Did you complete training on any of the following topics? (Please check all the apply)
Do you consider yourself to be Hispanic or Latino?
Yes
No
Decline to answer
Don't know
What race or races do you consider yourself to be? Please select one or more of these categories.
2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940
Gender - Do you think of yourself as:
Male
Female
Not listed
Decline to answer
If you said not listed, please specify
Are you currently working?
Yes
No
What is your highest level of degree attainment in social work?
Associate Degree in Social Work
Bachelor of Social Work (BSW)
Master of Social Work (MSW)
Doctor of Social Work (DSW)
PhD in Social Work or other
How many years have you been a practicing social worker and/or instructor/researcher in social work?
1-2 years
3-5 years
6-9 years
10+
Are you currently in a supervisoring role at your job?
Yes
No
Please indicate all appropriate descriptions of your background. (Select all that apply)
How would you describe your work arrangement in your job?
I am an independent contractor, an independent consultant, or a freelance worker
I am on call and work only when called to work
I am paid by a temporary agency
I work for a contractor who provides workers and services to others under contract
I am a regular, permanent employee
I am a student worker
Does not apply
Are you a current student?
Yes
No
If yes, select your major
Allied Health
Behavioral Health
Dentistry
Medicine
Nursing
Paraprofessional
Physician Assistant
Public Health
Management
Health informatics
Nutrition sciences
Social work
Other
How would you describe your work arrangement in your job?
Full-time
Part-time
On leave of absence
What is the Employer Type/Setting you work in?
Health Center Program
Rural Health Clinic
Critical Access Hospital
Hospital (not critical access)
State Public Health Agency
Local Public Health Agency
Federal Agency
Physician's Office
Free Clinic
Community-Based Organization
Other
How long have you worked in your job?
Less than 1 year
1-5 years
6-10 years
10-20 years
More than 20 years
What is your healthcare professional role? (Select all that apply)
Using your own definition of burnout - please indicate which of the following statements best describes how you feel about your situation at work (select only one response):
I enjoy my work
I have no symptoms of burnout
Occasionally I am under stress, and I don't always have as much energy as I once did, but I don't feel burned out
I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion
The symptoms of burnout that I'm experiencing won't go away. I think about frustrations at work a lot; and
I feel completely burned out and often wonder if I can go on practicing. I am at the point where I may need some changes. Responses at three or higher are classified as having burnout.
Overall, I am ____ with my job.
Not at all satisfied
Not too satisfied
Somewhat satisfied
Very satisfied
Not at all satisfied
Not too satisfied
Somewhat satisfied
Very satisfied
I am ____ with the benefits provided by my employer.
Not at all satisfied
Not too satisfied
Somewhat satisfied
Very satisfied
I am ____ with my chances for advancement on the job.
Not at all satisfied
Not too satisfied
Somewhat satisfied
Very satisfied
I can count on my supervisor for support when I need it.
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
I can count on my coworkers for support when I need it.
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
I am given a lot of freedom to decide how to do my own work.
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
I never seem to have enough time to get everything done on my job.
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
The work I do is meaningful to me
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
The work I do serves a greater purpose.
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
How often do you experience fatigue when you are working?
Never
Almost never (a few times a year or less)
Rarely (once a month or less)
Sometimes (a few times a month)
Often (once a week)
Very often (a few times a week)
Always (every day)
Never
Almost never (a few times a year or less)
Rarely (once a month or less)
Sometimes (a few times a month)
Often (once a week)
Very often (a few times a week)
Always (every day)
Never
Almost never (a few times a year or less)
Rarely (once a month or less)
Sometimes (a few times a month)
Often (once a week)
Very often (a few times a week)
Always (every day)
When I get up in the morning, I feel like going to work
Never
Almost never (a few times a year or less)
Rarely (once a month or less)
Sometimes (a few times a month)
Often (once a week)
Very often (a few times a week)
Always (every day)
At my organization, I am treated with respect
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
My organization values my contributions
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
My organization cares about my general satisfaction at work
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
My organization is willing to extend resources in order to help me perform my job to the best of my ability
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
I receive recognition for a job well done
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
I trust the management at my organization
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
My organization is committed to employee health and well-being
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
My organization encourages me and provides opportunities to engage in healthy behaviors, such as being physically active, eating a healthy diet, living tobacco free, and managing my stress
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
How often do the demands of your job interfere with your personal life?
Never
Almost never (a few times a year or less)
Rarely (once a month or less)
Sometimes (a few times a month)
Often (once a week)
Very often (a few times a week)
Always (every day)
How often do the demands of your personal life interfere with your work on the job?
Never
Almost never (a few times a year or less)
Rarely (once a month or less)
Sometimes (a few times a month)
Often (once a week)
Very often (a few times a week)
Always (every day)
I have the freedom to vary my work schedule
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
I have the freedom to work wherever is best for me-either at home or at my organization.
Strongly disagree
Somewhat disagree
Somewhat agree
Strongly agree
Does not apply
Overall, how safe do you think your workplace is?
Very unsafe
Somewhat unsafe
Somewhat safe
Very safe
How often do you experience stress with regard to your work?
Never
Almost never (a few times a year or less)
Rarely (once a month or less)
Sometimes (a few times a month)
Often (once a week)
Very often (a few times a week)
Always (every day)
Are you limited in the kind or amount of work you can do because of a physical, mental, or emotional problem?
Not at all
Slightly
Moderately
Extremely
Does not apply/do not have problem
Do you have the skills you need to manage your work-related stressors?
Yes
No
If you said no, please elaborate: