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Burn-out questionnaire

To better understand your unique situation and assess the impact and effectiveness of my services, I kindly ask you to complete the following questionnaire.


By filling out the same questionnaire at the end of our sessions/program, we can track any changes and progress over time.

The questionnaire takes a couple of minutes to complete. Some questions may seem similar, but each one serves a distinct purpose—please answer them individually.

The best approach is to respond intuitively and avoid overthinking; simply select the option that feels most accurate.


Rest assured that all information will be handled with the utmost confidentiality and will not be shared with anyone.


Thank you for your time and participation!

Please answer the following questions:

1. How often do you feel tired? (PB)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
2. Does your work frustrate you? (W)
1. To a very high degree
2. To a high degree
3. Somewhat
4. To a low degree
5. To a very low degree
3. How often are you emotionally exhausted? (PB)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
4. Do you feel burnt out because of your work? (W)
1. To a very high degree
2. To a high degree
3. Somewhat
4. To a low degree
5. To a very low degree
5. How often do you think: ”I can’t take it anymore”? (PB)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
6. How often are you physically exhausted? (PB)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
7. How often do you feel worn out? (PB)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
8. Do you have enough energy for family and friends during leisure time? (W)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
9. Are you exhausted in the morning at the thought of another day at work? (W)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
10. How often do you feel weak and susceptible to illness? (PB)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
11. Do you feel worn out at the end of the working day? (W)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
12. Do you feel that every working hour is tiring for you? (W)
1. Always
2. Often
3. Sometimes
4. Seldom
5. Never/almost never
13. Is your work emotionally exhausting? (W)
1. To a very high degree
2. To a high degree
3. Somewhat
4. To a low degree
5. To a very low degree

Wil je contact met mij?

Dank voor je bericht!

Telefoon nummer

+31 (0)6 22 04 47 38

E-mail adres

​

 

Tessavannes@kpnmail.nl

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