Stress at work is one of the major factors affecting health and safety of employees. Companies can design their policies related to health and safety after administering the Health and Safety Stress Questionnaire on their employees. This can significantly reduce absenteeism and increase productivity of employees.

Health and Safety Stress Questionnaire Sample:

Name:                       ____________________

Address:            ____________________

Phone Number:   ____________________

Email id:            ____________________

Designation:               ____________________

Q1. You are working

a)   Full-time

b)   Part-time

c)   Freelance

d)   Not working

Q2. In the last two years, your job satisfaction in work is

a)   Increasing

b)   Declining

c)   Has been constant

Q3. What kind of environment is maintained in your workplace?

a)   Harsh and adverse environment

b)   Good ambience

c)   Clumsy and packed

d)   Other ___________________________________________________

Q4. Do you have a replacement for your job?

a)   Yes

b)   No

Q5. Tick which among the following have you experienced?

a)   Unfair appraisal

b)   Hard work with no recognition

c)   No increment since a long time

d)   Stagnation in learning

e)   Other ______________________________________________________

Q6. Do you utilise the breaks at your office to have proper food?

a)   Yes

b)   No

Q7. Do you utilise your LTA (Leave Travel Allowance) and the allotted number of leaves?

a)   Yes

b)   No

Q8. Does your work lead to health and safety issues?

a)   Yes

b)   No

c)   I can’t say

Q9. Have you taken general and/or life insurance?

a)   Yes

b)   No

Q10. Does your firm have health and safety benefits apart from your compensation?

a)   Yes

b)   No

c)   I don’t know

Q11. Are you facing any health problems now? Is yes, list them