Work Organization Questionnaire

Attachment G5:

Work Organization and Non-Occupational Physical Activity

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/20xx

Part I: Your Supervisor

Indicate how often the following statements describe your supervisor's behavior.

1 Lets group members know what is expected of them.

Never

Often

Sometimes

Often

Always

2 Is friendly and approachable.

Never

Rarely

Sometimes

Often

Always

3 Encourages the use of uniform procedures.

Never

Rarely

Sometimes

Often

Always

4 Does little things to make it pleasant to be a member of the group.

Never

Rarely

Sometimes

Often

Always

5 Tries out his or her ideas in the group.

Never

Rarely

Sometimes

Often

Always

Public reporting burden of this collection of information is estimated to average 26 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

6 Puts suggestions made by the group into operation.

Never

Rarely

Sometimes

Often

Always

7 Makes his or her attitudes clear to the group.

Never

Rarely

Sometimes

Often

Always

8 Treats all group members as his or her equals.

Never

Rarely

Sometimes

Often

Always

9 Decides what shall be done and how it will be done.

Never

Rarely

Sometimes

Often

Always

10 Gives advance notice of changes.

Never

Rarely

Sometimes

Often

Always

11 Assigns group members to particular tasks.

Never

Rarely

Sometimes

Often

Always

12 Keeps to himself or herself.

Never

Rarely

Sometimes

Often

Always

13 Makes sure that his or her part in the group is understood by the group members.

Never

Rarely

Sometimes

Often

Always

14 Looks out for personal welfare of group members.

Never

Rarely

Sometimes

Often

Always

15 Schedules the work to be done.

Never

Rarely

Sometimes

Often

Always

16 Is willing to make changes.

Never

Rarely

Sometimes

Often

Always

17 Maintains definite standards of performance.

Never

Rarely

Sometimes

Often

Always

18 Refuses to explain his or her actions.

Never

Rarely

Sometimes

Often

Always

19 Asks that group members follow standard rules and regulations.

Never

Rarely

Sometimes

Often

Always

20 Acts without consulting the group.

Never

Rarely

Sometimes

Often

Always

21 Gives praise on your performance.

Never

Rarely

Sometimes

Often

Always

22 Gives feedback on how you are doing your job.

Never

Rarely

Sometimes

Often

Always

23 Tells you what is expected of you on the job.

Never

Rarely

Sometimes

Often

Always

24 Helps you in planning your future in this organization.

Never

Rarely

Sometimes

Often

Always

25 Coaches and develops you to improve work performance.

Never

Rarely

Sometimes

Often

Always

26 Leads by example.

Never

Rarely

Sometimes

Often

Always

27 Treats all employees fairly.

Never

Rarely

Sometimes

Often

Always

28 How often does your supervisor give praise on your performance?

Never

Rarely

Sometimes

Often

Always

29 How often does your supervisor complain about your performance?

Never

Rarely

Sometimes

Often

Always

30 How often does your supervisor make any comment on the QUANTITY of your work?

Never

Rarely

Sometimes

Often

Always

31 How often does your supervisor make any comment on the QUALITY of your work?

Never

Rarely

Sometimes

Often

Always

32 How often do you worry about being reprimanded by your supervisor?

Never

Rarely

Sometimes

Often

Always

How much do each of following people go out of their way to do things to make your work life easier for you?

33 Your immediate supervisor.

Don't have any such person

Not at all

A little

Somewhat

Very much

34 Other people at work.

Don't have any such person

Not at all

A little

Somewhat

Very much

35 Your spouse^ friends^ and relatives.

Don't have any such person

Not at all

A little

Somewhat

Very much

How easy is it to talk with each of the following people?

36 Your immediate supervisor.

Don't have any such person

Not at all

A little

Somewhat

Very much

37 Other people at work.

Don't have any such person

Not at all

A little

Somewhat

Very much

38 Your spouse^ friends^ and relatives.

Don't have any such person

Not at all

A little

Somewhat

Very much

How much can each of the following people be relied on when things get tough at work?

