Username or Email Address Password Remember Me Log In Lost your password? | Register Continue with Google Stress Meter EN (#12) CodeGeneral Information Family Status Smoking status Mental health Sleep quality Chronic condition Financial stress Work-related stress This questionnaire gives you a chance to share your feelings and thoughts about various aspects of your life and how you handle the demands that may cause you different types of stress.There are no 'right' or 'wrong' answers and no 'good' or 'bad' choices. Please answer openly and honestly, reflecting your true feelings rather than what you think you should feel. Ensure that you consider and respond to each question. If the space provided in a ‘Comments’ section is insufficient, please continue on a separate sheet of paper, noting the question number.The aim is to develop a high-quality stress management and mental wellbeing program tailored to the majority's needs and demands.Please ensure that you do not write your name or any other identifying information.If you have any concerns or questions, please contact the program owner.Note: The personal information collected is used only by Info Entrepreneurs’ staff for the purposes defined at the time of collection or for a use that complies with these purposes. We do not share your information with any third parties.CodePreviousNextFull NameID NumberDepartmentJob TitleContact Email WeightHeightGender Male FemaleDo you manage other people? Yes NoPreviousNextWhat is your marital status? Married, living with a spouse. Married, not living with a spouse. Divorced Widowed SingleAre you responsible for taking care of an elderly relative or friend ? Yes NoNumeric Score Are you responsible for taking care of an elderly relative or friend Do you have a spouse or child who is chronically ill or requires special care ? Yes NoNumeric Score Do you have a spouse or child who is chronically ill or requires special care Rate your family's daily stress level (1 lowest, 10 highest).0Textarea Message Family Stress Family Stress : • Consider Family Counseling: Seek support from a licensed family therapist or counselor to address and manage family-related stress. Professional guidance can help improve family dynamics and provide strategies to cope with challenges. • Prioritize Self-Care: Ensure you are taking time for yourself to recharge. Managing family stress effectively often involves taking care of your own mental and physical well-being. • Develop a Family Plan: Create a structured plan to manage family responsibilities and allocate tasks among family members. This can help distribute the workload and reduce individual stress. • Consider Time Management Techniques: Use time management strategies to better balance family duties and personal time. Tools like scheduling apps or to-do lists can help organize tasks effectively.Numeric Score Rate your family's daily stress level 1Numeric Score Rate your family's daily stress level 2Numeric Score Rate your family's daily stress level 3Numeric Score Rate your family's daily stress level 4Numeric Score Rate your family's daily stress level 5Numeric Score Rate your family's daily stress level 6Numeric Score Rate your family's daily stress level 7Numeric Score Rate your family's daily stress level 8Numeric Score Rate your family's daily stress level 9Numeric Score Rate your family's daily stress level 10PreviousNextAre you a smoker ? Yes NoNumeric Score Are you a smoker How many times do you smoke each day ? Less than 10 10-20 More than 20Do you increase the intensity of smoking with stress? Yes NoNumeric Score Do you increase the intensity of smoking with stressDo you consider quitting smoking in the next 12 months? Yes NoNumeric Score Are you a smoker Textarea Message SmokingSmoking : • Participate in smoking cessation programs to help you quit smoking. • Consult with a healthcare provider to get personalized advice and support for quitting smoking. • Adopt alternative stress-relief techniques like exercise or mindfulness to reduce the urge to smoke.PreviousNextTextarea Message Mental Health Fatigue Mental Health Fatigue : • Engage with a mental health professional to address issues like anxiety, irritability, and difficulty concentrating. • Incorporate stress-reduction practices such as deep breathing exercises and mindfulness meditation into your routine. • Utilize company wellness programs focused on mental health and stress management.Are you easily irritated, annoyed, angry, or frustrated ? Yes NoNumeric Score Are you easily irritated, annoyed, angry, or frustratedDo you get frustrated or anxious even if you are winning or are successful ? Yes NoNumeric Score Do you get frustrated or anxious even if you are winning or are successful Do you express anger easily ? Yes NoNumeric Score Do you express anger easilyDo you feel constant pressure or a need to succeed ? Yes NoNumeric Score Do you feel constant pressure or a need to succeed Do you often have many projects, activities, or demands occurring at the same time? Yes NoNumeric Score Do you often have many projects, activities, or demands occurring at the same timeDo you find it difficult to stay calm in stressful situations? Yes NoNumeric Score Do you find it difficult to stay calm in stressful situationsDo often do you feel