Job Insecurity Assessment Questionnaire Form
Use this questionnaire to assess concerns about job stability, likely causes, personal impact, and preferred support or next steps.
Respondent Profile
Current employment status
*
Employed full-time
Employed part-time
Contract/Freelance
Self-employed
Unemployed
Student
Other
Job / role title
Department or industry
Length of time in current role or situation
Please Select
Less than 3 months
3–6 months
6–12 months
1–2 years
More than 2 years
Other
Job Insecurity Assessment
Overall job insecurity severity
*
Very low
1
2
3
4
5
6
7
8
9
Very high
10
1 is Very low, 10 is Very high
Expected risk of job loss or reduced hours in the next 6 months
*
Very low
Low
Moderate
High
Very high
Please indicate how much you agree with each statement
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I am concerned about layoffs.
1
2
3
4
5
I am concerned about reduced pay or hours.
6
7
8
9
10
I am concerned about lack of contract renewal.
11
12
13
14
15
I feel unclear about my future with my employer.
16
17
18
19
20
I feel less confident in my job stability.
21
22
23
24
25
Main sources of concern
*
Company finances
Performance feedback
Restructuring
Contract end date
Workload changes
Management changes
Industry downturn
Other
Impact and Support Needs
How has this situation affected you?
*
Increased stress or anxiety
Reduced wellbeing or morale
Difficulty focusing at work
Lower productivity
Concern about financial planning
Considering career changes
Other
Additional context or concerns
Preferred follow-up method or next step
*
No follow-up needed
Email follow-up
HR contact
Manager discussion
Confidential support referral
Submit Assessment
Should be Empty: