Mental Health Survey

Section 1 of 26


Mental Health and Wellness Survey


Last year we asked that you complete this survey as a baseline. Our intention was to conduct the survey on a yearly basis and we felt that even though things are very different this year, we are asking that you take the time to complete the survey again this year. Your mental health and wellness are important and we'd like to continue to monitor it and to identify common issues. Personal data will not be collected and all responses will remain anonymous. This survey should take about 5 minutes to complete.

Thank you!

Section 2 of 26


Work Demands

AlwaysOftenSometimesSeldomNever
AlwaysOftenSometimesSeldomNever

Section 3 of 26


Work Place

AlwaysOftenSometimesSeldomNever
AlwaysOftenSometimesSeldomNever

Section 4 of 26


Emotional Demands

AlwaysOftenSometimesSeldomNever
AlwaysOftenSometimesSeldomNever

Section 5 of 26


Influence at Work

AlwaysOftenSometimesSeldomNever
AlwaysOftenSometimesSeldomNever

Section 6 of 26


Possibilities For PD

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 7 of 26


Meaningful Work

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 8 of 26


Predictability (Sufficient Information)

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 9 of 26


Recognition

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 10 of 26


Role Clarity

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 11 of 26


Role Conflicts

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 12 of 26


Quality of Leadership

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 13 of 26


Social Support From Colleagues

AlwaysOftenSometimesSeldomNever / Hardly Ever

Section 14 of 26


Social Support From Supervisors

AlwaysOftenSometimesSeldomNever / Hardly Ever
AlwaysOftenSometimesSeldomNever / Hardly Ever

Section 15 of 26


Sense Of Community At Work

AlwaysOftenSometimesSeldomNever / Hardly Ever

Section 16 of 26


Insecurity Over Employment

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 17 of 26


Insecurity Over Working Conditions

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 18 of 26


Vertical Trust

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 19 of 26


Organizational Justice

To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent
To a very large extentTo a large extentSomewhatTo a small extentTo a very small extent

Section 20 of 26


Physical Work Environment

Not applicableWell designed / controlledPresent, but not usually an issue or concernExposures cause concernExposures cause annoyanceExposures interfere with ability to get the job done
Not applicableWell designed / controlledPresent, but not usually an issue or concernExposures cause concernExposures cause annoyanceExposures interfere with ability to get the job done

Section 21 of 26


Satisfaction With Work - Job Satisfaction

Very satisfiedSatisfiedNeither / norUnsatisfiedVery unsatisfied

Section 22 of 26


Work-life Conflict

Yes, certainlyYes, to a certain degreeYes, but only very littleNo, not at all
Yes, certainlyYes, to a certain degreeYes, but only very littleNo, not at all
Yes, certainlyYes, to a certain degreeYes, but only very littleNo, not at all

Section 23 of 26


Overall Health

ExcellentVery GoodGoodFairPoor

Section 24 of 26


Burnout Symptoms

All the timeA large part of the timePart of the timeA small part of the timeNot at all
All the timeA large part of the timePart of the timeA small part of the timeNot at all

Section 25 of 26


Stress Symptoms

All the timeA large part of the timePart of the timeA small part of the timeNot at all
All the timeA large part of the timePart of the timeA small part of the timeNot at all

Section 26 of 26


Conflicts And Offensive Behaviour

At your workplace during the last 12 months, have you been exposed to:

NoYes, a few timesYes, monthlyYes, weeklyYes, daily
NoYes, a few timesYes, monthlyYes, weeklyYes, daily
NoYes, a few timesYes, monthlyYes, weeklyYes, daily
NoYes, a few timesYes, monthlyYes, weeklyYes, daily

* bullying means that a person is repeatedly exposed to unpleasant, unwanted, or degrading treatment, and that person finds it difficult to defend themselves against it