This questionnaire contains 225 questions. Please complete all of them as this will enable us to send you a full report

Section: AOrganizational, Interpersonal and Physical Environment Factors

1. Overall work is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
2. Communication in this organization is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
3. My customers/clients/students leave me feeling valued for the work I do.
   Almost never Almost Always Not Applicable
   
   
4. The amount of work I am expected to do is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
5. The deadlines I am expected to work to are a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
6. The physical conditions that I have to work in are a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
7. The match between my responsibilities and authority levels is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
8. My senior managers are a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
9. The degree to which I am able to participate in the decision making process is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
10. The way this organization is managed is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
11. The intellectual/technical demands of the job are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
12. The equipment that I use in my job is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
13. My level of role/job clarity is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
14. The level of staff turnover is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
15. The resources we have to do the job we are expected to do are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
16. The level of training I receive is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
17. My level of pay and other rewards is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
18. The risk of physical injury or illness from my work is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
19. The hours I work are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
20. The level of physical effort required in my job is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
21. The potential consequences of making a mistake in my job are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
22. Overall the people I have contact with at work are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
23. Rigid work practices that I have to follow are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
24. My level of enjoyment at work is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
25. The organizations approach to health and safety is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
26. The way this organization listens to concerns and requests that are raised is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
27. My immediate manager/supervisor is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
28. My feelings of job security are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
29. The level of control that I have over my work is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
30. My customers/clients/students are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
31. The shift work that I do is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
32. The level of morale in this organization is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
33. My workmates are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
34. I usually hear about important matters through the grapevine.
    Almost never Almost Always Not Applicable
    
    
35. Interruptions make it difficult for me to complete all my work.
    Almost never Almost Always Not Applicable
    
    
36. The deadlines I am set get changed.
    Almost never Almost Always Not Applicable
    
    
37. The space I have to work in feels too crowded.
    Almost never Almost Always Not Applicable
    
    
38. Morale is low within this organization.
    Almost never Almost Always Not Applicable
    
    
39. I am responsible for areas that I have no authority over.
    Almost never Almost Always Not Applicable
    
    
40. My ideas are sought when decisions are made that will affect me.
    Almost never Almost Always Not Applicable
    
    
41. Management decisions are fair and consistent.
    Almost never Almost Always Not Applicable
    
    
42. The equipment I work with in my job is outdated.
    Almost never Almost Always Not Applicable
    
    
43. The tasks that I am required to do are boring.
    Almost never Almost Always Not Applicable
    
    
44. I have a clear understanding of the task I am expected to do.
    Almost never Almost Always Not Applicable
    
    
45. There is a risk of physical injury or contracting an illness in my working environment(s).
    Almost never Almost Always Not Applicable
    
    
46. Staff turnover makes it harder for me to do my job.
    Almost never Almost Always Not Applicable
    
    
47. I have all the resources I need to do my job.
    Almost never Almost Always Not Applicable
    
    
48. I receive adequate training for all new tasks that I am requested to do.
    Almost never Almost Always Not Applicable
    
    
49. My immediate manager/supervisor leaves me feeling valued for the work I do.
    Almost never Almost Always Not Applicable
    
    
50. I am fairly paid and rewarded for the work I do.
    Almost never Almost Always Not Applicable
    
    
51. I can complete my work within the hours I am paid for.
    Almost never Almost Always Not Applicable
    
    
52. My senior managers leave me feeling valued for the work I do.
    Almost never Almost Always Not Applicable
    
    
53. The tasks I do are physically demanding.
    Almost never Almost Always Not Applicable
    
    
54. If I was to make a mistake at work it could result in serious injury to myself or others.
    Almost never Almost Always Not Applicable
    
    
55. I have to follow the work rules that are laid down even if some of them are impractical.
    Almost never Almost Always Not Applicable
    
