exan wellness

Workplace Stress Study
01/01/2007 - PR.098337


 

Thank you for participating in Exan Wellness Inc.'s 2007 Workplace Stress Study. Your participation furthers the understanding of workplace stress and enables our medical team to develop educational programs to help people increase their stress resilience.

Procedures: Please complete this survey during a time when you are not rushed and feel relaxed. If you're not sure how to answer some of the questions, please ask for feedback from your partner or a person who knows you well to ensure your responses are as accurate as possible.

Confidentiality commitment: Information submitted will be held in the strictest confidence by the members of Exan Wellness Inc.'s medical health team and will not be disclosed to any other persons or organizations, including your employer. Your information will be added to the aggregate report and permanently deleted thereafter.

Submitting your survey: When you have completed the survey after the last question, please click on the "Send" button to confidentially submit your responses.

Receiving a copy of the study report: Once the project is complete, a copy of the final report will be sent to you via your submitted e-mail address.

Phone contact: Survey participants will be called randomly. If you agree to be called to provide further input, please enter your phone number in the questionnaire section. If you choose not to be contacted, please select "do not contact."

click here to download pdf printable version

Questionnaire:
Name:
Age:
Sex: female     male
Marital Status: married    single    divorced    separated
Country: United States     Canada
City/town:
Contact phone #:

daytime    evening    do not contact

Your city/town population:
Number of children/dependants:
Name of employer:
Occupation:
Weekly hours worked: 20 hrs or less     20 - 30 hrs    30 - 40 hrs
  40 - 50 hrs    50 - 60 hrs     60 - 70 hrs    70+ hrs

Salary:
Less than $50,000
$50,000-$79,999
 
$80,000-$109,999
$110,000-$129,000
  Over $130,000
   
Time spent commuting to work daily.

 (total minutes, both ways)
Do you currently experience an illness?
type 1 diabetes yes No
type 2 diabetes yes No
heart-related illnesses yes No
cancer yes No
cancer survivor yes No
depression yes No

Other:

Stress is an emotional and mental state in which you experience inflamed emotions and extreme thoughts. Based on the definition provided, please answer the following questions about your personal experience with stress.


1) How frequently do you experience stress?

Often
Regularly
Occasionally
Seldom

COMMENTS

2) When you experience stress, at what level do you experience it?

Low
Medium
High

COMMENTS

3) How uncomfortable does stress make you feel physically on a scale from 1-10, with 1 being the lowest level of physical discomfort, and 10 being the highest?

low 1 2 3 4 5 6 7 8 9 10 high   

COMMENTS

4) Rank the emotional discomfort level you feel when stressed, with 10 being the highest:

low 1 2 3 4 5 6 7 8 9 10 high

COMMENTS

5) Rank the negative impact stress has on your relationships, with 10 being the highest:

low 1 2 3 4 5 6 7 8 9 10 high

COMMENTS

6) Rank the negative impact stress has on your productivity, with 10 being the highest:

low 1 2 3 4 5 6 7 8 9 10 high

COMMENTS

7) Rank the impact stress has on your physical health*, with 10 being the highest:

low 1 2 3 4 5 6 7 8 9 10 high

COMMENTS

* This can include weakening of the immune system, making you susceptible to colds, flues, headaches and inflammation, or increased pain/discomfort with a current illness.

8) Rank the negative impact stress has on your creativity/resourcefulness, with 10 being the highest:

low 1 2 3 4 5 6 7 8 9 10 high

COMMENTS

9) Choose one or more circumstances in which you have experienced difficulties:
Relationship conflict/issues from home or at work
Financial issues
Projects or work-related challenges (not people-related)
Physical/emotional abuse from another person
Exposure to difficult/traumatic situations
Divorce/separation
Onset of adolescence/teenagers

Others:

COMMENTS

10) Throughout my childhood, I:
Experienced physical, emotional or sexual abuse
I did not experience any serious forms of abuse.
I did but have become aware of it and dealt with it, and it no longer has an impact on me.
Not sure

11) Have you engaged in any type of stress education before?
No
Yes
COMMENTS

12) Do you feel your stress is the result of:
 Difficult events and circumstances you experience
Your stress resilience level being low

COMMENTS

13) Is your lifestyle:
Mostly sedentary
Low levels of physical activity
Medium levels of physical activity
High levels of physical activity

COMMENTS

14) I would rank my eating habits to be:
Poor
Just okay
Good
Very good

COMMENTS

15) When faced with difficulties/events that seem to be irresolvable:
I discuss my problems openly with people who will give me honest feedback that I value.
I discuss my problems with people who do not provide me with sound objective feedback.
I would like to be able to discuss my problems with people but find it uncomfortable doing so.
I don’t believe it's helpful discussing my problems with other people.

COMMENTS

16) When stressed I tend to:
Shut down/become introverted/go numb
Medicate myself with one or more of the following things:
Recreational/pharmaceutical drugs or alcohol/emotional eating
Other activities that I know are unhealthy for me

COMMENTS

 

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