercise or brisk walking)
17. How many hours do you spend sitting/sedentary at work per day?
18. Has a doctor ever told you that you have any of the following? (Select all that apply)
19. Does anyone in your immediate family (parents, siblings) have any of the following? (Select all that apply)
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Section C — Cancer Risk Assessment
Oral, Cervical, Breast & General Cancer Screening (NPCDCS / NHM aligned)
20. Do you have any non-healing sore or white / red patch in your mouth or lips that has persisted for more than 2 weeks?
21. Do you experience unexplained difficulty swallowing, hoarseness, or a persistent lump in the throat / neck?
22. Have you noticed any unexplained weight loss (> 5 kg) in the past 6 months without dieting?
23. (For women only) Have you noticed any unusual lump, nipple discharge, or skin change in your breast?
24. (For women only) Do you have any unusual vaginal bleeding (between periods, after intercourse, or after menopause)?
25. Have you ever undergone any cancer screening test (Pap smear, mammography, oral exam, PSA, etc.)?
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Section D — Mental Health & Wellbeing
PHQ-9 / GAD-7 aligned assessment (over the past 2 weeks)
For the following questions, please rate how often you have been bothered by each problem over the last 2 weeks.
0 = Not at all  |  1 = Several days  |  2 = More than half the days  |  3 = Nearly every day
26. Little interest or pleasure in doing things?
Not at allNearly every day
27. Feeling down, depressed, or hopeless?
Not at allNearly every day
28. Trouble falling asleep, staying asleep, or sleeping too much?
Not at allNearly every day
29. Feeling nervous, anxious, or on edge?
Not at allNearly every day
30. Feeling so stressed that it is hard to concentrate on work?
31. Have you ever sought help from a doctor, counsellor, or mental health professional for emotional or psychological problems?
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Section E — Cardiovascular Disease Assessment
Heart attacks, stroke risk & related symptoms
32. Have you ever experienced chest pain, chest tightness or pressure — especially during physical activity or stress?
33. Have you ever had palpitations (rapid or irregular heartbeat) or felt your heart "skipping a beat"?
34. Do you get breathless or feel extreme fatigue with mild physical activity (walking on flat ground or climbing 1–2 floors)?
35. Have you ever had a heart attack or stroke diagnosed by a doctor?
36. Do you have swelling in your legs / feet that is worse at the end of the day?
37. Have you had your cholesterol (blood lipids) tested in the past 3 years?
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Section F — Respiratory Disease Assessment
Asthma, COPD & related lung conditions
38. Do you have a persistent cough (lasting more than 3 months in a year)?
39. Do you experience wheezing (whistling sound from chest) or chest tightness?
40. Are you frequently exposed to any of the following? (Select all that apply)
41. Have you ever been diagnosed with Asthma or COPD by a doctor?
42. Do you currently use any inhaler or nebuliser for breathing problems?
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Section G — Diabetes Assessment
Indian Diabetes Risk Score & symptom screening
43. Have you ever been told by a doctor that you have diabetes or pre-diabetes (raised blood sugar)?
44. Do you experience any of these symptoms frequently? (Select all that apply)
45. What is your waist circumference? (measured at navel level)
46. When was your last fasting blood glucose (FBG) test done?
47. Are you currently on medication or insulin for diabetes?
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Section H — Hypertension Assessment
High blood pressure screening & management
48. Have you ever been told by a doctor that you have high blood pressure (hypertension)?
49. Do you have frequent headaches, dizziness, or visual disturbances (blurred or double vision)?
50. How often do you add extra salt to your food at the table (after cooking)?
51. When was your last blood pressure (BP) reading?
52. Are you currently taking anti-hypertensive (BP-lowering) medication?
53. Any additional health concerns or symptoms you would like to mention?
Upon submission, your data will be securely recorded on askravi.org. For queries, info@askravi.org.
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Survey Submitted Successfully!

Thank you for completing the NCD Health Survey.
Your responses have been recorded. Please follow up with your District NCD Clinic for further screening and guidance.


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