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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Cut inspection time by 50% Uncover more issues and solve them 4x faster Select from over 4000 expert-proofed templates Return to Work Questionnaire Template Demands Did different people at work demand things from you that were hard to combine? Yes No N/A Did you have unachievable deadlines? Yes No N/A Did you have to work very intensively? Yes No N/A Did you have to neglect some tasks because you had too much to do? Yes No N/A Were you unable to take sufficient breaks? Yes No N/A Did you feel pressured to work long hours? Yes No N/A Did you feel you had to work very fast? Yes No N/A Did you have unrealistic time pressures? Yes No N/A Control Could you decide when to take a break? Yes No N/A Did you feel you had a say in your work speed? Yes No N/A Did you feel you had a choice in deciding how you did your work? Yes No N/A Did you feel you had a choice in deciding what you did at work? Yes No N/A Did you feel you had some say over the way you did your work? Yes No N/A Did you feel your time could be flexible? Yes No N/A Support Did your manager give you enough supportive feedback on the work you did? Yes No N/A Did you feel you could rely on your manager to help you with a work problem? Yes No N/A Did you feel you could talk to your manager about something that upset or annoyed you at work? Yes No N/A Did you feel your manager supported you through any emotionally demanding work? Yes No N/A Did you feel your manager encouraged you enough at work? Yes No N/A Peers Did you feel your colleagues would help you if work became difficult? Yes No N/A Did you get the help and support you needed from your colleagues? Yes No N/A Did you get the respect at work you deserved from your colleagues? Yes No N/A Were your colleagues willing to listen to your work-related problems? Yes No N/A Relationships Were you personally harassed, in the form of unkind words or behavior? Yes No N/A Did you feel there was friction or anger between colleagues? Yes No N/A Were you bullied at work? Yes No N/A Were relationships strained at work? Yes No N/A Role Were you clear about what was expected of you at work? Yes No N/A Did you know how to go about getting your job done? Yes No N/A Were you clear about what your duties and responsibilities were? Yes No N/A Were you clear about the goals and objectives for this department? Yes No N/A Did you understand how your work fits into the overall aim of the organization? Yes No N/A Change Did you have enough opportunities to question managers about change at work? Yes No N/A Did you feel consulted about change at work? Yes No N/A When changes were made at work, were you clear about how they would work out in practice? Yes No N/A 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? Yes No N/A Completion Full Name and Signature of Inspector
Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.