39 Your immediate supervisor.

Don't have any such person

Not at all

A little

Somewhat

Very much

40 Other people at work.

Don't have any such person

Not at all

A little

Somewhat

Very much

41 Your spouse^ friends^ and relatives.

Don't have any such person

Not at all

A little

Somewhat

Very much

Part II: Your Co-Workers

Please indicate how much you agree or disagree with the following statements.

42 There is harmony within my work group.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

43 In our group^ we have lots of bickering over who should do what job.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

44 There is a difference of opinion among the members of my group.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

45 There is dissension in my group.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

46 The members of my group are supportive of each other's ideas.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

47 There are clashes between subgroups within my group.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

48 There is friendliness among the members of my group.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

49 There is a 'we' feeling among the members of my group.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

50 There are disputes between my group and other groups.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

51 There is agreement between my group and other groups.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

52 Other groups withhold information necessary for the attainment of our group's tasks.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

53 The relationship between my group and other groups is harmonious in attaining the overall organizational goals.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

54 There is lack of mutual assistance between my group and other groups.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

55 There is cooperation between my group and other groups.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

56 There are personality clashes between my group and other groups.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

57 Other groups create problems for my group.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

How often do you find that the following statements describe your work unit?

58 In my unit new ideas on how work should be done are encouraged.

Never

Rarely

Sometimes

Often

Always

59 In my unit expressing my opinion is encouraged.

Never

Rarely

Sometimes

Often

Always

60 My unit tries its best to carry out new ideas.

Never

Rarely

Sometimes

Often

Always

61 When I need to communicate with people IN my unit^ it is difficult to get in touch with them.

Never

Rarely

Sometimes

Often

Always

62 When I need to communicate with people OUTSIDE OF my unit^ it is difficult to get in touch with them.

Never

Rarely

Sometimes

Often

Always

63 The goals and strategies in my department are consistent with the goals and strategies in my unit.

Never

Rarely

Sometimes

Often

Always

64 In my unit^ employees are encouraged to take reasonable risks to improve things at work.

Never

Rarely

Sometimes

Often

Always

Part III: Your Organization

Please indicate the extent to which you agree or disagree with the following statements about TEMA.

65 I am quite proud to be able to tell people who I work for.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

66 I sometimes feel like leaving TEMA.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

67 I am not willing to put myself out just to help TEMA.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

68 I feel myself to be part of TEMA.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

69 In my work^ I like to think that I am making some effort^ not just for myself but for TEMA as well.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

70 I would not recommend to a close friend to join our staff.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

71 It would please me to know that my own work has made a contribution to the good of TEMA.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

72 I am appreciated around here.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

73 There is honest communication at TEMA.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

74 There is trust between TEMA and me.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

75 There is an honest commitment to quality at TEMA.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

76 The work I do at TEMA has meaning to me.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

77 TEMA is family-friendly.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

78 TEMA is interested in the welfare of its employees.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

79 TEMA treats its employees fairly.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

80 TEMA clearly communicates its goals and business strategy to the workers.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

81 TEMA lives up to its empowerment philosophy.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

82 TEMA actively encourages and supports diversity in the workplace.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Part IV: Your Job

This series of questions asks about how much influence you now have in each of several areas. By influence we mean the degree to which you control what is done by others at work and have freedom to determine what you do yourself at work.

