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How satisfied are you with the following:
Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied
Work Environment
Workload
Colleagues
Supervisor
Overall
 
 
 
How satisfied are you with your job?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
 
 
 
What are the positive aspects of your job?
   
 
 
 
What is/are the most stressful aspect(s) of your job?
   
 
 
 
How would you rate the level of your job stress?
 
None
 
Mild
 
Moderate
 
Severe
 
Extreme

 
 
 
Is your job stress caused by your relationship with another person you work with?
 
Yes
 
No
 
Maybe
 
 
 
If your job stress doesn't involve another person, is it caused by the:
 
Volume of work
 
Nature of the job and its responsibilities
 
Physical work environment
 
Personal health issue
 
Other

 
 
How much do you agree or disagree with the following:
Strongly Disagree Disagree Undecided Agree Strongly Agree
Work assignments are distributed fairly.
Sufficient effort is made to get the opinions and ideas of the employees.
There is good alignment between my department and other with whom I need to coordinate.
The amount of work I am expected to do on my job is reasonable.
I have enough information to do my job well.
Diverse perspectives are valued within my department.
Overall
 
 
 
What would help you to be more productive and provide higher quality service?
   
 
 
 
How can your immediate supervisor help you improve your performance?