What is your main interest in burnout?
I may have burnout
I am concerned about a friend, relative or colleague with burnout
My study, sport or carer role seems to be causing exhaustion
I am responsible for others who may get burnout ( HR/ tutors/ trainers)
I am a counsellor/ coach/ therapist with clients who have burnout
I am a director or business owner concerned about burnout reducing business performance
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Personal section
This section is for anyone suffering burnout themselves from any cause ( not just work - could include athlete, student or carer for example) heading for it or working/living with someone who may have burnout.
If it is you who could have burnout how long might you have had it? (Leave this question if you are concerned about someone else with burnout)
1-3 years
5-10 years
More than 10 years
Less than a year
What is your biggest difficulty in getting to grips with burnout?
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What do you feel would be the ideal outcome from addressing burnout?
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What is the worst thing about burnout?
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If you would like to and in confidence - please outline the situation you are in that is causing concern about burnout ( your own or someone else’s)
If you might have burnout do you think burnout is
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Affecting your personal relationships?
Affecting the quality of your work?
Limiting your career progression?
Reducing your satisfaction at work?
Draining your finances?
Spoiling your enjoyment of life?
Damaging your health (mental or physical)?
Ruining your sleep
Leaving you exhausted all the time
Making holidays seem pointless or unrefreshing
Which of the following ( please choose no more than 3) do you feel is contributing to your burnout
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Long hours
Pressures/ deadlines
A difficult or micromanaging boss or colleague/s
Bullying
Work life balance mismatch
Feeling trapped in a job you hate
Shift work/ irregular hours
Career mismatch
Lack of control over your work
Residual burnout from past job
Other
By when would you like to have a burnout plan for addressing or turning around your burnout?
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I already have a plan and it is working
As soon as possible
Within a few months
Within a year
I don't have burnout but I know someone who does
What do you think your first step in beating burnout could be?
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Learning more about burnout in courses and webinars
Speaking to a burnout expert by phone
Speaking up at work more constructively
Stop pretending it is not there ( denial)
Get my family member/friend/colleague to understand my predicament
Find the courage to face up to burnout
How much time can you realistically begin to allocate to your burnout learning ,reversal & prevention plan?
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under an hour a week
up to 4 hours a week
None
Other
Did you find filling in this questionnaire
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Difficult
Easy
Depressing
Pointless
Helpful
Enlightening
Other
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Company burnout
This section is for those who are concerned about burnout in their organisation or personnel.
With regard to burnout which statements do you feel are true?
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I think it is a widespread problem in society overall
I think it may be increasing in my organisation
I know it is increasing in my organisation
It is losing us money
It is reducing profits
We have stress and burnout totally under control
What are your greatest concerns regarding burnout in your organisation?
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I may have it myself
That it might be more rife than I can easily see
It is affecting our staffing levels and recruitment costs
It is reducing performance and profits
It seems to be getting worse
Not relevant to my organisation
Other
If you would like to - in confidence - please outline your concerns about burnout in your organisation.
*
This section is optional
Which of the following do you have in place to help minimise, prevent or tackle burnout in your personnel
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An occupational health input
A reduce burnout policy
Burnout monitoring
Regular burnout risk analysis
Burnout support programme
A burnout education plan
Not relevant
Other
Your details
Optional but needed if you would like a response from us
Name
*
Full Forname
Initial or surname
Please add your email
*
Confirmation Email
Please check email entry carefully
If you would like one of the following please indicate
A response to your answers
To book a consultation with a burnout expert
No more communications from the geese whatsoever
To remain on our newsletter list
We wouid appreciate knowing your industry so we can keep things as relevant as possible for as many people as possible. Please choose an industry or expand on 'other'.
Healthcare
Education
Finance
IT
Engineering
Law
Other
Other : please write your industry here if it is not mentioned above
Submit
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Caring for those with burnout
This section is for those who may be involved in helping others to address burnout
Please select your role
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Coach
Mentor
Counsellor
Health care professional ( eg doctor/ mental health nurse)
Therapist
Friend or family
Other
Please describe your main interest, concerns or challenges with regard to helping people with burnout.
*
Would you like one or more of the following
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To be kept informed of training materials on burnout
A complimentary phonecall scheduled at your convenience
To find out how to make the Burnout Geese burnout test work in your organisation
Hear more about our "how to help someone with burnout" course
Name
*
First Name
Last Name
Email
*
example@example.com
Submit
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Your details and what next?
assuming you’d like our feedback on this questionnaire
Name
*
First Name
Last Name
Email
example@example.com
What would you like to do next
*
Book a one hour phone appointment with a burnout expert
Join a Monday evening goosey gaggle ( zoom or teleconference)
Stay in the loop
No need for further support thanks
Please verify that you are human
*
Submit
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