83 How much influence do you have over the variety of tasks you perform?

Very little

Little

A moderate amount

Much

Very much

84 How much influence do you have over the availability of supplies and equipment you need to do your work?

Very little

Little

A moderate amount

Much

Very much

85 How much influence do you have over the order in which you perform tasks at work?

Very little

Little

A moderate amount

Much

Very much

86 How much influence do you have over the amount of work you do?

Very little

Little

A moderate amount

Much

Very much

87 How much influence do you have over the pace of your work/task^ that is how fast or slow you work?

Very little

Little

A moderate amount

Much

Very much

88 How much influence do you have over the quality of work that you do?

Very little

Little

A moderate amount

Much

Very much

89 How much influence do you have over the arrangement and decoration of your work area?

Very little

Little

A moderate amount

Much

Very much

90 How much influence do you have over the decisions concerning which individuals in your work unit do which task?

Very little

Little

A moderate amount

Much

Very much

91 How much influence do you have over the hours or schedule that you work?

Very little

Little

A moderate amount

Much

Very much

92 How much influence do you have over the decisions as to when things will be done in your work unit?

Very little

Little

A moderate amount

Much

Very much

93 How much influence do you have over the policies^ procedures^ and performance in your work unit?

Very little

Little

A moderate amount

Much

Very much

94 How much influence do you have over the availability of materials that you need to do your work?

Very little

Little

A moderate amount

Much

Very much

95 How much influence do you have over the training of other workers in your unit?

Very little

Little

A moderate amount

Much

Very much

96 How much influence do you have over the arrangement of furniture and other work equipment in your unit?

Very little

Little

A moderate amount

Much

Very much

97 To what extent can you do your work ahead and take a short rest break during work hours?

Very little

Little

A moderate amount

Much

Very much

98 In general^ how much influence do you have over work and work-related factors?

Very little

Little

A moderate amount

Much

Very much

How often do you face problems in your work like the following?

99 How often does your job require you to work very fast?

Rarely

Occasionally

Sometimes

Fairly often

Very often

100 How often does your job require you to work very hard?

Rarely

Occasionally

Sometimes

Fairly often

Very often

101 How often does your job leave you with little time to get things done?

Rarely

Occasionally

Sometimes

Fairly often

Very often

102 How often is there a great deal to be done?

Rarely

Occasionally

Sometimes

Fairly often

Very often

103 How often is there a marked increase in the amount of concentration required on your job?

Rarely

Occasionally

Sometimes

Fairly often

Very often

104 How often is there a marked increase in how fast you have to think?

Rarely

Occasionally

Sometimes

Fairly often

Very often

105 How often is there a marked increase in your workload?

Rarely

Occasionally

Sometimes

Fairly often

Very often

Please indicate how much you agree or disagree with the following statements:

106 It takes a long time to learn the skills required to do my job.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

107 I do not have enough training to do my job well.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

108 I have more than enough training and skills to do my job well.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

109 My job is so simple that almost anybody could handle it with little or no initial training.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

110 To be successful on my job requires all my skills and abilities.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

111 I have all the skills I need in order to do my job.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

112 On my job^ I seldom get a chance to use my special skills and abilities.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

113 My job is very challenging.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

114 I feel a sense of personal satisfaction when I do my job well.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

115 My opinion of myself goes down when I do my job badly.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

116 I take pride in doing my job as well as I can.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

117 I feel unhappy when my work is not up to my usual standard.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

118 I like to look back on the day's work with a sense of a job well done.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

119 I try to think of ways of doing my job effectively.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

120 I am willing to put out extra effort to make sure that the customer gets the information he or she needs.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

121 I am effectively dealing with the stress in this organization.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

122 I am able to maintain a healthy balance between my work life and my home life.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

To what extent do you face the following conditions in doing your work?

123 Backlog of work.

None

A little

Some

A lot

124 Work deadlines.

None

A little

Some

A lot

125 Understaffing.

None

A little

Some

A lot

126 Lack of notification about new policies or procedures.

None

A little

Some

A lot

127 Telephone contact with people who are upset or emotional.

None

A little

Some

A lot

128 Expected work quality requirements.

None

A little

Some

A lot

How accurate are each of the following statements in describing your job?

129 I feel certain about how much authority I have.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

130 There are clear^ planned goals and objectives for my job.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

131 I have to do things that should be done differently.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

132 I know that I have divided my time properly.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

133 I receive an assignment without the help I need to complete it.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

134 I know what my responsibilities are.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

135 I have to bend or break a rule or policy in order to carry out an assignment.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

136 I work with two or more groups who operate quite differently.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

137 I know exactly what is expected of me.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

138 I receive incompatible requests from two or more people.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

139 I do things that are likely to be accepted by one person and not accepted by others.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

140 I receive an assignment without adequate resources and materials to execute it.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

