Pre-Job Stress Survey

Are you full-time or part-time?

Full-time

Part-time

How would you rate your job stress level?

Mild

Moderate

Severe

Extreme

How long have you experienced this job stress?

Is your job stress caused by your relationship with someone you work with?

Yes

No

If your job stress doesn't involve another person, is it caused by: (Choose all that apply)

Volume of work

Nature of the job and its responsibilities

Physical work environment

Personal health issue

Overtime

Other

How many attempts have you made to relieve your job stress or solve the problem causing it?

None

One

Two

Three or more

Do you feel that problems go ignored when brought to management's attention?

Yes

No

Do you feel supported by your co-workers and supervisors?

Yes

No

How is your relationship with your supervisor?

Excellent

Good

OK

Poor

Has job stress affected you in any of the following ways: ( Check all that apply)

Decreased Attendance

Decreased Health

Poor or reduced performance

Thoughts of quitting your job

PreJob Stress