Individual Stress Assessment Form

• Job Title :

• Job Category - (use closest category) :

  Select

• Employee Name : ( If Anonymous, State "Anon")

• Department

• Location

  Select

• Date Conducted

  Date

• 

• 

WORKLOAD AND DEMANDS OF JOB

• Are you struggling to cope with your workload

  Yes

  No

• Frequency of Workload Pressures / Demand - Use slider bar to indicate : 1 if Annually, 2 if Monthly, 3 if Weekly, 4 if Daily

• Do you need help or support to carry out work tasks?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Have you been given unachievable deadlines?

  Yes

  No

• EXISTING CONTROLS : Do you have one to one meetings with your manager or supervisor to discuss and plan your workload ?

  Yes

  No

  N/A

• FUTURE IMPROVEMENT : Please suggest any changes / adaptions that could be considered to prevent unacceptable workload demand

CHANGE

• How often do you experience changes in relation to your work - Use slider bar to indicate : 1 if Annually, 2 if Monthly, 3 if Weekly, 4 if Daily

• Are you consulted about any changes in your work environment or work tasks ?

  Yes

  No

  N/A

• Have you given input into changes before they happen?

  Yes

  No

  N/A

• Have you been told the reason for changes to your work environment or work tasks?

  Yes

  No

  N/A

• EXISTING CONTROLS : Have you used the See It / Save It / Solve It T Card Boards to suggest / communicate improvements?

  Yes

  No

  N/A

• EXISTING CONTROLS : Are you aware of the Employee Forum Representative in your area to whom you can consult with to get topics of concern raised?

  Yes

  No

  N/A

• EXISTING CONTROLS : Have you read the Employee Forum Newsletter which is a tool used to communicate change ?

  Yes

  No

  N/A

• FUTURE IMPROVEMENT : Please suggest any changes / adaptions that could be considered to improve communication and handling of change

SUPPORT

• How often do you feel unsupported by your direct supervisor, managers or team - Use slider bar to indicate : 1 = Never, Enter 2 = Occasionally , 3= If Regularly, 4= Always

• How supported do you feel by your manager or supervisor when carrying out your work? - Use slider bar to indicate : 1=Consistently Good and Responsive , 2=Good Support Level , 3=Occasional Support , 4= No Support

• When you raise a problem or issue, does your Manager or Supervisor act quickly to resolve issues or report back to you with explanations of decisions / progress?

  Yes

  No

  N/A

• EXISTING CONTROLS : Are you aware of employee mental health and wellbeing (24/7) confidential helpline 0800 414 8247 ( and other counselling / health services through Benenden Health - Download app at https://www.benenden.co.uk/mobile

  Yes

  No

• EXISTING CONTROLS : Are you aware of Spectrum Life wellness classes which are included in your Benenden measurements (free of charge)

  Yes

  No

• FUTURE IMPROVEMENT : Please suggest any changes / adaptions that could be considered to improve any issues relating to support in your current role

RELATIONSHIPS

• How often have you experienced bullying, harrassment, discrimination at work ? -Use slider bar to indicate : 1 = Never, Enter 2 = Occasionally , 3= If Regularly, 4= Always

• How often have you experienced conflict at work eg. verbal abuse or physical abuse - Use slider bar to indicate : 1 = Never, Enter 2 = Occasionally , 3= If Regularly, 4= Always

• EXISTING CONTROLS : Have you received a copy of the Employee Handbook?

  Yes

  No

  N/A

• EXISTING CONTROLS : Are you aware of the Company Grievance Procedure ?

  Yes

  No

  N/A

• EXISTING CONTROLS ; Have you read Harlequin's Bullying and Harrassment Policy?

  Yes

  No

  N/A

• EXISTING CONTROLS : Have you read Harlequin's Whistle Blower Policy?

  Yes

  No

  N/A

• FUTURE IMPROVEMENT : Please suggest any changes / adaptions that could be considered to improve any relationship/ conflict issues

ROLE

• Have you been diagnosed with any medical condition or prescribed any medication which could make you more susceptible to stress in the workplace?

  Yes

  No

• Have you informed your manager or HR Manager of the condition and medication?

  Yes

  No

• Please notify your supervisor or the HR Manager

• Does your work involve periods of intense focus / concentration?

  Yes

  No

• Is your work repetitive and mundane doing the same task over and over again ?

  Yes

  No

• Do you work extended hours /overtime ?

  Yes

  No

• Have you been trained in how to carry out your tasks ?

  Yes

  No

• EXISTING CONTROLS : Have you read Harlequin's Training and Development Policy

  Select Yes No N/A

  • Yes
  • No
  • N/A

• EXISTING CONTROLS : Have you been informed about taking regular breaks during repetitive focused tasks?

  Yes

  No

  N/A

• EXISTING CONTROLS : Where applicable to your Role, Have you investigated the possibility of flexible hours or working from home?

  Yes

  No

  N/A

• FUTURE IMPROVEMENT: Please suggest any changes /adaptations that could be considered to improve aspects of your role?

CONTROL

• Are you consulted and in agreement with the way your work is organised ?

  Yes

  No

• Are you encouraged to use your skills and initiative?

  Yes

  No

• Do you feel your skills are used to good effect?

  Yes

  No

• EXISTING CONTROLS: Have you seen and read your Job Specification

  Yes

  No

  N/A

• FUTURE IMPROVEMENT: Please suggest any changes /adaptations that could be considered to improve your ability to be in control of your job?

YOUR STRESS AT WORK LEVEL

• How stressed do you feel in work? (Use slider bar to answer within range : - 0 Not Stressed to 10 Extremely Stressed)

• Please give details about anything that makes you feel stressed in the workplace - (if none, state none)

Completion

• Additional Comments

• If you have filled this in anonymously and wish to speak to someone in confidence, please contact the HR Manager

• Full Name and Signature (If non-anonymous, please write n/a)

  Sign