141 Explanation is clear about what has to be done on my job.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

142 I work on unnecessary things.

Very inaccurate

Mostly inaccurate

Somewhat inaccurate

Neither accurate nor inaccurate

Somewhat accurate

Mostly accurate

Very accurate

143 Do you have work tasks to take care of which keep you wondering if they have to be done at all?

Never

Rarely

Once in a while

Rather often

Frequently

144 Do you have work tasks to take care of which keep you wondering if they make sense at all?

Never

Rarely

Once in a while

Rather often

Frequently

145 Do you have work tasks to take care of which keep you wondering if they would not exist (or could be done with less effort) if they were organized differently?

Never

Rarely

Once in a while

Rather often

Frequently

146 Do you have work tasks to take care of which keep you wondering if they would not exist (or could be done with less effort) if some other people made fewer mistakes?

Never

Rarely

Once in a while

Rather often

Frequently

147 Do you have work tasks to take care of which keep you wondering if they just exist because some people simply demand it this way?

Never

Rarely

Once in a while

Rather often

Frequently

148 Do you have work tasks to take care of which you believe should be done by someone else?

Never

Rarely

Once in a while

Rather often

Frequently

149 Do you have work tasks to take care of which you believe are going too far and should not be expected from you?

Never

Rarely

Once in a while

Rather often

Frequently

150 Do you have work tasks to take care of which you believe put you into an awkward position?

Never

Rarely

Once in a while

Rather often

Frequently

151 Do you have work tasks to take care of which you believe are unfair for you to have to deal with?

Never

Rarely

Once in a while

Rather often

Frequently

Please answer the following questions:

152 During the day how often are you able to take brief unscheduled rest breaks from your work when you feel you need them?

Never

One time

Two times

Three times

Four times

More than four times

153 On average how frequently do you get up and leave your workstation during the day (to get work, take a break, talk to you supervisor, etc.)?

Never

One time

Two times

Three times

Four times

More than four times

Part V: Individual Reactions

Indicate how often IN THE LAST MONTH you have felt this way at work.

154 Have been upset because of something that happened unexpectedly?

Never

Rarely

Sometimes

Often

Always

155 Felt you were unable to control the important things in your life?

Never

Rarely

Sometimes

Often

Always

156 Felt nervous and stressed?

Never

Rarely

Sometimes

Often

Always

157 Dealt successfully with irritating life hassles?

Never

Rarely

Sometimes

Often

Always

158 Felt that you were effectively coping with important changes that were occurring in your life?

Never

Rarely

Sometimes

Often

Always

159 Felt confident about your ability to handle your personal problems?

Never

Rarely

Sometimes

Often

Always

160 Felt that things were going your way?

Never

Rarely

Sometimes

Often

Always

161 Found that you could not cope with all the things that you had to do?

Never

Rarely

Sometimes

Often

Always

162 Have been able to control irritations in your life?

Never

Rarely

Sometimes

Often

Always

163 Felt that you were on top of things?

Never

Rarely

Sometimes

Often

Always

164 Have been angered because of things that happened that were outside of your control?

Never

Rarely

Sometimes

Often

Always

165 Found yourself thinking about things that you have to accomplish?

Never

Rarely

Sometimes

Often

Always

166 Have been able to control the way you spend your time?

Never

Rarely

Sometimes

Often

Always

167 Felt difficulties were piling up so high that you could not overcome them?

Never

Rarely

Sometimes

Often

Always

168 Worked more slowly or took longer to complete tasks than expected?

Never

Rarely

Sometimes

Often

Always

169 Noticed that your productivity was lower than expected?

Never

Rarely

Sometimes

Often

Always

Answer these statements according to how you have been feeling during the past month including today:

