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Return to Work Questionnaire Template

This HSE Return to Work questionnaire is used to determine work-related stress or outside of work factors which may have caused an employee to underperform and lose motivation to work. This template is divided into 7 categories to identify the main causes of stress among the employees.
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Return to Work Questionnaire Template

Audit

Demands

Did different people at work demand things from you that were hard to combine?

Did you have unachievable deadlines?

Did you have to work very intensively?

Did you have to neglect some tasks because you had too much to do?

Were you unable to take sufficient breaks?

Did you feel pressured to work long hours?

Did you feel you had to work very fast?

Did you have unrealistic time pressures?

Control

Could you decide when to take a break?

Did you feel you had a say in your work speed?

Did you feel you had a choice in deciding how you did your work?

Did you feel you had a choice in deciding what you did at work?

Did you feel you had some say over the way you did your work?

Did you feel your time could be flexible?

Support

Did your manager give you enough supportive feedback on the work you did?

Did you feel you could rely on your manager to help you with a work problem?

Did you feel you could talk to your manager about something that upset or annoyed you at work?

Did you feel your manager supported you through any emotionally demanding work?

Did you feel your manager encouraged you enough at work?

Peers

Did you feel your colleagues would help you if work became difficult?

Did you get the help and support you needed from your colleagues?

Did you get the respect at work you deserved from your colleagues?

Were your colleagues willing to listen to your work-related problems?

Relationships

Were you personally harassed, in the form of unkind words or behavior?

Did you feel there was friction or anger between colleagues?

Were you bullied at work?

Were relationships strained at work?

Role

Were you clear about what was expected of you at work?

Did you know how to go about getting your job done?

Were you clear about what your duties and responsibilities were?

Were you clear about the goals and objectives for this department?

Did you understand how your work fits into the overall aim of the organization?

Change

Did you have enough opportunities to question managers about change at work?

Did you feel consulted about change at work?

When changes were made at work, were you clear about how they would work out in practice?

Other issues

Is there anything else that was a source of stress for you, at work or at home, that may have contributed to you going off work with work-related stress?

Completion

Full Name and Signature of Inspector

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