Workplace Wellness Survey

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* 1. Please indicate the size of your organization.

1-50 employees

51-100 employees

101-200 employees

201-500 employees

501- 1000 employees

1000 + employees

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* 2. In a typical week, how many hours do you work?

I work 1 to 10 hours/week

I work 11 to 20 hours/week

I work 21 to 30 hours/week

I work 31 to 40 hours/week

I work 41 to 50 hours/week

I work 51 to 60 hours/week

I work 61 to 70 hours/week

I work 71 to 80 hours/week

I work more that 80 hours a week

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* 3. Do you experience any of the following symptoms of stress?

	Never	Seldom	Sometimes	Often	Usually
headaches / migraines	headaches / migraines Never	headaches / migraines Seldom	headaches / migraines Sometimes	headaches / migraines Often	headaches / migraines Usually
muscle tightness / back ache / stiff neck	muscle tightness / back ache / stiff neck Never	muscle tightness / back ache / stiff neck Seldom	muscle tightness / back ache / stiff neck Sometimes	muscle tightness / back ache / stiff neck Often	muscle tightness / back ache / stiff neck Usually
insomnia or sleeping too much	insomnia or sleeping too much Never	insomnia or sleeping too much Seldom	insomnia or sleeping too much Sometimes	insomnia or sleeping too much Often	insomnia or sleeping too much Usually
sleep is disturbed or unrefreshing / nightmares	sleep is disturbed or unrefreshing / nightmares Never	sleep is disturbed or unrefreshing / nightmares Seldom	sleep is disturbed or unrefreshing / nightmares Sometimes	sleep is disturbed or unrefreshing / nightmares Often	sleep is disturbed or unrefreshing / nightmares Usually
lack of concentration / fatigue / lethargy	lack of concentration / fatigue / lethargy Never	lack of concentration / fatigue / lethargy Seldom	lack of concentration / fatigue / lethargy Sometimes	lack of concentration / fatigue / lethargy Often	lack of concentration / fatigue / lethargy Usually
proneness to errors	proneness to errors Never	proneness to errors Seldom	proneness to errors Sometimes	proneness to errors Often	proneness to errors Usually
acne breakouts	acne breakouts Never	acne breakouts Seldom	acne breakouts Sometimes	acne breakouts Often	acne breakouts Usually
nail biting / hair chewing	nail biting / hair chewing Never	nail biting / hair chewing Seldom	nail biting / hair chewing Sometimes	nail biting / hair chewing Often	nail biting / hair chewing Usually
significant hair loss	significant hair loss Never	significant hair loss Seldom	significant hair loss Sometimes	significant hair loss Often	significant hair loss Usually
depression / anxiety	depression / anxiety Never	depression / anxiety Seldom	depression / anxiety Sometimes	depression / anxiety Often	depression / anxiety Usually
anger / resentment	anger / resentment Never	anger / resentment Seldom	anger / resentment Sometimes	anger / resentment Often	anger / resentment Usually
on the verge of crying / can’t stop crying	on the verge of crying / can’t stop crying Never	on the verge of crying / can’t stop crying Seldom	on the verge of crying / can’t stop crying Sometimes	on the verge of crying / can’t stop crying Often	on the verge of crying / can’t stop crying Usually
confusion / memory loss	confusion / memory loss Never	confusion / memory loss Seldom	confusion / memory loss Sometimes	confusion / memory loss Often	confusion / memory loss Usually
desire to "run away"	desire to "run away" Never	desire to "run away" Seldom	desire to "run away" Sometimes	desire to "run away" Often	desire to "run away" Usually
chain cigarette smoking	chain cigarette smoking Never	chain cigarette smoking Seldom	chain cigarette smoking Sometimes	chain cigarette smoking Often	chain cigarette smoking Usually
drinking too much alcohol / drinking alone / abusing drugs	drinking too much alcohol / drinking alone / abusing drugs Never	drinking too much alcohol / drinking alone / abusing drugs Seldom	drinking too much alcohol / drinking alone / abusing drugs Sometimes	drinking too much alcohol / drinking alone / abusing drugs Often	drinking too much alcohol / drinking alone / abusing drugs Usually
poor judgement	poor judgement Never	poor judgement Seldom	poor judgement Sometimes	poor judgement Often	poor judgement Usually
menstrual irregularities	menstrual irregularities Never	menstrual irregularities Seldom	menstrual irregularities Sometimes	menstrual irregularities Often	menstrual irregularities Usually
overeating / undereating	overeating / undereating Never	overeating / undereating Seldom	overeating / undereating Sometimes	overeating / undereating Often	overeating / undereating Usually
diarrhea / constipation / nausea	diarrhea / constipation / nausea Never	diarrhea / constipation / nausea Seldom	diarrhea / constipation / nausea Sometimes	diarrhea / constipation / nausea Often	diarrhea / constipation / nausea Usually
rapid weight gain / weight loss	rapid weight gain / weight loss Never	rapid weight gain / weight loss Seldom	rapid weight gain / weight loss Sometimes	rapid weight gain / weight loss Often	rapid weight gain / weight loss Usually
swearing / irritability / impatience	swearing / irritability / impatience Never	swearing / irritability / impatience Seldom	swearing / irritability / impatience Sometimes	swearing / irritability / impatience Often	swearing / irritability / impatience Usually
feeling overwhelmed	feeling overwhelmed Never	feeling overwhelmed Seldom	feeling overwhelmed Sometimes	feeling overwhelmed Often	feeling overwhelmed Usually
no sense of enjoyment / no sense of humour	no sense of enjoyment / no sense of humour Never	no sense of enjoyment / no sense of humour Seldom	no sense of enjoyment / no sense of humour Sometimes	no sense of enjoyment / no sense of humour Often	no sense of enjoyment / no sense of humour Usually
problems in relationships	problems in relationships Never	problems in relationships Seldom	problems in relationships Sometimes	problems in relationships Often	problems in relationships Usually
over-indulging	over-indulging Never	over-indulging Seldom	over-indulging Sometimes	over-indulging Often	over-indulging Usually
reckless behaviour	reckless behaviour Never	reckless behaviour Seldom	reckless behaviour Sometimes	reckless behaviour Often	reckless behaviour Usually
often get a cold / the flu / allergies	often get a cold / the flu / allergies Never	often get a cold / the flu / allergies Seldom	often get a cold / the flu / allergies Sometimes	often get a cold / the flu / allergies Often	often get a cold / the flu / allergies Usually
accident-proneness / clumsiness	accident-proneness / clumsiness Never	accident-proneness / clumsiness Seldom	accident-proneness / clumsiness Sometimes	accident-proneness / clumsiness Often	accident-proneness / clumsiness Usually

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* 4. Have you suffered from a stress-related illness within the last 1 to 2 years and have missed work as a result?

Yes

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* 5. Have you ever had a chair massage at work before?

Yes