Personal Details

1. Name :

2. Sex : Male Female

3. Age : 2030 31-40

41-50 Above 50

4. Marital Status : Married Single

5. Designation or Grade :

6. Experience : 1-5 years 6-10 years

11-15 years 16-20 years

Above 20 years

1 Do you suffer with difficulty in sleeping?

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

2 Do you find it difficult to concentrate?

a. Not at all b. Rarely c. Sometimes d. Often

 e. Very Often

3
Do you find yourself 'self-medicating' with additional alcohol, nic

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

5 Do you get angry quickly?

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

6 Do you find you are prone to negative thinking about your job?

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

7 When you have been ill with relatively minor illnesses, does it take you a long time

a. Not at all b. Rarely c. Sometimes d. Often

 e. Very Often

8 Do you feel you are isolated, with no one to talk to?

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

9 When conflict arises at work or at home, do you tend to over-react?

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

10 Do you feel that there is more work to do than you realistically have the capacity t

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

11 Do you feel caught between the pressures of responsibility for family and for work
 a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

12 Do you feel 'under par' even at the beginning of a working day?

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

13 Do you shy away from social contact with colleagues and friends?

a. Not at all b. Rarely c. Sometimes d. Often

e. Very Often

14
Do you feel misunderstood or unappreciated by your colleagues, friends or family m
.