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

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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.