Form 0920 Medical History

A Longitudinal Examination of Mental and Physical Health among Police Associated with COVID–19

Attachment D2- Medical History

Att D2- Medical History

OMB: 0920-1350

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Attachment D3

Spielberger Stress Survey







Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/20xx





Spielberger Stress Survey

ID Number __________


I. This section contains a list of job-related items that have been identified by police officers as stressful. Please rate each item as follows:


1. In the stress rating column below, please mark from 0-100 how stressful you think this event might be for a police officer. The higher the score, the more stressful the item. Please assign a stress rating, even if you have not experienced this event.


2. Mark an “X” for the number of times that you have personally experienced the item within the past month and during the past year.



Stress Rating

(0-100)

Mark an “X” for the Number of Times this Event Occurred




In the Past Month

In the Past Year




0

1

2

3-5

6-9

10+

0

1

2-5

6-10

11-24

25+


1

Assignment of disagreeable duties














2

Changing from day to night shift















3

Assignment to new or unfamiliar duties














4

Fellow officers not doing their job














5

Court leniency with criminals















6

Political pressure from within the department















7

Political pressure from outside the department


















In the Past Month

In the Past Year




0

1

2

3-5

6-9

10+

0

1

2-5

6-10

11-24

25+


8

Incapacitating physical injury on the job














9

Working a second job















10

Strained relations with non-police friends















11

Exposure to death of civilians















12

Inadequate support by supervisor















13

Inadequate support by department















14

Court appearances on day off or day following night shift















Shape2

Public reporting burden of this collection of information is estimated to average 7 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 (XXXX).



Stress Rating

(0-100)

Mark an “X” for the Number of Times this Event Occurred




In the Past Month

In the Past Year




0

1

2

3-5

6-9

10+

0

1

2-5

6-10

11-24

25+

15

Assignment of incompatible partner













16

Delivering a death notification














17

Periods of inactivity and boredom













18

Dealing with family disputes and crisis situations













19

High-speed chases














20

Difficulty getting along with supervisors














21

Responding to a felony in progress














22

Experiencing negative attitudes toward police officers
















Stress Rating

(0-100)

In the Past Month

In the Past Year




0

1

2

3-5

6-9

10+

0

1

2-5

6-10

11-24

25+

23

Public criticism of police














24

Disagreeable departmental regulations













25

Confrontations with aggressive crowds














26

Fellow officer killed in the line of duty














27

Distorted or negative press accounts of police














28

Making critical on-the-spot decisions














29

Ineffectiveness of the judicial system














30

Ineffectiveness of the correctional system


















Stress Rating

(0-100)

In the Past Month

In the Past Year




0

1

2

3-5

6-9

10+

0

1

2-5

6-10

11-24

25+

31

Personal insult from citizen














32

Insufficient manpower to adequately handle a job














33

Lack of recognition for good work













34

Excessive or inappropriate discipline














35

Performing non-police tasks














36

Demands made by family for more time














37

Promotion or commendation














38

Inadequate or poor quality equipment
















Stress Rating

(0-100)

In the Past Month

In the Past Year




0

1

2

3-5

6-9

10+

0

1

2-5

6-10

11-24

25+

39

Assignment of increased responsibility














40

Racial pressures or conflicts














41

Lack of participation on policy-making decisions














42

Inadequate salary














43

Accident in a patrol car














44

Physical attack on one’s person














45

Demands for high moral standards














46

Situations requiring use of force


















Stress Rating

(0-100)

In the Past Month

In the Past Year




0

1

2

3-5

6-9

10+

0

1

2-5

6-10

11-24

25+

47

Job conflict (by-the-book vs. by-the-situation)














48

Court decisions unduly restricting police













49

Killing someone in the line of duty














50

Making arrests while alone














51

Public apathy toward police














52

Competition for advancement














53

Poor or inadequate supervision
















Stress Rating

(0-100)

In the Past Month

In the Past Year




0

1

2

3-5

6-9

10+

0

1

2-5

6-10

11-24

25+

54

Exposure to battered or dead children














55

Plea bargaining and technical rulings leading to case dismissal














56

Frequent changes from boring to demanding activities














57

Exposure to adults in pain














58

Possibility of minor physical injury on the job














59

Put-downs and mistreatment of police officers in court














60

Excessive paperwork



















File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSawyer, Tamela (CDC/NIOSH/OD/ODDM)
File Modified0000-00-00
File Created2021-07-30

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