Entrepreneur Burnout Assessment Form
Evaluate your current experience as an entrepreneur with this brief burnout assessment. Your responses will help you reflect on your well-being and work-life balance.
How often do you feel emotionally exhausted by your work?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Rate your current level of work-related stress.
*
1
2
3
4
5
How satisfied are you with your work-life balance?
*
Very dissatisfied
1
2
3
4
Very satisfied
5
1 is Very dissatisfied, 5 is Very satisfied
On average, how many hours do you work per week?
*
Less than 40
40-50
51-60
More than 60
How would you rate your sleep quality over the past month?
*
1
2
3
4
5
Please indicate how much you agree with the following statements.
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I feel motivated to work most days.
1
2
3
4
5
I find it hard to disconnect from work.
6
7
8
9
10
I feel accomplished in my role.
11
12
13
14
15
How often do you feel detached or indifferent towards your business?
*
Never
1
2
3
4
Very often
5
1 is Never, 5 is Very often
Which of the following best describes your current coping strategies?
*
Please Select
Regular exercise
Talking with friends/family
Taking breaks/vacations
Hobbies or creative activities
None of the above
Other
In the past month, how often have you considered stepping away from your business?
*
Never
Once or twice
A few times
Frequently
What is one thing you believe would help reduce your burnout?
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