Work Stress Questionnaire

There is no need to write your name and all answers will remain confidential.

Tick or circle your answers and return the completed survey to your Health and
Safety Representative by: ________

1. Do you have influence over how your 10. Have you taken leave from work during the
work is organised? past 12 months for stress?

Yes Yes
No No
2. Are job events clearly predictable or are they 11. If YES to Question 10, what type of leave
subject to last-minute deadlines? did you take?

Usually predictable Sick Leave

Sometimes preditable Recreation Leave
Rarely predictable Workers Comp
Other: ____________
3. Do you know exactly what is required
of you at work? 12. If YES to Question 10, what do you believe is the
cause of your stress?
Yes
No Organisational Change/Restructuring
Excessive Workload
4. Is too much required of you at work? Poor Communication
Yes Job Insecurity
No Supervisor Conflict/Harrassment
Insufficient Training
5. Does your job involve contact with clients/public? Accommodation/Working Conditions
Public/Client Conflict
Yes Child Care Problems
No
6. Have you been adequately trained to Other: ____________________________
perform your job?
_________________________________
Yes 13. What would be the solution to your
No stress at work?
7. Do you experience conflict at work? Reduce Workload
Achievable Deadlines
Never
Opportunity to participate in decision making
Sometimes
Better Training
Frequently
Better Conflict Resolution Procedures
8. Have you experienced organisational change at Better Communication with Supervisor
work in the past 12 months? Work-Based Child Care

Yes Other: ____________________________

No _________________________________
9. Do you suffer from any of the following? _________________________________
Headaches Cramps
Indigestion Insomnia
Fatigue High Blood Pressure