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Questions marked with a * are required Exit Survey
 
 
* 1. This question is related to situations where it is difficult to leave job-related concerns at your work place. Please describe two or three situations where this has occurred. Please be as specific as possible and include all of the issues that were related to each situation and why you felt it was necessary to “bring the job home.” Please also describe the extent to which this might have led to a maintenance error at work.
   
 
 
 
* 2. Tell us about a time in which something or someone at work irritated you to the point where you found it difficult to perform your job safely or led to an unsafe act.
   
 
 
 
* 3. Let’s discuss your workload and how it relates to your stress level. Please describe any maintenance errors or unsafe acts you might have committed as a result of being assigned a heavy workload or a tight deadline that made you feel tense? Please provide as much information about the workload, the error/unsafe act, and why this made you feel tense.
   
 
 
 
* 4. Let’s now talk about your general feeling about the amount of time you have to relax during work hours. Please tell me to what extent you feel you have sufficient time on the job to rest and how this might impact your job performance relative to safety. Please be as specific as possible.
   
 
 
 
5. Please describe or give an example of how worrying about your job when trying to sleep at night affected your attention to detail at work the next day that then led to your committing an unsafe act. Please be as specific as possible and include what you were worrying about and what was the unsafe act.
   
 
 
 
* 6. Please describe or give an example of when you felt unhappy or depressed about something that then led to an error when performing a maintenance task. Please be as specific as possible and include what led to your unhappiness/depression, what maintenance task you were performing, and what the error was.
   
 
 
 
* 7. Please describe or give an example of when you lost confidence in your ability to perform a maintenance task, which then led to an error. Please be as specific as possible and include what led to your lack of confidence, what maintenance task you were performing, and what was the error.
   
 
 
 
* 8. Please describe or give an example of a situation in which you felt you were playing a useful part in promoting safe behavior in the workplace. Please be as specific as possible and include what led you to feel you were being useful and what safe behavior you were promoting.
   
 
 
 
* 9. Please describe or give an example of a situation in which you felt you could not overcome any personal and/or work-related difficulties you might have been facing and how this led to a maintenance error. Please be as specific as possible and include what difficulty you could not overcome and what error was committed.
   
 
 
 
10. Let’s focus on any errors you might have committed as a result of working under a mental strain. Please give an example of how this mental strain led to an error. Please be as specific as possible and include the mental strain you were under, the source of the strain, the situation you were involved in, the error that was committed, and the final result.