Burnout Assessment Survey*

This survey aims to assess your experience with workplace burnout, including its symptoms, causes, and effects. Your feedback will help us better understand common burnout factors and develop effective resources to address them.

How often have you felt emotionally exhausted from your work in the past month?*

This question helps us evaluate the frequency of one of the key symptoms of burnout.

From Never to Always
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Which of the following symptoms have you experienced related to burnout?*

Select all that apply, as some symptoms may overlap.

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To what extent do you feel supported by your supervisor or manager at work?*

This question measures perceived support, which influences the risk of burnout.

From Not at all supported to Fully supported
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What are the primary factors contributing to your feelings of burnout?*

Please describe the main causes, such as workload, lack of recognition, or unclear expectations.

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How would you rate your ability to balance work and personal life?*

An imbalance between work and life is a common contributor to burnout.

From Very poor to Excellent
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In the last four weeks, how many days have you considered taking time off due to work-related stress?*

This provides insight into the potential severity and impact of burnout symptoms.

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What strategies, if any, have you used to manage stress or prevent burnout?

Please share specific practices, techniques, or resources you rely on.

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Would you be interested in company-provided resources to help manage burnout?*

Identifying resource needs ensures the right support is developed.

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Please share any additional comments or suggestions about how your organization could better address burnout.

Your insights can guide improvements in workplace wellness initiatives.

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Thank you for taking a part in this survey.