Occupational Health Anxiety Assessment Questionnaire
Occupational Health Anxiety Assessment Questionnaire for understanding work-related anxiety, common triggers, and preferred workplace support. Please answer based on your current work experience.
Respondent Profile and Work Context
Full Name
*
First Name
Last Name
Job Title / Role
*
Department / Team
Employment Type
*
Full-time
Part-time
Contract
Temporary
Intern
Other
Primary Work Setting
*
On-site
Hybrid
Remote
Field-based
Other
Anxiety Assessment Items
Overall work-related anxiety severity
*
Mild
1
2
3
4
5
6
7
8
9
Severe
10
1 is Mild, 10 is Severe
Frequency of common anxiety experiences
*
Rows
Never
Rarely
Sometimes
Often
Always
Excessive worry before work
1
2
3
4
5
Difficulty concentrating at work
6
7
8
9
10
Physical tension
11
12
13
14
15
Sleep disruption
16
17
18
19
20
Avoidance of work tasks
21
22
23
24
25
Panic-like feelings
26
27
28
29
30
When anxiety feels strongest
*
Before work
During work
After work
During meetings
When communicating with supervisors
When workload increases
Other
How much work stress affects daily functioning
*
Not at all
1
2
3
4
5
6
7
8
9
Extremely
10
1 is Not at all, 10 is Extremely
Support and Follow-Up
Preferred support from workplace or occupational health
*
Self-management resources
Manager check-in
Workload review
Flexible scheduling
Occupational health referral
Counseling resources
Other
Additional comments, workplace triggers, or requested accommodations
Submit
Should be Empty: