1. Do you feel you have a purpose to each day?:
(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?:

3. Do you have confidence you will be able to return to your job?:

4. Do you believe the compensation system supports you?:

5. How often do you participate in physical activity?:

6. How often do you worry about your relationship with immediate family members or your role in the family?:

7. How often do you feel isolated or low in mood?:

8. How often do you worry about money and financial security?:

9. In the last month, how often have you participated in social activities with friends, sporting clubs or interest groups?:

10. In the last month, have you drunk alcohol, smoked or taken illicit drugs more often than before your injury? If yes, how much?: