1. Do you feel you have a purpose to each day?:
Never
Rarely
Sometimes
Often
Frequently
Always
(Do you have goals or activities to complete?)
2. Do you have trust in your employer to help you return to work/treat you fairly?:
Never
Rarely
Sometimes
Often
Frequently
Always
3. Do you have confidence you will be able to return to your job?:
Never
Rarely
Sometimes
Often
Frequently
Always
4. Do you believe the compensation system supports you?:
Never
Rarely
Sometimes
Often
Frequently
Always
5. How often do you participate in physical activity?:
Never
Rarely
Every 1-2 weeks
1-2 times/week
3-5 times/week
Daily
6. How often do you worry about your relationship with immediate family members or your role in the family?:
Always
Frequently
Often
Sometimes
Rarely
Never
7. How often do you feel isolated or low in mood?:
Always
Frequently
Often
Sometimes
Rarely
Never
8. How often do you worry about money and financial security?:
Always
Frequently
Often
Sometimes
Rarely
Never
9. In the last month, how often have you participated in social activities with friends, sporting clubs or interest groups?:
Never
Rarely
Monthly
Every 1-2 weeks
1-2 times/week
More than 3 times/week
10. In the last month, have you drunk alcohol, smoked or taken illicit drugs more often than before your injury? If yes, how much?:
Daily
3-5 times/week
1-2 times/week
Every 1-2 weeks
Rarely
No