170 I feel tense.

Not at all

A little

Moderately

Quite a bit

Extremely

171 I feel on edge.

Not at all

A little

Moderately

Quite a bit

Extremely

172 I feel worn out.

Not at all

A little

Moderately

Quite a bit

Extremely

173 I feel relaxed.

Not at all

A little

Moderately

Quite a bit

Extremely

174 I feel fatigued.

Not at all

A little

Moderately

Quite a bit

Extremely

175 I feel shaky.

Not at all

A little

Moderately

Quite a bit

Extremely

176 I feel uneasy.

Not at all

A little

Moderately

Quite a bit

Extremely

177 I feel bushed.

Not at all

A little

Moderately

Quite a bit

Extremely

178 I feel nervous.

Not at all

A little

Moderately

Quite a bit

Extremely

179 I feel listless.

Not at all

A little

Moderately

Quite a bit

Extremely

180 I feel panicky.

Not at all

A little

Moderately

Quite a bit

Extremely

181 I feel exhausted.

Not at all

A little

Moderately

Quite a bit

Extremely

182 I feel anxious.

Not at all

A little

Moderately

Quite a bit

Extremely

183 I feel weary.

Not at all

A little

Moderately

Quite a bit

Extremely

184 I feel sluggish.

Not at all

A little

Moderately

Quite a bit

Extremely

185 At your job during the last month would you say that you experienced:

A lot of stress

A moderate amount of stress

Relatively little stress

Almost no stress at all

186 All in all how satisfied would you say you are with your job?

Very satisfied

Somewhat satisfied

Not too satisfied

Not at all satisfied

187 In general how would you rate your health?

Excellent

Very good

Good

Fair

Poor

188 During the last three months how many days were you absent when you had been scheduled to work? (DO NOT count vacations holidays or any other time that you were scheduled off in advance).

No days missed

One day missed

Two days missed

Three days missed

Four or more days missed

189 On my last performance evaluation my supervisor rated my performance as:

Needs Improvement

Meets expectations

Exceeds expectations

Don't know/Unsure

Prefer not to answer

Part VI: Background

190 How long have you worked with TEMA?

6 months or less

6 months to 1 year

1 year to 5 years

5 years to 10 years

10 years to 20 years

20 years or more

191 How long have you worked in your current job?

6 months or less

6 months to 1 year

1 year to 5 years

5 years to 10 years

10 years to 20 years

20 years or more

192 DELETED

193a Select the time that comes closest to your present work start time.

6:00 am

6:30 am

7:00 am

7:30 am

8:00 am

8:30 am

9:00 am

9:30 am

Other (please specify)

193b Select the time that comes closest to your present work end time.

3:00 pm

3:30 pm

4:00 pm

4:30 pm

5:00 pm

5:30 pm

6:00 pm

6:30 pm

Other (please specify)

193c Select the period of time that comes closest to your present lunch period length.

30 minutes

45 minutes

60 minutes

Other (please specify)

