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Work Burnout Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
Do you feel overwhelmed at work?
Select the option that best describes your feelings.
Yes
No
2
On a scale of 1 to 10, how stressed are you at work currently?
Rate your stress level on a scale of 1 to 10, with 1 being the least stressed and 10 being extremely stressed.
3
Describe how work burnout affects your personal life.
Provide a detailed description of how work burnout impacts your personal life.
4
Have you experienced physical symptoms of burnout (e.g., fatigue, insomnia, headaches)?
Select the option that best aligns with your experiences.
Yes
No
5
How often do you take breaks during work hours?
Indicate the frequency of your breaks during work hours.
Rarely
Occasionally
Frequently
6
Do you feel valued and appreciated in your current work environment?
Select the option that best reflects your perception of value and appreciation at work.
Yes
No
Neutral
7
How would you rate your work-life balance?
Rate your satisfaction with the balance between your work and personal life.
8
What strategies do you use to cope with work-related stress?
Provide insights into the coping mechanisms you employ to manage work-related stress.
9
Do you have clear boundaries between work and personal life?
Select the option that best describes the separation of work and personal life.
Yes
No
Partially
10
Have you discussed your work burnout with your supervisor or HR?
Indicate whether you have communicated your work burnout concerns to relevant authorities.
Yes
No
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