overwhelmed by the demands placed on you? Yes NoNumeric Score How often do you feel overwhelmed by the demands placed on youDo you find yourself overreacting to minor setbacks or challenges? Yes NoNumeric Score Do you find yourself overreacting to minor setbacks or challengesDo you feel tense or on edge most of the time? Yes NoNumeric Score Do you feel tense or on edge most of the timeDo you have difficulty focusing or concentrating under pressure? Yes NoNumeric Score Do you have difficulty focusing or concentrating under pressureDo you feel stressed when facing any unexpected changes or challenges? Yes NoNumeric Score How do you typically respond when faced with unexpected changes or challengesDo you experience physical symptoms, such as headaches or muscle tension, when under stress? Yes NoNumeric Score Do you experience physical symptoms, such as headaches or muscle tension, when under stressDo you feel that you are unable to control the important things in your life? Yes NoNumeric Score How often do you feel that you are unable to control the important things in your lifePreviousNextTextarea Message Sleep QualitySleep Quality : - Consult with a sleep specialist if you have ongoing sleep issues. - Follow good sleep hygiene practices, such as maintaining a consistent sleep schedule and creating a restful sleep environment.Textarea Message Sleep Quality 2- Review your use of sleep medications with your healthcare provider and explore alternative treatments if necessary.Are you a shift worker? Yes NoNumeric Score Are you a shift workerhave you found effective sleep management strategies to handle shift patterns sleep stress ? Yes NoNumeric Score have you found effective sleep management strategies to handle shift patterns sleep stress Do you get enough sleep to feel rested upon waking in the morning? Yes NoNumeric Score Do you get enough sleep to feel rested upon waking in the morningDo you have trouble falling asleep? Yes NoNumeric Score Do you have trouble falling asleepDo you wake up short of breath or with a headache? Yes NoNumeric Score Do you wake up short of breath or with a headacheDo you have trouble staying awake during the day? Yes NoNumeric Score Do you have trouble staying awake during the dayDo you use prescribed sleep medications to help you sleep? Yes NoNumeric Score Do you use prescribed sleep medications to help you sleepDo sleep problems cause a decline in the quality of your work? Yes NoNumeric Score Do sleep problems cause a decline in the quality of your workIn the past 12 months, do sleep problems lead to any accidents on or off the job? Yes NoNumeric Score In the past 12 months, do sleep problems lead to any accidents on or off the jobOn average, how many hours of sleep do you get each night ? Numeric Score On average, how many hours of sleep do you get each nightRate your sleep-related stress from 1 to 10 0Numeric Score Rate your sleep-related stress 1Numeric Score Rate your sleep-related stress 2Numeric Score Rate your sleep-related stress 3Numeric Score Rate your sleep-related stress 4Numeric Score Rate your sleep-related stress 5Numeric Score Rate your sleep-related stress 6Numeric Score Rate your sleep-related stress 7Numeric Score Rate your sleep-related stress 8Numeric Score Rate your sleep-related stress 9Numeric Score Rate your sleep-related stress 10PreviousNextTextarea Message Chronic Condition Chronic Condition : • Schedule regular check-ups with your healthcare provider to manage chronic conditions effectively. • Request ergonomic adjustments at work to alleviate physical strain related to your condition. • Join support networks for people with similar chronic conditions to share experiences and strategies.In the past year, have you been diagnosed by a physician , or do you suffer from any of the following? Chronic bronchitis or any respiratory disease Any form of arthritis Chronic back problems Any form of headache Chronic allergies or recurring sinusitis Chronic stomach or intestinal problems Any other unmentioned disease None of the aboveNumeric Score In the past year, have you been diagnosed by a healthcare professional 1Numeric Score In the past year, have you been diagnosed by a healthcare professional 2Numeric Score In the past year, have you been diagnosed by a healthcare professional 3Numeric Score In the past year, have you been diagnosed by a healthcare professional 4Numeric Score In the past year, have you been diagnosed by a healthcare professional 5Numeric Score In the past year, have you been diagnosed by a healthcare professional 6Numeric Score In the past year, have you been diagnosed by a healthcare professional 7Numeric Score In the past year, have you been diagnosed by a healthcare professional 8Are you on regular medication for any of the following? Diabetes Blood pressure Cholesterol NothingNumeric Score Are you on regular medication for any of the following 1Numeric Score Are you on regular medication for any of the following 2Numeric Score Are you on regular medication for any of the following 3Numeric Score Are you on regular medication for any of the following 4Have any of your first-degree relatives suffered from any of the following conditions ? Diabetes Blood pressure Cholesterol NothingNumeric Score Have any of your mother, father, sisters, or