Sample brief stress questionnaire
Scales
0 = Rarely or never stressed
5 = A great deal of stress
| 1 Trouble with clients/customers | 0 | 1 | 2 | 3 | 4 | 5 |
| 2 Having to work late | 0 | 1 | 2 | 3 | 4 | 5 |
| 3 Constant people interruptions | 0 | 1 | 2 | 3 | 4 | 5 |
| 4 Trouble with boss | 0 | 1 | 2 | 3 | 4 | 5 |
| 5 Deadlines and time pressures | 0 | 1 | 2 | 3 | 4 | 5 |
| 6 Dealing with the bureaucracy at work | 0 | 1 | 2 | 3 | 4 | 5 |
| 7 Technological breakdowns (e.g. computers) | 0 | 1 | 2 | 3 | 4 | 5 |
| 8 Trouble with work colleagues | 0 | 1 | 2 | 3 | 4 | 5 |
| 9 Too many jobs to do at once | 0 | 1 | 2 | 3 | 4 | 5 |
| 10 Telephone interruptions | 0 | 1 | 2 | 3 | 4 | 5 |
| 11 Travelling to and from work | 0 | 1 | 2 | 3 | 4 | 5 |
| 12 Travelling associated with job | 0 | 1 | 2 | 3 | 4 | 5 |
| 13 Making mistakes | 0 | 1 | 2 | 3 | 4 | 5 |
| 14 Job interfering with home/family life | 0 | 1 | 2 | 3 | 4 | 5 |
| 15 Can’t cope with ‘in’ tray | 0 | 1 | 2 | 3 | 4 | 5 |
| 16 Can’t say ‘no’ when I should | 0 | 1 | 2 | 3 | 4 | 5 |
| 17 Not enough stimulating things to do | 0 | 1 | 2 | 3 | 4 | 5 |
| 18 Too many meetings | 0 | 1 | 2 | 3 | 4 | 5 |
| 19 Having to tell colleagues or subordinates unpleasant things | 0 | 1 | 2 | 3 | 4 | 5 |
| 20 Co-ordinating activities with colleagues or boss | 0 | 1 | 2 | 3 | 4 | 5 |
Suggested scoring:
80 – 100: Severe
50 – 79: Moderate
20 – 49: Mild
0 – 19: Insignificant
Note: A score of 4 or 5 in any category may indicate a need for action, no matter what the total score is.