    
56. I get a real ‘buzz’ out of the work that I do.
    Almost never Almost Always Not Applicable
    
    
57. My workmates leave me feeling valued for the work I do.
    Almost never Almost Always Not Applicable
    
    
58. Management is genuinely interested in the health and safety of employees.
    Almost never Almost Always Not Applicable
    
    
59. If I raise concerns or requests at work they are taken into consideration.
    Almost never Almost Always Not Applicable
    
    
60. My staff are a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
61. I feel that I have good career opportunities in this organization.
    Almost never Almost Always Not Applicable
    
    
62. I can control the pace that I am required to work at.
    Almost never Almost Always Not Applicable
    
    
63. The shifts that I work are in a regular and predictable pattern.
    Almost never Almost Always Not Applicable
    
    
64. I have a good working relationship with my immediate manager/supervisor.
    Almost never Almost Always Not Applicable
    
    
65. I am kept informed of the things I need to know.
    Almost never Almost Always Not Applicable
    
    
66. No matter how hard I work I still slip behind.
    Almost never Almost Always Not Applicable
    
    
67. The air conditioning system works well.
    Almost never Almost Always Not Applicable
    
    
68. I have access to the tools and equipment that I need to do my job.
    Almost never Almost Always Not Applicable
    
    
69. The deadlines I have to work to are realistic.
    Almost never Almost Always Not Applicable
    
    
70. I have the authority I need to achieve the tasks I am responsible for.
    Almost never Almost Always Not Applicable
    
    
71. Suggestions I put forward are taken notice of when decisions are made.
    Almost never Almost Always Not Applicable
    
    
72. I am exposed to potential hazards such as loud noises, dust, fumes etc. in my working 
    environment(s).
    Almost never Almost Always Not Applicable
    
    
73. This organization is managed well.
    Almost never Almost Always Not Applicable
    
    
74. My work is interesting and challenging.
    Almost never Almost Always Not Applicable
    
    
75. I have a good working relationship with my senior managers.
    Almost never Almost Always Not Applicable
    
    
76. The boundaries between my role and other peoples roles are unclear.
    Almost never Almost Always Not Applicable
    
    
77. Staff turnover results in me spending more time coaching new staff than I should have to.
    Almost never Almost Always Not Applicable
    
    
78. A lack of resources means that it is difficult for me to do my job.
    Almost never Almost Always Not Applicable
    
    
79. I receive training that will help me develop beyond my existing role.
    Almost never Almost Always Not Applicable
    
    
80. I have a good working relationship with my customers/clients/students.
    Almost never Almost Always Not Applicable
    
    
81. The rewards and recognition I receive leaves me feeling valued for the work I do.
    Almost never Almost Always Not Applicable
    
    
82. I am expected to work long hours
    Almost never Almost Always Not Applicable
    
    
83. I am physically exhausted at the end of work.
    Almost never Almost Always Not Applicable
    
    
84. If I was to make a mistake most people wouldn’t notice it.
    Almost never Almost Always Not Applicable
    
    
85. I have a good working relationship with my workmates.
    Almost never Almost Always Not Applicable
    
    
86. I can control the way I do the different tasks that make up my job.
    Almost never Almost Always Not Applicable
    
    
87. I have fun at work.
    Almost never Almost Always Not Applicable
    
    
88. People take short cuts that put my health and safety at risk.
    Almost never Almost Always Not Applicable
    
    
89. Concerns and requests that people raise are dismissed without consideration.
    Almost never Almost Always Not Applicable
    
    
90. I have concerns related to how secure my job is.
    Almost never Almost Always Not Applicable
    
    
91. The things that make the biggest difference to how well my job goes are out of my control
    Almost never Almost Always Not Applicable.
    
