Return-to-Work Anxiety Self-Assessment
Reflect on your feelings and concerns about returning to the workplace with this confidential self-assessment.
Your Name (optional)
First Name
Last Name
Email Address (optional, for follow-up)
example@example.com
How would you rate your current level of anxiety about returning to work?
*
No anxiety
1
2
3
4
5
6
7
8
9
Extremely anxious
10
1 is No anxiety, 10 is Extremely anxious
Please indicate how much you agree with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel nervous thinking about returning to work.
1
2
3
4
5
I worry about my health and safety at the workplace.
6
7
8
9
10
I am concerned about changes in workplace routines or policies.
11
12
13
14
15
I feel confident in my ability to cope with work-related stress.
16
17
18
19
20
I believe my employer will support my transition back to work.
21
22
23
24
25
Which of the following concerns you most about returning to work? (Select all that apply)
*
Health and safety risks
Commuting and transportation
Work-life balance
Social interactions
Job expectations or workload
Childcare or family responsibilities
Other
How comfortable are you discussing your concerns about returning to work with your employer or supervisor?
*
Very comfortable
Somewhat comfortable
Neutral
Somewhat uncomfortable
Very uncomfortable
What coping strategies or resources have you found helpful in managing your anxiety? (Select all that apply)
Talking with friends or family
Seeking professional support
Mindfulness or relaxation techniques
Physical activity or exercise
Other
How soon are you expected to return to work?
*
Please Select
Already returned
Within 1 week
Within 1 month
1-3 months
Not sure
Would you like to request any of the following supports from your employer? (Select all that apply)
Flexible work arrangements
Mental health resources
Clear communication about safety protocols
Additional training or orientation
Other
Please share any additional comments or specific concerns you may have about returning to work.
Submit Assessment
Should be Empty: