Burnout Survey

Personal Information

Tell Us About Yourself

Name(Required)

Email(Required)

Phone(Required)

Your Workplace Experience

Tell us about your job satisfaction, teamwork, and workload control."

1. Overall, I am satisfied with my current job:(Required)

Strongly Agree (5)

Agree (4)

Neither agree nor disagree (3)

Disagree (2)

Strongly disagree (1)

2. Using your own definition of “burnout”, please choose one of the numbers below:(Required)

I enjoy my work. I have no symptoms of burnout. (5)

I am beginning to burn out and have one or more symptoms of burnout, e.g. emotional exhaustion. (3)

I feel completely burned out. I am at the point where I may need to seek help. (1)

3. My professional values are well aligned with those of my clinical leaders:(Required)

Strongly Agree (5)

Agree (4)

Neither agree nor disagree (3)

Disagree (2)

Strongly disagree (1)

4. The degree to which my care team works efficiently together is:(Required)

Optimal (5)

Good (4)

Satisfactory (3)

Marginal (2)

Poor (1)

5. My control over my workload is:(Required)

Optimal (5)

Good (4)

Satisfactory (3)

Marginal (2)

Poor (1)

Your Results & Submission

See your workplace wellness score and submit your response

Total Score Calculation:

40-50 → 🎉 Joyful workplace!
30-39 → ⚠️ Some areas need improvement.
Below 30 → 🚨 High risk of burnout!

Subscale 1 (supportive work environment):

≥ 20 → Strong support system
Below 20 → Needs improvement

Subscale 2 (work pace and EMR stress):

≥ 20 → Reasonable pace & manageable EMR stress
Below 20 → Potential burnout risk

Email

This field is for validation purposes and should be left unchanged.

Mini Z Workplace Survey

Personal Information

Your Workplace Experience

Work Pace & EMR Impact

Your Results & Submission

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