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
Sex
Marital Status
Secondary Education
Tertiary Education
Industry
Occupation
Work Type
Shift Worker
Workplace
Department
Demands of Work #


#Mental: e.g. office, teaching and administrative work. Physical: e.g. auxiliary, installation and home care work.

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