Title Page
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Client / Site
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Department
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Location
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Conducted on
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Prepared by
Demands
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Did different people at work demand things from you that were hard to combine?
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Did you have unachievable deadlines?
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Did you have to work very intensively?
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Did you have to neglect some tasks because you had too much to do?
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Were you unable to take sufficient breaks?
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Did you feel pressured to work long hours?
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Did you feel you had to work very fast?
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Did you have unrealistic time pressures?
Control
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Could you decide when to take a break?
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Did you feel you had a say in your work speed?
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Did you feel you had a choice in deciding how you did your work?
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Did you feel you had a choice in deciding what you did at work?
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Did you feel you had some say over the way you did your work?
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Did you feel your time could be flexible?
Support
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Did your manager give you enough supportive feedback on the work you did?
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Did you feel you could rely on your manager to help you with a work problem?
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Did you feel you could talk to your manager about something that upset or annoyed you at work?
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Did you feel your manager supported you through any emotionally demanding work?
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Did you feel your manager encouraged you enough at work?
Peers
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Did you feel your colleagues would help you if work became difficult?
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Did you get the help and support you needed from your colleagues?
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Did you get the respect at work you deserved from your colleagues?
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Were your colleagues willing to listen to your work-related problems?
Relationships
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Were you personally harassed, in the form of unkind words or behavior?
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Did you feel there was friction or anger between colleagues?
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Were you bullied at work?
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Were relationships strained at work?
Role
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Were you clear about what was expected of you at work?
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Did you know how to go about getting your job done?
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Were you clear about what your duties and responsibilities were?
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Were you clear about the goals and objectives for this department?
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Did you understand how your work fits into the overall aim of the organization?
Change
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Did you have enough opportunities to question managers about change at work?
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Did you feel consulted about change at work?
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When changes were made at work, were you clear about how they would work out in practice?
Other issues
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Is there anything else that was a source of stress for you, at work or at home, that may have contributed to you going off work with work-related stress?
Completion
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Full Name and Signature of Inspector
