June 12, 2008
BWA would love to receive your feedback on this survey - any comments can be sent via email to dwoods@swin.edu.au - Thank you.
The Work Ability Index you are about to complete is a tool designed to help support you to maintain your ability to do your job. You can download a PDF document and read more about it on the BWA website.
This questionnaire contains questions about your work, factors affecting your ability to do your job and your general health. The results from the survey can help determine factors that may lead to a reduction in your ability to work and in your general health and wellness over time.
Your answers will help establish whether you can take actions and be supported by your employer to improve your health and your ability to do your job.
Please fill out the questionnaire carefully and answer all the questions.
IMPORTANT NOTE: YOUR PRIVACY IS OF THE UTMOST IMPORTANCE. You are NOT required to provide your name, although there is an option to do so.
Your identity will NOT be revealed to your employer. If work ability information is collected for a specific workplace and reported back to an employer, it will only ever be presented in generic format, ensuring no individuals are identified. The information you provide is protected by privacy legislation.
You will receive a rating once you have completed the survey giving you a score between 7 and 49, with 7 being the lowest possible result and 49 being the highest. You will also be provided with some general advice about what your score might mean. The advice is quite general but suggests some actions you may consider taking to improve work ability.
Background Information
Name
Date of Birth
Month
Day
Year
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Sex
Male
Female
Marital Status
Never Married
Married
Separated
Divorced
Widowed
Secondary Education
Year 10
Year 11
Year 12
Tertiary Education
Certificate
Diploma or Advanced Diploma
Graduate Certificate or Diploma
Bachelor Degree
Post-Graduate Degree
Industry
Accommodation, Cafes and Restaurants
Agriculture, Forestry and Fishing
Communication Services
Construction
Cultural and Recreational Services
Education
Electricity, Gas and Water Supply
Finance and Insurance
Government Administration and Defense
Health and Community Services
Manufacturing
Mining
Personal and Other Services
Property and Business Services
Retail Trade
Transport and Storage
Wholesale Trade
Occupation
Advanced Clerical and Service Workers
Agricultural or Horticultural Tradsperson
Automotive Tradesperson
Business and Inforamtion Professionals
Clerical, Sales or Service Worker
Construction Tradesperson
Education Professionals
Electrical and Electronic Tradesperson
Food Tradesperson
General Labourer or Related Workers
General or Specialist Managers
Health Professionals
Machine Operators
Managers and Administrators
Managing Supervisors (Sales and Services)
Mechanical and Fabrication Tradesperson
Mining Worker
Other Workers
Production or Transport Workers
Professionals
Science, Building and Engineering Professionals
Secretary or Personal/Executive Assistants
Sports Professionals
Tradespersons and Related Workers
Work Type
Full Time
Part Time
Contract/Temp
Casual/Vacation
Shift Worker
yes
no
Workplace
Department
Demands of Work
Mental
Physical
Mental & Physical
#
#Mental: e.g. office, teaching and administrative work. Physical: e.g. auxiliary, installation and home care work.
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