brothers had any of the following 1Numeric Score Have any of your mother, father, sisters, or brothers had any of the following 2Numeric Score Have any of your mother, father, sisters, or brothers had any of the following 3Numeric Score Have any of your mother, father, sisters, or brothers had any of the following 4Do you think the company promotes a healthy work environment and encourages healthy behaviors? Yes NoNumeric Score Do you think the company promotes a healthy work environment and encourages healthy behaviorsDo you feel any pain in any part of your body after or during work? Yes NoNumeric Score Do you feel any pain in any part of your body after or during workRefer to specific areas where you may experience pain. Then, indicate the degree of pain you feel in each identified area 1- Head front / side 2- Neck front 3- Shoulder front 4- Chest 5- Arm / elbow outer 6- Arm / elbow inner 7- Abdominal 8- Groin 9- Hand wrist 10- Hip front 11- Thigh outer 12- Thigh inner 13- Knee front 14- Shin / ankle outer 15- Shin / ankle inner 16- Foot front 17- Head back / side 18- Neck back 19- Shoulder back 20- Upper back 21- Arm / elbow outer 22- Arm / elbow inner 23- Lower back 24- Buttock / hip back 25- Hand wrist 26- Thigh outer / back 27- Thigh inner / back 28- Knee back 29- Calf/ ankle outer 30- Calf/ ankle inner 31- Foot / heelNote : you can choose more than one areaNumeric Score - Refer to specific areas PreviousNextTextarea Message Financial Stress Financial Stress : • Seek advice from a financial counselor to create a budget and manage financial stress. • Take advantage of any financial wellness resources offered by your company. • Practice stress-reduction techniques to help manage anxiety related to financial concerns.Do financial concerns frequently cause you anxiety or stress? Yes NoNumeric Score Do financial concerns frequently cause you anxiety or stressDo you feel that financial stress affects your performance or concentration at work? Yes NoNumeric Score Do you feel that financial stress affects your performance or concentration at workDo you have access to resources or support to help manage financial stress? Yes NoNumeric Score Do you have access to resources or support to help manage financial stressPreviousNextTextarea Message Work-Related Stress Work-Related Stress : Discuss your workload and job responsibilities with your manager to address any stressors. Pursue professional development opportunities to build skills and confidence in your role. Ensure you receive regular feedback and support from your manager to help manage work-related stress. Use time management skills to manage your workload .Do you have the right amount of work for your hours? Yes NoNumeric Score Do you have the right amount of work for your hoursCan you fulfill your job tasks and responsibilities? Yes NoNumeric Score Can you fulfill your job tasks and responsibilitiesHave you received sufficient training for your job? Yes NoNumeric Score Have you received sufficient training for your jobDoes your manager encourage you to take on new challenges? Yes NoNumeric Score Does your manager encourage you to take on new challengesDo you get enough support from your manager? Yes NoNumeric Score Do you get enough support from your managerIs your manager accessible and approachable for work-related issues? Yes NoNumeric Score Is your manager accessible and approachable for work-related issuesDo changes in your work environment simplify your work? Yes NoNumeric Score Do changes in your work environment simplify your workDo you receive regular feedback on your work objectives? Yes NoNumeric Score Do you receive regular feedback on your work objectivesAre you affected by conflicts with colleagues or your manager? Yes NoNumeric Score Are you affected by conflicts with colleagues or your managerAre you subjected to bullying, harassment, or similar issues at work? Yes NoNumeric Score Are you subjected to bullying, harassment, or similar issues at workDo you think everyone has an equal chance for a successful career in the company? Yes NoNumeric Score Do you think everyone has an equal chance for a successful career in the companyDo you have energy left to enjoy your personal life after work? Yes NoNumeric Score Do you have energy left to enjoy your personal life after workDoes the company support your work-life balance? Yes NoNumeric Score Does the company support your work-life balanceRate your daily work stress level 0What areas of training might you need related to stress? Sleep Family , Life and Relationships Work and career Health and wellbeing Financial stressFeel free to add any other comments or feedback you have! Numeric Score Rate your daily work stress level 1Numeric Score Rate your daily work stress level 2Numeric Score Rate your daily work stress level 3Numeric Score Rate your daily work stress level 4Numeric Score Rate your daily work stress level 5Numeric Score Rate your daily work stress level 6Numeric Score Rate your daily work stress level 7Numeric Score Rate your daily work stress level 8Numeric Score Rate your daily work stress level 9Numeric Score Rate your daily work stress level 10Numeric - Final ScoreTextarea Score - Low RiskLow RiskTextarea Score - Medium RiskMedium RiskTextarea Score - High RiskHigh Risk Previous Send