    
92. The shifts I am required to work change unpredictably.
    Almost never Almost Always Not Applicable
    
    
93. The level of morale in the team I work with is high.
    Almost never Almost Always Not Applicable
    
    
94. I have good working relationships with my staff.
    Almost never Almost Always Not Applicable
    
    
95. Overall the physical conditions I work in and the equipment I use is a source of stress for me.
    Almost never Almost Always Not Applicable
    
    
96. My staff leave me feeling valued for the work I do.
    Almost never Almost Always Not Applicable

Section B:Private Life

1. Overall my private life is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
2. My financial situation is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
3. My relationship with my spouse/partner is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
4. Trying to balance work and private life activities is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
5. My children are a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
6. My health is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
7. The health of other family members is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
8. Loneliness is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
9. Not achieving the things I want out of life is a source of stress for me.
   Almost never Almost Always Not Applicable
   
   
10. Keeping up with work around the house/flat/section is a source of stress for me.
    Almost never Almost Always Not Applicable

1. I worry about things that might happen.
   Almost never Almost Always Not Applicable
   
   
2. I draw strength from my religious/spiritual beliefs.
   Almost never Almost Always Not Applicable
   
   
3. I am self confident.
   Almost never Almost Always Not Applicable
   
   
4. When I play a game with children I still like to win.
   Almost never Almost Always Not Applicable
   
   
5. I maintain a well balanced diet.
   Almost never Almost Always Not Applicable
   
   
6. I feel physically healthy.
   Almost never Almost Always Not Applicable
   
   
7. I had a happy and stable childhood.
   Almost never Almost Always Not Applicable
   
   
8. I feel in control of my own destiny.
   Almost never Almost Always Not Applicable
   
   
9. I enjoy life.
   Almost never Almost Always Not Applicable
   
   
10. I worry about things I have said to people.
    Almost never Almost Always Not Applicable
    
    
11. I am able to speak openly about my feelings when angry or worried.
    Almost never Almost Always Not Applicable
    
    
12. No matter what happens in life I seem to cope well with it.
    Almost never Almost Always Not Applicable
    
    
13. I have set routines in the way I like to do things.
    Almost never Almost Always Not Applicable
    
    
14. I eat junk foods or fast foods.
    Almost never Almost Always Not Applicable
    
    
15. I exercise at a level at which I perspire/sweat three or more times per week.
    Almost never Almost Always Not Applicable
    
    
16. I am a perfectionist.
    Almost never Almost Always Not Applicable
    
    
17. The things that happen to me in life are a result of chance or luck.
    Almost never Almost Always Not Applicable
    
    
18. I do something just for fun at least twice per week.
    Almost never Almost Always Not Applicable
    
    
19. If I can’t keep something from happening I don’t worry about it.
    Almost never Almost Always Not Applicable
    
    
20. I get good support from the people I work with.
    Almost never Almost Always Not Applicable
    
    
21. Other people seem to be more self confident than me.
    Almost never Almost Always Not Applicable
    
    
22. I like to time things I do. Eg: when exercising, driving on a trip, work tasks, etc.
    Almost never Almost Always Not Applicable
    
    
23. I drink five or more cups of coffee or other high caffeine drinks per day.
    Almost never Almost Always Not Applicable
    
    
24. I have emotional/mental health problems.
    Almost never Almost Always Not Applicable
    
    
25. I put others’ need before my own.
    Almost never Almost Always Not Applicable
    
    
26. What makes people succeed in life is the effort they put into it.
    Almost never Almost Always Not Applicable
    
    
27. My life is dull and boring.
    Almost never Almost Always Not Applicable
    
    
28. I worry about things at work.
    Almost never Almost Always Not Applicable
    
    
29. I feel lonely.
    Almost never Almost Always Not Applicable
    
    
30. I know I’m not perfect but overall I feel good about myself.
    Almost never Almost Always Not Applicable
    
    
31. I’m a relaxed/laid back person.
    Almost never Almost Always Not Applicable
    
    
32. I have five or less alcoholic drinks per week.
    Almost never Almost Always Not Applicable
    
    
33. I’m scared to try things in case I fail.
    Almost never Almost Always Not Applicable
    
    
34. My stress levels have a negative impact on my health.
    Almost never Almost Always Not Applicable
    
    
35. The actions I take will determine how well my career goes.
    Almost never Almost Always Not Applicable
    
    
36. When I wake up I look forward to the day ahead.
    Almost never Almost Always Not Applicable
    
    
37. Other people seem to worry about things that I just get on and deal with.
    Almost never Almost Always Not Applicable
    
