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What is/are the most stressful aspect(s) of your job?
   
 
 

How long have you had this particular job stress?
 
Less Than A Month
 
1-3 Months
 
4-6 Months
 
6 months - 1 year
 
More than 1 year
 
 

How would you rate the level of your job stress?
 
Mild
 
Moderate
 
Severe
 
Extreme
 
 

How many attempts have you made to relieve your job stress or solve the problem causing it?
 
None
 
One
 
Two
 
Three or more
 
 

Is your job stress caused by your relationship with another person you work with?
 
Yes
 
No
 
 

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
 
 
 
What is your job title?
   
 
 
 
What are the positive aspects of your job?
   
 
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