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At work

1. I have clear targets

Always Frequently Sometimes Never

2. I can achieve what I need to without feeling overloaded

Always Frequently Sometimes Never

3. Other people value the job I do

Always Frequently Sometimes Never

4. I  have problems communicating with people

Always Frequently Sometimes Never

5. I am critical of the ways others work

Always Frequently Sometimes Never

6. I get irritable with others

Always Frequently Sometimes Never

7. My job is boring

Always Frequently Sometimes Never

8. I dread going to work

Always Frequently Sometimes Never

9. I feel isolated

Always Frequently Sometimes Never

10. I am happy to go to work

Always Frequently Sometimes Never

11. I  take my full holiday entitlement

Always Frequently Sometimes Never

12. I am given supportive feedback on the work I do

Always Frequently Sometimes Never

At home

1. I take care about my appearance

Always Frequently Sometimes Never

2. I have difficulty waking in the morning

Always Frequently Sometimes Never

3. I feel in control

Always Frequently Sometimes Never

4. I am anxious

Always Frequently Sometimes Never

5. I suffer from loss of concentration

Always Frequently Sometimes Never

6. I get headaches

Always Frequently Sometimes Never

7. I feel ill

Always Frequently Sometimes Never

8. I spend time on hobbies

Always Frequently Sometimes Never

9. I get regular exercise

Always Frequently Sometimes Never

10. I take work home with me

Always Frequently Sometimes Never

11. My family/friends are willing to listen to my work-related problems

Always Frequently Sometimes Never

12. I have clear goals about what I want to get out of my life

Always Frequently Sometimes Never

Additional optional  questions

Are you:   Male Female

Age Range:  less than 30 30-50 over 50

Postcode area (EG: BN27)

Occupation:

Company size (No: of Employees): 1 2-5 6-20 21-100 101+

If you have any specific issues that you would like to mention please do so here.

If you would like to give your name and email address please do so here:

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