    
38. I get good support from my family and/or friends.
    Almost never Almost Always Not Applicable
    
    
39. I just feel useless.
    Almost never Almost Always Not Applicable
    
    
40. I act on impulse.
    Almost never Almost Always Not Applicable
    
    
41. I enjoy being busy.
    Almost never Almost Always Not Applicable
    
    
42. I eat more than I should.
    Almost never Almost Always Not Applicable
    
    
43. I feel that I am physically fit for my age.
    Almost never Almost Always Not Applicable
    
    
44. Luck and chance makes the biggest difference to how well people succeed in life.
    Almost never Almost Always Not Applicable
    
    
45. I do something to relax and unwind at least twice per week.
    Almost never Almost Always Not Applicable

Over the last two years how much change has there been in your:

1. Financial situation
   No change Major change
   
   
2. Work
   No change Major change
   
   
3. Health
   No change Major change
   
   
4. Location (i.e. Where you live)
   No change Major change
   
   
5. Private life
   No change Major change

1. Overall, how stressed do you consider that you currently are.
   Not at all stressed Extremely stressed
   
   
2. Are you currently receiving treatment for stress related disorders.
   Yes No
   If Yes: a) How ill/unwell do you feel
   Extremely ill/unwell Slightly ill/unwell
   
   
3. Have you ever received treatment for stress related disorders
   Yes No
   - If Yes: a) How ill/unwell did you feel
   Extremely ill/unwell Slightly ill/unwell
   b) How long ago did you receive treatment
   A very long time ago Very recently

Section F: Anticipatory Stress

Please indicate how often you have experienced:

1. Felt sick or tense at the end of a weekend because of the thought of going back to work
   Never Very Often
   
   
2. Felt sick or tense at the end of annual leave because of the thought of going back to work
   Never Very Often
   
   
3. Felt nervous before a meeting with your manager
   Never Very Often
   
   
4. Felt sick or tense when the phone is for you at work
   Never Very Often
   
   
5. Felt sick or tense when people come into your office/workspace
   Never Very Often

Section G:Delayed Effects

Please indicate how often you have experienced:

1. Becoming sick on annual leave
   Never Very Often
   
   
2. Racing/palpitating heart
   Never Very Often
   
   
3. Head aches just after a stressful event has been dealt with
   Never Very Often
   
   
4. Becoming sick after a major project has been completed
   Never Very Often
   
   
5. Feeling exhausted once a stressful situation has passed
   Never Very Often

Section H:Symptoms

In the LAST MONTH how often have you experienced:

