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1.
Do you
think about work (whether you want to or
not) when you at home or away from work? |
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Yes |
No |
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2.
Do
pictures of things you’ve seen or heard
others talk about in your work flash in
your mind? |
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Yes |
No |
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3.
Do you
feel like you are “on call” (e.g.,
checking your pager/cell phone) during
your free time? |
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Yes |
No |
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4.
Do you
ever dream about your work (related to a
specific situation or in general)?
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Yes |
No |
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5.
Do you
have trouble falling asleep because you
can't stop thinking about your work? |
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Yes |
No |
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6.
Are
there times when you feel you sleep too
much (or feel like you need more sleep
than normal)? |
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Yes |
No |
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7.
Have you
experienced a decrease in your appetite? |
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Yes |
No |
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8.
Have you
found yourself eating more, whether or
not you are hungry? |
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Yes |
No |
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9.
When you
arrive at work (or even in the parking
lot), do you ever experience: a racing
heart, a tight stomach, nausea,
headaches, increased perspiration,
muscle tension, or other physical
changes? |
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Yes |
No |
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10.
Do you
avoid people, activities, TV programs,
or places that frequently or strongly
remind you of your work? |
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Yes |
No |
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11.
At work,
do you find yourself spending
significant time on menial, less
significant and/or easily completed
tasks, at the expense of key/necessary
tasks essential to your work? |
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Yes |
No |
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12.
Do you
ever feel as though you are
“going-through-the-motions” at work? |
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Yes |
No |
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13.
Do you
ever have a sense that your work, while
producing immediate changes, has no
lasting impact? |
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Yes |
No |
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14.
Do you
feel a decreased ability to “relate,”
empathize, or understand the perspective
of your clients/consumers? |
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Yes |
No |
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15.
In your current job, have you
experienced a steady and continuous
decrease in your ability to concentrate? |
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Yes |
No |
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16.
Do you
feel that you have become increasingly
irritable and/or “moody” since starting
your current position? |
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Yes |
No |
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17.
Do you
feel increasingly “jumpy” or “on edge”
since taking your current
position? |
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Yes |
No |
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18.
Do you
find yourself spending significant time
checking and re-checking your work?
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Yes |
No |
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19.
Do you
experience uneasy, anxious feelings or a
sense of dread in response to previously
common events (e.g., when the phone
rings)? |
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Yes |
No |