194 How many hours per week do you normally work (NOT INCLUDING overtime)?

Less than 30 hours per week

30 - 35 hours per week

36 - 40 hours per week

More than 40 hours per week

195 How many hours overtime do you work in an average week?

No overtime

4 hours or less

4 to 8 hours

8 to 12 hours

More than 12 hours

196 How many hours per week do you work on any other job?

No other job

4 hours or less

4 to 8 hours

8 to 12 hours

More than 12 hours

197 Do you use a computer keyboard during your non-working hours (e.g. at home, at another job, volunteer work etc.)?

Yes

No

198 If you use a keyboard outside of work how many hours a day do you spend at the keyboard on average?

Less than 1 hour per day

1 - 2 hours per day

3 - 4 hours per day

More than 4 hours per day

199 What type of keyboard do you use when not at work? (You may choose more than one option)

Conventional

Alternative/Ergonomic

Laptop

200 Do you use a computer mouse during your non-working hours (e.g. at home, at another job, volunteer work, etc.)?

Yes

No

201 If you use a computer mouse outside of the workplace how many hours per day do you use the mouse on average?

Less than 1 hour per day

1 - 2 hours per day

3 - 4 hours per day

More than 4 hours per day

202 What type of mouse do you use when not at work? (You may choose more than one option)

Conventional

Alternative/Ergonomic

Laptop – touchpad button or rollerball

203 What is your gender?

Female

Male

204 How old are you?

Under 25 years

Between 25 - 34 years

Between 35 - 44 years

Between 45 - 54 years

Between 55 - 64 years

Over 64 years

205 What is your marital status?

Married

Single, never married

Single, widowed

Single, divorced

206 Do you have children living at home who are age six or younger?

Yes

No

207 Are you Hispanic or Latino?

Yes

No

208 Which one or more of the following would you say is your race? (Check all that apply)

White

Black or African American

Asian

Native Hawaiian or Other Pacific Islander

American Indian or Alaskan Native

209 Do you currently smoke cigarettes?

Every day

Some days

Not at all

210 How often do you have trouble getting to sleep, waking up in the middle of the night, or waking up early in the morning?

Never

A few times per year

A few times per month

A few times per week

Daily

211 Which hand is your dominant hand?

Right hand

Left hand

Neither hand – ambidextrous

Non-Occupational Physical Activity and Use of the Arms

Think about an average week in the past months. Please indicate how many days per week you performed the following activities, how much time on average you were engaged in this, and (if applicable) how strenuous this activity was for you

COMMUTING ACTIVITIES (round trip)	days per week	average time per day	Effort (circle please)
Walking to/from work or school	_____ days	_____ hour _____ minutes	slow/moderate/fast
Bicycling to/from work or school	_____ days	_____ hour _____ minutes	slow/moderate/fast
Not applicable

LEISURE TIME ACTIVITIES	days per week	average time per day	Effort (circle please)
Walking	_____ days	_____ hour _____ minutes	slow/moderate/fast
Bicycling	_____ days	_____ hour _____ minutes	slow/moderate/fast
Gardening	_____ days	_____ hour _____ minutes	light/moderate/intense
Odd Jobs	_____ days	_____ hour _____ minutes	light/moderate/intense
Sports (please write down yourself) e.g., tennis, fitness, skating, swimming, dancing
1. __________________	_____ days	_____ hour _____ minutes	light/moderate/intense
2. __________________	_____ days	_____ hour _____ minutes	light/moderate/intense
3. __________________	_____ days	_____ hour _____ minutes	light/moderate/intense
4. __________________	_____ days	_____ hour _____ minutes	light/moderate/intense

HOUSEHOLD ACTIVITIES	days per week	average time per day
Light household work (cooking, washing dishes, ironing, child care)	_____ days	_____ hour _____ minutes
Intense household work (scrubbing floor, walking with heavy shopping bags)	_____ days	_____ hour _____ minutes

ACTIVITY AT WORK AND SCHOOL	average time per week
Light work (sitting/standing with some walking, e.g. a desk job)	_____ hour _____ minutes
Intense work (regularly lifting heavy objects at work)	_____ hour _____ minutes
Not applicable

These three questions are about activities in which you use your arms and hands when you are not at work. These activities might include, but are not limited to: Housework, Dependent Care, Sports, Grocery Shopping, Hobbies, Auto and Home Repair. Although you may not do the same activities every week, tell us how much time you spend on average or in a typical week on physical activities outside of work.

1. When you are not at work, how many hours do you use your hands with moderate to heavy effort (such as scrubbing, using a hammer, gripping a bowling ball, weight lifting. etc.)?

• Less than 1 hour a week

• 1 to less than 5 hours a week

• 5 to less than 10 hours a week

• 10 to less than 20 hours a week

• 20 or more hours a week

2. When you are not at work, how many hours on average do you spend on activities in which you twist your back or bend forward at least as much as shown in this picture (such as raking, working under the hood of a car, bathing a child, etc.)?

• Less than 1 hour a week

• 1 to less than 5 hours a week

• 5 to less than 10 hours a week

• 10 to less than 20 hours a week

• 20 or more hours a week

3. When you are not at work, how many hours on average do you spend on activities in which you have your arm(s) raised as much as shown in this picture, where the elbow is as high as the shoulder (such as throwing a ball, or other overhead sports or hobbies)?

• Less than 1 hour a week

• 1 to less than 5 hours a week

• 5 to less than 10 hours a week

• 10 to less than 20 hours a week

• 20 or more hours a week