Burnout Prevention Work Survey Form
Help us understand and prevent work-related burnout by sharing your experiences and needs. Your feedback is confidential and will guide our workplace well-being efforts.
Your Role or Department
*
How would you rate your current workload?
*
Very light
1
2
3
4
Very heavy
5
1 is Very light, 5 is Very heavy
How often do you feel stressed at work?
*
Never
Rarely
Sometimes
Often
Always
Which of the following burnout symptoms have you experienced at work? (Select all that apply)
*
Feeling exhausted or drained
Lack of motivation
Reduced work performance
Difficulty concentrating
Increased irritability
Other
What are your main burnout triggers at work? (Select up to 3)
*
Unclear expectations
Heavy workload
Tight deadlines
Lack of support
Limited control over work
Work-life imbalance
Other
Which coping strategies do you currently use?
*
Taking breaks
Talking with colleagues
Physical activity
Time management techniques
Seeking support from manager
Other
What support do you need from your manager or organization to prevent burnout?
*
Which burnout prevention resources would you find most helpful?
*
Workshops or training
Access to counseling or EAP
Flexible scheduling
Wellness activities
Peer support groups
Other
Do you have any suggestions for improving burnout prevention at work?
Are you willing to be contacted for follow-up about your responses?
Yes
No
Submit Survey
Should be Empty: