Burnout Self-Assessment Survey - StellaPsychologist

Burnout Self-Assessment Survey

Instructions: Please read each statement carefully and select the response that best describes your experience over the past month. Choose the number that corresponds to how often each statement applies to you:

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

Name

Phone

I feel cynical or negative about my job or tasks I need to complete.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I feel that my work is not meaningful or that I have lost purpose in what I do.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I feel irritable or impatient with colleagues, clients, or customers.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I have withdrawn socially or emotionally from colleagues or friends.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I have trouble sleeping or staying asleep due to work-related stress.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I feel physically and emotionally drained from my work.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I find it difficult to concentrate or stay focused on tasks at work.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I have become less productive at work or feel less efficient.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I have physical symptoms such as headaches, muscle tension, or stomach issues related to work stress.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

I have thoughts of quitting my job or changing my career due to stress or burnout.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)