Brian Anderson
banderson@csm-institute.com
954-204-5428
"Improving the Day to Day of Athletic Healthcare"
C&U ATC Stress Assessment Survey

Rate each question based on the past 30 days and according to the following scale:

(1 = never 2 = rarely 3 = sometimes 4 = often 5 = always)
Do you:

                                  1. Worry at night or have trouble sleeping?

                                  2. Feel less competent or fell ineffective than you used to feel?

                                  3. Consider yourself unappreciated or “used” on the job?

                                  4. Feel tired, even when you get enough sleep?

                                  5. Dread going to work?

                                  6. Get angry or irritated easily?

                                  7. Have recurring headaches, stomach aches, or lower back pain?

                                  8. Feel overwhelmed?

Are you:

                                  9. Counting down the minutes until quitting time (or days until season ends) ?

                                  10. Negative toward or in conflict with, coworkers?

                                  11. Rigidly applying rules without considering more creative solutions?

                                  12. Using alcohol or other drugs in an unhealthy way?

                                  13. Chronically dehydrated?

                                  14. Overweight?

Does your job:

                                  15. Overload you with work?

                                  16. Deny you enough breaks, lunch time, sick leave, or vacation?

                                  17. Require monotonous or repetitive tasks?

                                  18. Pay too little?

                                  19. Lack access to a social outlet or professional support group?

                                  20. Depend on unreliable funding sources?

                                  21. Lack the funds to accomplish stated objectives?

                                  22. Lack clear guidelines or objectives?

                                  23. Require you to wear so many hats that you feel overwhelmed?

                                  24. Require you to deal with rapid program (schedule, time, etc.,) changes?

                                  25. Demand you deal with angry clients (student-athletes, coaches, etc.,)  or 
                                        disrespectful superiors?


General Information:

                                  Over the duration of your employee agreement (10 / 12 / Etc) months how many hours 
                                  per week do you work?

                                             How would you rate your job satisfaction?

                      How many years have you been in the profession?

                                         Salary Range​

​                                                  School Classification

                                                     Which title best describes your role?



Optional Information:

If you would like to have your results and analysis please complete the form below.

Name:

Email Address:

​School: