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Work Function Assessment Form Survey

Work Function Assessment Form Survey

The Work Function Assessment Form is provided to help you determine a patient’s capacity to function effectively at his or her job. Please evaluate the usefulness of the form by filling out this survey.
1.This form contains the right questions to help determine an individual's work function capacity.
Strongly Disagree
Disagree
Agree
Strongly Agree
N/A
2.I will use this form as a regular practice in my professional setting.
Strongly Disagree
Disagree
Agree
Strongly Agree
N/A
3.The impairment scale contains all the components needed to move beyond a person's diagnostic condition to work functionality.
Strongly Disagree
Disagree
Agree
Strongly Agree
N/A
4.My overall experience using the Work Function Assessment Form was positive.
Strongly Disagree
Disagree
Agree
Strongly Agree
N/A
5.This form helped me more accurately determine Activities of Daily Living.
Strongly Disagree
Disagree
Agree
Strongly Agree
N/A
6.This form helped me more accurately determine Social Functioning.
Strongly Disagree
Disagree
Agree
Strongly Agree
7.This form helped me more accurately determine Concentration, Persistence and Pace.
Strongly Disagree
Disagree
Agree 
Strongly Agree
N/A
8.This form helped me more accurately determine Performance of Mental-Interpersonal, Time-Management and Physical Tasks.
Disagree
Strongly Disagree
Agree
Strongly Agree
N/A
9.In the last three months, how often have you used this form?
10.I prefer this form over any other disability form.
Strongly Disagree
Disagree
Agree
Strongly Agree
N/A