Cumbria County Council Individual Stress Questionnaire for school-based staff

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Appendix to SAN(G) 33

Cumbria County Council Individual Stress Questionnaire for school-based staff
This questionnaire should be used by the headteacher or other nominated school’s representative appointed by them, e.g. department head or deputy, when an employee reports work-related stress issues or when they are returning from a work-related stress absence. Your overall school Stress Risk Assessment/Action Plan should also be referred to, as this outlines the overall strategies put in place to help combat and minimise work-related stress for groups of employees. This questionnaire does not replace existing return to work procedures but should be used alongside them.

Name of employee ………………………………………….. Date ……………………………………………
Name of headteacher/other involved …………………………………………………………………………….

Cause of



Was it a problem for you?

Use this space to detail what the problem was. If it was not a problem, leave it blank.

What can be done about it?

Can we make any adjustments?


Do different people at work demand things from you that were hard to combine?

Do you have unachievable


Do you have to work very


Do you have to neglect some tasks because you have too much to do?

Are you unable to take sufficient breaks?

Do you feel pressured to work long hours?

Do you feel you have to work very fast?

Do you have unrealistic time



Can you decide when to take a break?

Do you feel you have a say in your work speed?

Do you feel you have a choice in deciding how you do your work?

Do you feel you have a choice in deciding what you do at work?

Do you feel you have some say over the way you do your work?

Do you feel your time can be




Did/does your manager give you enough supportive feedback on your work?

Do you feel you can rely on your manager to help you with a work problem?

Do you feel you can talk to your manager about something that upset or annoyed you at work?

Do you feel your manager supported you through any emotionally-demanding work?

Did/do you feel your manager

encouraged you enough at work?



Do you feel your colleagues would help you if work became difficult?

Do you get the help and support you

need from your colleagues?

Do you get the respect at work you

deserve from your colleagues?

Are your colleagues willing to listen to your work-related problems?


Were you personally harassed, in the

form of unkind words or behaviour?

Do you feel there is friction or

anger between colleagues?

Have you been bullied at work?

Are relationships strained at work?


Are you clear about what is

expected of you at work?

Do you know how to go about getting

your job done?

Are you clear about what your

duties and responsibilities are?

Are you clear about the goals and

objectives for this department?

Do you understand how your work fits

into the overall aim of the organisation?


Do you have enough opportunities to

question your manager about change at work?

Do you feel consulted about change at work?

When changes are made at work, are you clear about how they might work out in practice?

Other issues

Is there anything else that was/is a

source of stress for you, at work, e.g. Performance Management procedures, or external factors from home, that may have contributed to you feeling pressured or going off work with stress- related illness?

Notes for the employee - factors outside work
This list of questions follows the HSE-approved format and has mainly focused on factors at work. However, there may be factors outside work, for example in your family life, which have contributed to or added to the pressures at work. These might have made it harder to deal with demands at work that you would normally be able to cope with. You may want to share these issues – people at work might be able to help and make adjustments such as being more flexible with work time/workloads, or just being sympathetic to the additional pressures you are under. If you do not feel happy telling your manager about these things, you can also seek support from your HR provider, Lead Health and Safety Adviser, or if available, your employer’s employee assistance programme or trade union representative.
You may also like to look at the links available from the Health and Safety Executive at:

Individual Stress Risk Assessment Questionnaire SAN(G) 33

Cumbria County Council – March 2015

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