CSTC COLLEGE OF SCIENCES, TECHNOLOGY AND

COMMUNICATIONS, INC.
Gen. Luna St., Maharlika Highway, Arellano Subdivision, Sariaya, Quezon
Telefax: 042-6512778 Landline: 042-6512648 Atimonan: 042-5111041
Smart: 0999-7446360 Globe: 0906-2283

INFORMED CONSENT

Dear Respondents,

The undersigned, student of College of Sciences, Technology and Communications Inc. are
presently conducting a study entitled “Level of Resiliency and Level of Emotional
Exhaustion Among Healthcare Workers in Lucena City” The study would like to help the
health workers of Lucena City increase their level of resiliency and handling emotional
exhaustion in the performance of their workplace

In keeping with this, you have been picked as one of the study's chosen participants. Two (2)
sets of questionnaires must be completed without time limit. We hope that you will take time
answering the question honestly. Additionally, there are no known dangers associated with
participating in this study. Rest assured that all data gathered will be treated with utmost
confidentiality and will be used for academic purpose only.

Thank you for your support and cooperation!

Truly yours,
BRIONES, CHRISTY
MARQUEZ, KIMBERLY
REMO CHRISTINE MAE V.
Researcher

Noted by:
FELOMENA E. MOORE, RGC, RPm, LPT
Research Adviser
I voluntarily agree to participate in this research study.
□ Yes □ No
I understand that I will be given a copy of this signed Consent Form.
Name of Participant: _______________________________________
Signature: __________________________ Date: _________________

Thank you!
 CSTC COLLEGE OF SCIENCES, TECHNOLOGY AND
COMMUNICATIONS, INC.
Gen. Luna St., Maharlika Highway, Arellano Subdivision, Sariaya,
Quezon
Telefax: 042-6512778 Landline: 042-6512648 Atimonan: 042-
5111041 Smart: 0999-7446360 Globe: 0906-2283

QUESTIONNAIRES

I. DEMOGRAPHICS
Directions: Supply the information needed or simply put a check mark whenever
necessary.

Name (optional): _______________________________________

Sex: ( ) Male
( ) Female

Age: ( ) 25-37 years old

( ) 38-50 years old
( ) 51-36 years old

I. LEVEL OF RESILIENCY

Directions: Below are concepts regarding level of rresiliency. Read each statement

carefully and put a check mark (/) to the column that corresponds to the level of your

resiliency for each situation below. Use the scale for your reference:

4 - Highly Resilient

3 - Moderately Resilient

2 - Slightly Resilient

1 - Not Resilient
Level of Resiliency in terms of Vision:

Statements 4 3 2 1
(SA) (A) (D) (SD)

1. I am willing to take risks.

2. I can delay gratification, resisting short-term

temptations to meet long-term goals.

3. I believe that my life has meaning and purpose.

4. I maintain a positive outlook in life despite many

challenges.

5. I make plans for future.

Level of Resiliency in terms of Composure:

Statements 4 3 2 1
(SA) (A) (D) (SD)

1. I can easily adjust to changes.

2. I solved problems right away.

3. I feel confident in myself.

4. I maintain my emotion even when I am angry.

5. I can stay calm under pressure.

Level of Resiliency in terms of Tenacity:

Statements 4 3 2 1
(SA) (A) (D) (SD)

1. I find it easy to cope effectively with stress.

2. I keep myself motivated doing my job.

3. I am capable to override an unwanted thought

feeling, or impulse.
 4. I am persistent in sticking to my plan.

5. I do avoid problem.

Level of Resiliency in terms of Reasoning:

Statements 4 3 2 1
(SA) (A) (D) (SD)

1. I am prone to think ahead and consistently focus on

improvement.

2. I focus on what I can control.

3. I can make my own decisions in life.

4. I take responsibility for my success.

5. I think creatively to find solutions to problems and

challenges.

Level of Resiliency in terms of Collaboration:

Statements 4 3 2 1
(SA) (A) (D) (SD)

1. I have a strong social support.

2. I work with a team rather than independently.

3. I count on my friends and family in times of

trouble.

4. I have a high level of awareness when

communicating with others.

5. I am sensitive to the feelings of others.

Level of Resiliency in terms of Health:

Statements 4 3 2 1
(SA) (A) (D) (SD)

1. I get enough good sleep.

2. I exercise regularly.

3. I eat healthy foods.

4. I avoid eating junk food and sweets.

5. I keep myself hydrated.

I. LEVEL OF EMOTIONAL EXHUASTION

Directions: Below are concepts regarding level of emotional exhaustion. Read each

statement carefully and put a check mark (/) to the column that corresponds to the

extent to which each item applies to you. Use the scale for your reference:

Scale Description Adjective Equivalence

4 Strongly Agree Highly Exhausted
3 Agree Moderately Exhausted
2 Disagree Minimally Exhausted
1 Strongly Disagree Not Exhausted
 Statements 4 3 2 1

( (A) (D) (SD)

SA)
1. I feel upset towards my job

2. I wake up every day feeling tired yet still

must attend work.

3. I find it difficult to interact with my

workmates.

4. I feel tired of my job because of work

overload.

5. I feel like I'm losing interest in my work.

6. I find it difficult to deal with my own

emotions at work.

7. I think my patience may have run out.

8. I feel out of place at my workplace.

9. I feel emotionally drained because of my

work.

10. I often get angry even in the workplace.

11. I usually get dizzy at my workplace.

12. I fear going to my workplace because I

might catch a disease.

13. I frequently get physical symptoms of stress

due to the nature of my work.

14. It is difficult for me to focus on my work.

15. I wish I don’t have to work anymore.