* 1. Please indicate the size of your organization.

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

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

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

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

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