Workplace Stress Assessment Intake Form
Full Name
Date
Position/Job Title
Department/Team
How long have you been in your current role?
Current Stress Levels
How would you rate your current level of workplace stress?
Low
Moderate
High
Very High
Are you experiencing any physical or emotional symptoms related to stress?
Sources of Stress
What do you believe are the main sources of your workplace stress? (E.g., workload, deadlines, communication, management, lack of support, etc.)
How do you currently manage or cope with stress at work?
How is workplace stress affecting your job performance or personal life?
Additional Comments
Any other information or concerns you would like to share?