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Welcome to the ICAS Pulse Survey
In the following pages, you will find questions relating to a range of lifestyle variables. Some of them may strike you as unusual or personal in nature. However, when combined, this collection of questions allows ICAS to provide a meaningful and incisive assessment of your personal circumstances. For this reason, we would strongly encourage you to answer all questions. However, you are under no obligation to answer everything in this questionnaire and mandatory questions appear with a red asterisk after them. Please also be aware that if you choose not to answer several questions, we may not be able to provide feedback on some or all sections in your personal report.
Because this is a personal assessment, ICAS undertakes to treat your responses in the strictest of confidence. To ensure this, no more than two people within ICAS will have access to your completed questionnaire or report, and ICAS undertakes not to disclose any personal details to any third party without your prior consent.
To further ensure your confidentiality, this file is saved in a password-protected format on submission.
The questionnaire should take between 15 and 20 minutes to complete. To enter responses, use your mouse to click on the pull down menus or click on your chosen answer using the buttons provided. For answers that require that you type a number or other text, click on the space provided and type your response.
Kind regards
The ICAS Well-Being Team |
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| How would you like your personalised report to be sent to you (leave blank if you do not want a report)? |
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| * ICAS currently provides a wellness service to staff in your organization. This survey allows ICAS to get a sense of the risks you face to your behavioural and emotional well-being. Please indicate below if you would be comfortable for ICAS to contact you to offer assistance with regard to any significant risks that might become apparent during this process. All assistance is confidential. |
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| * Mobile telephone number we should use to offer support: | | |
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| Please enter the postal address to which your report should be sent. |
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| * What is the year of your birth (eg. 1978)? | | |
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| * What is your height in metres (eg. 1.65)? | | |
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| * What is your weight in kilogrammes (eg. 72)? | | |
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| * Are you in a long-term, intimate relationship with another person (eg. spouse, boyfriend, girlfriend)? |
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| How many children do you have? |
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| * How many children live in the same home as you and are under your care? |
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| How long have you worked for the GPG Department of Treasury, in years and months? |
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| * In which division are you employed? |
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| * In which position are you employed? |
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| * What is your gross monthly salary (before deductions)? |
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| * How often do you feel supported at work? |
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| How often do you feel recognised for the effort you put in at work? |
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| * At work, how would you describe your relationship with your immediate superior? |
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| * How do you experience communication among colleagues within your workplace? |
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| How easy is it for colleagues to communicate with management in your organisation? |
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| How would you rate the quality and frequency of communication from management to colleagues at your place of work? |
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| How frequently do you argue with colleagues at work? |
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| How would you rate your level of motivation at work? |
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| How would you rate your workplace in terms of respect for different cultures? |
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| How would you rate your self-esteem (the extent to which you have a positive opinion about yourself)? |
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| * How would you rate levels of conflict inside your workplace? |
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| * In general, what is your level of stress at work? |
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| * In general, what is your level of stress at home? |
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| * How many days have you been absent from work in the past 12 months (excluding your annual holiday leave)? | | |
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| How often do you feel you have significant control over, or influence in, your work? |
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| How often are you clear about what you are supposed to accomplish in your work? |
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| * How often do you feel you have too much work to do and/or unreasonable deadlines? |
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| * How often do you enjoy and feel satisfied with your job? |
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| * How often does your work interfere with your home life? |
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| * How often does your home life interfere with your work? |
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| * How often do you have trouble falling or staying asleep? |
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| * How often have you found yourself withdrawing from people lately? |
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| When confronted by a stressful situation, how often do you approach it in a focused, problem-solving way? |
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| * How often have you felt down, hopeless or depressed in the past month? |
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| * How happy are you with your life as a whole? |
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| Do you participate in hobbies, sports or spiritual activities of your choice at least once a week? |
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| How many major losses have you experienced in the past year, eg, the death of a loved one, divorce or loss of a job? | | |
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| Are there at least two sympathetic people with whom you can discuss your concerns? |
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| * When stressed, do you find yourself drinking or smoking more or using medications inappropriately? |
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| * Do you feel little interest or pleasure in doing things |
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| How many traumatic incidents have you survived in the past year ( a traumatic incident is one that threatens your life or safety, or the life or safety of somebody close to you, e.g. armed robbery, natural disaster)? | | |
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| Below is a list of emotions. Please indicate to what extent you have felt each during the past few weeks.
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| Here is a list of potential difficulties for which your employee wellness programme might make services available. Please rate their importance in terms of your own needs.
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| Rate each of the following in terms of their adequacy in ensuring that you can do your job safely and effectively.
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| * How would you describe your relationship with your spouse or partner? |
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| How often do you and your spouse or partner agree on how to spend money? |
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| When you argue with your partner, how often do your arguments tend to begin in a negative and emotionally charged manner (eg. with accusations, criticism or sarcasm)? |
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| On the whole, to what extent would you say you love and respect your partner and enjoy his/her company? |
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| How often do you consider having a sexual relationship with somebody other than your primary partner? |
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| Do your children enhance your marital satisfaction more than they reduce it? |
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| In your relationship with your partner, would you say that the positive experiences outweigh the negative experiences? |
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| How would you rate the overall level of conflict in your home? |
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| To what extent can members of your family depend on one another? |
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| Do you spend at least five hours of relaxation or recreational time together with your family each week? |
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| Does at least one member of your family suffer with chronic health problems (physical and/or psychological) that put extra strain on your home life? |
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| How do you experience your role as a parent? |
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| How frequently are there arguments between parents and children in your family? |
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| How often do you and your partner disagree about the children (i.e. childrearing practices, discipline, decision-making, etc.)? |
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| Do you know how to easily locate the paperwork and documents for all of your insurance policies, investments, hire purchase and home loan obligations? |
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| Without looking it up, do you know the total value of your net worth (how much would be left in your estate if you died), including all savings, investments, home equity, unsettled debt, etc? |
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| Do you know how much you spend on electricity, water and basic groceries each month? |
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| Have you set a maximum amount that you allow yourself to spend of your income each month and do you stay strictly within that limit? |
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| Have you reached the maximum limit on your credit card in the past three months? |
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| Are you up to date with all monthly credit repayments? |
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| Have you ever taken out a loan to repay another loan? |
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| Do you have at least three to six months worth of living expenses saved in a short-term savings facility in case of an emergency? |
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| Do you have at least three long-term financial goals, such as saving for a down payment on a home, investing for a child’s education, or retirement? |
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| Do you know the rate at which you are paying interest on all your hire purchase and home loan accounts? |
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| Have you reviewed your life insurance policy in the last 24 months to see if the price you are paying for it is still competitive in today’s marketplace? |
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| Do you struggle to stay out of debt? |
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| Which of the following best describes your history of smoking? |
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| How many units of alcohol do you drink in a week, on average (a unit is equivalent to one beer, a glass of wine or one tot measure of spirits)? | | |
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| Do you exercise recreationally to the point of being mildly out of breath for three or more hours a week? (Brisk walking is sufficient to achieve a state of mild breathlessness.) |
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| Enter any other comments you may wish to add here: | | |
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