WEB PAGE FOR DR JOHN C MCEWAN  -  DR STRESS

SAFETY SELF OBSERVATION

 

CHECK LIST                          STRESS

 

WORK PLACE ..

 

DATE    

 

 

A.BEHAVIOURS (Circle a number for each question that best reflects where you feel you have been over the last fortnight.)

 

1.             MENTAL FUNCTIONING

 

0                              1                              2                              3                              4                              5

Anxious/depressed                                                                                                                             relaxed/calm

 

 

2.             CONFIDENCE IN LIFE AND WORK

 

0                              1                              2                              3                              4                              5

Total lack of confidence                                                                                                                     very confident

 

 

3.             RELATIONSHIP AT WORK

 

0                              1                              2                              3                              4                              5

Total breakdown                                                                                                                                  Harmonious

Of relationships                                                                                                                                       positive              

 

 

4.             PHYSIOLOGICAL

 

0                              1                              2                              3                              4                              5

Poor health and sleep                                                                                                                          excellent health

 

 

B.            JOB CONTENT AND CONTEXT  (Circle a number for each question that best reflects where you feel you have been over the last fortnight.)

 

1.             COMMUNICATION IN THE WORKPLACE

 

0                              1                              2                              3                              4                              5

            Bad                       Barely                    Fair                      Good               Very Good            Excellent

                 

 

2.             SUPPORT IN THE WORK PLACE

 

0                              1                              2                              3                              4                              5

            Bad                       Barely                    Fair                      Good               Very Good            Excellent

                 

 

3.             ROLE CLARITY IN THE WORK PLACE

 

0                              1                              2                              3                              4                              5

            Bad                       Barely                    Fair                      Good               Very Good            Excellent

                 

 

4.             RECOGNITION/ REWARD FOR WORK WELL DONE

 

0                              1                              2                              3                              4                              5

            Bad                       Barely                    Fair                      Good               Very Good            Excellent

                 

 

5.             TEAM WORK AND INVOLVEMENT IN PROJECTS TOGETHER

 

0                              1                              2                              3                              4                              5

            Bad                       Barely                    Fair                      Good               Very Good            Excellent

                 

 

6.             WORKLOAD LEVEL

 

0                              1                              2                              3                              4                              5

      Bad/too high            Barely                    Fair                      Good               Very Good            Excellent

                 

 

7.             HOURS WORKED PER WEEK

 

0                              1                              2                              3                              4                              5

            80+                           70+                       60+                        50+                      45                         40

 

 

WORK OUT YOUR TOTAL SCORES

 

SECTION   A     =      ./20

 

                                Scores under ten mean that stress is starting to hit you hard. Discuss with HR, your manager or the EAP counselor, but seek help now!

 

SECTION   B         =              /35

 

                                Scores under 20 indicate some significant problems in your section. 

 

Pass this completed form in to your for their report.

 

 

 

Do not place your name on this form unless you wish to personally approach a manager or HR team member to seek assistance for the specific things this form uncovers for you.

                 

 

 

THIS FORM MAY ASSIST WORK PLACES KEEPING A CLOSE EYE ON STRESS RELATED PROBLEMS WITHIN THE WORK PLACE IN ACCORDANCE WITH THE HSE ACT CHANGES MAY 2003.

 

  DR JOHN C MCEWAN 14 AUGUST 2004

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