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Employee Information
Employee Name
Job Title
Department
Supervisor Name
Potential Stress Factors
Workload - Do you often feel overwhelmed by the amount of work you have to do?
Work Pace - Do you feel you have to work under time pressure?
Lack of Control - Do you feel you have little control over your work?
Work-Life Balance - Do you struggle to balance your work and personal life?
Role Clarity - Is your role and responsibilities unclear?
Interpersonal Relationships - Do you experience conflicts or poor relationships with co-workers?
Job Security - Do you feel insecure about your employment?
Career Development - Do you feel you lack opportunities for growth and advancement?
Physical Environment - Do you have concerns about the physical work environment (e.g. noise, temperature, lighting)?
Other Factors - Are there any other potential stress factors not covered above?
Impact Assessment
How would you rate the overall impact of stress on your well-being and job performance?
Have you experienced any physical, mental or emotional symptoms of stress?
Other (please specify)
Mitigation Strategies
What strategies or resources do you currently use to manage your stress?
What additional support or resources do you think would be helpful in managing your stress?
Action Plan
Summarize the key stress factors identified and proposed mitigation measures.
Who needs to be involved in implementing the stress management plan?
What is the timeline for implementing the stress management plan?
How will the effectiveness of the stress management plan be evaluated?