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  1. Surveys
  2. 2013
  3. April
  4. W
  5. Work ability index
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Exit Survey
 
Please provide your phone number and Email address for contact purposes. All identities will be kept anonymous.
Phone : 
Email : 
 
 
 
Assume that your work ability at its best has a value of 10 points, how many points would you give your current work ability?
0 1 2 3 4 5 6 7 8 9
10
 
 
 
How do you rate your current work ability with respect to the physical demands of your work?
Very poor Rather Poor Moderate Rather good Very good
 
 
 
How do you rate your current work ability with respect to the mental demands of your work?
Very poor Rather poor Moderate Rather good Very good
 
 
Number of current diseases diagnosed by physician
(In the following list, mark your diseases or injuries. Also indicate whether a physician has diagnosed or treated these diseases. For each disease, therefore, there can be 2, 1, or no alternatives circled.)
Yes, own opinion Yes, physician's diagnosis
Back
Arm/hand
Leg/foot
Disorder of the upper back or cervical spine, repeated Instances of pain
Disorder of the lower back, repeated instances of pain
(sciatica) pain radiating from the back into the leg
Musculoskeletal disorder affecting the limbs, repeated instances of pain
Rheumatoid arthritis
Hypertension (high blood pressure)
Coronary heart disease, chest pains during exercise (angina pectoris)
Coronary thrombosis, myocardial infarction
Cardiac insufficiency
Others
 
 
 
Is your illness or injury a hindrance to your current job?
 
There is no hindrance / I have no diseases
 
I am able to do my job, but it causes some symptoms
 
I must sometimes slow down my work pace or change my work methods
 
I must often slow down my work pace or change my work methods
 
Because of my disease, I feel I am able to do only part-time work
 
In my opinion, I am entirely unable to work