1. Tension Headaches
   Never Very Often
   
   
2. Problems getting off to sleep
   Never Very Often
   
   
3. Nervousness or Trembling
   Never Very Often
   
   
4. Loose bowels/diarrhea
   Never Very Often
   
   
5. Difficulties remembering things
   Never Very Often
   
   
6. Feeling irritable
   Never Very Often
   
   
7. Tension or pains in the chest
   Never Very Often
   
   
8. A lack of self confidence
   Never Very Often
   
   
9. Difficulties concentrating
   Never Very Often
   
   
10. Feeling indecisive
    Never Very Often
    
    
11. Racing or irregular heartbeat
    Never Very Often
    
    
12. Worries about how you are feeling
    Never Very Often
    
    
13. A loss of interest in sex
    Never Very Often
    
    
14. Migraine Headaches
    Never Very Often
    
    
15. Problems staying asleep
    Never Very Often
    
    
16. Feeling panicky
    Never Very Often
    
    
17. Worries about failing
    Never Very Often
    
    
18. Feeling sick/ Nausea
    Never Very Often
    
    
19. Crying
    Never Very Often
    
    
20. Feeling annoyed or irritated
    Never Very Often
    
    
21. Dizziness
    Never Very Often
    
    
22. Needing to double check things you normally wouldn’t have.
    Never Very Often
    
    
23. Procrastination
    Never Very Often
    
    
24. Feeling trapped
    Never Very Often
    
    
25. Tension in the neck or shoulders
    Never Very Often
    
    
26. Difficulties concentrating because of the symptoms you are experiencing
    Never Very Often
    
    
27. Worries about how you will feel in certain situations
    Never Very Often
    
    
28. Difficulties breathing
    Never Very Often
    
    
29. Anger outbursts
    Never Very Often
    
    
30. Feeling depressed
    Never Very Often
    
    
31. Excessive wind (either end)
    Never Very Often
    
    
32. Memory blanks
    Never Very Often
    
    
33. A loss of interest in food
    Never Very Often
    
    
34. Feeling anxious in situations that didn’t concern you previously
    Never Very Often
    
    
35. Fatigue
    Never Very Often
    
    
36. Shaking hands
    Never Very Often
    
    
37. Feeling concerned that you will not be able to cope
    Never Very Often
    
    
38. Skin rashes or itching
    Never Very Often
    
    
39. An increased interest in food
    Never Very Often
    
    
40. Rumbling stomach/ gut
    Never Very Often
    
    
41. Feeling "distant" from the situation you are in
    Never Very Often
    
    
42. Tightness / lump in the throat
    Never Very Often
    
    
43. Worries that others will notice how you are feeling
    Never Very Often
    
    
44. Jiggling hands or feet
    Never Very Often
    
    
45. A Knot in the stomach
    Never Very Often

Section I:Job Satisfaction

Overall, how satisfied are you with your current job
Extremely dissatisfied Extremely satisfied Not Applicable

Section K:Stress Management Training

1. How much stress training or counselling have you had before
   None A very large amount
   
   

2. Overall, how useful have you found the stress management training or counselling you have received
   Not at all useful Extremely useful Not Applicable

Section K:Personal Details

Note we are asking for your full name so that we can link your scores on the Brief Stress Assessment Survey to this data and to be able to link your original data should you choose to repeat this questionnaire in the future.

We have asked for information on age, gender, management level etc. so that we can form groups to assess whether there is a relationship between the variables and stress levels.

We have asked for your employer’s name so that we could provide grouped results to employers. We would only provide employers information when the numbers in each group, or sub group, would maintain confidentiality, i.e. When the grouping analyzed contains more than twenty people.

Surname/Family Name:

First Name(s):

Email address for normal contact:

Email address that you would like your report sent to (if different from above):

Country of Residence

New Zealand AustraliaOther Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakstan Kenya Kiribati Kuwait Kyrgystan Lao Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia (FYR) Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Caledonia Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands United States of America Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe

Age:

15-20 21-30 31-40 41-50 51-60 61-70 71+

Gender

Male Female

Ethnicity

AfricanAsianEuropeanIndianMaori
Other Non EuropeanPacific Islands People

Formal Education Qualifications

No school qualifications
High School diploma or certificate
Technical/Vocational/Trade certificate
Undergraduate degree
Post graduate degree

Employment Status

Full time paid employment
Part time (20 hours +) paid employee
Part time (less than 20 hours) paid employee
Self employed
Student
Home worker
Retired
Seeking Employment
Other

Name of organization you work for

City/Town located in

Occupational classification (e.g. accountant, banker, builder, clerk, police officer, teacher, nurse, etc.)

Job title

Job level
Staff memberSupervisor/Team leaderMiddle managerSenior manager

Number of people reporting directly to you
None 1-2 3-5 6-10 11-15 16-20 20+

Number of people whom you have overall responsibility for
None 1-20 21-50 51-100 101-200 200-500 500+

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