Overall, I feel well and whole (emotionally, physically, socially and spiritually). (1 being strongly disagree and 5 being strongly agree)

 

How much do you agree with each of the following statements? (1 being strongly disagree and 5 strongly agree)

I feel emotionally strong and resilient.

 

I find it easy to express my emotions in positive, constructive ways.

 

I am resilient and can bounce back after a disappointment or problem.

 

I am flexible and adapt to change in a positive way.

 

I am able to recognize and manage the things that cause me stress.

 

I love and accept myself for who I am.

 

How much do you agree with each of the following statements? (1 being strongly disagree and 5 strongly agree)

I am in a comfortable environment (work and home).

 

I recognize the impact of my actions on my work and home environment.

 

I recognize the impact of my home and work environment on my health.

 

I contribute toward making my home and work environment a safer and healthier place.

 

I live in a safe environment.

 

I spend time outdoors enjoying nature.

 

How much do you agree with each of the following statements? (1 being strongly disagree and 5 strongly agree)

I am intellectually stimulated by my work and non-work activities.

 

I can critically consider the opinions and information presented by others and provide constructive feedback.

 

I feel capable of making important decisions.

 

I keep informed about social, political and/or current issues.

 

I look for ways to use my creativity and critical thinking skills.

 

I seek personal growth by learning new skills.

 

How much do you agree with each of the following statements? (1 being strongly disagree and 5 strongly agree)

My work is personally satisfying.

 

I get personal satisfaction and enrichment from work.

 

My workload is manageable.

 

I am content with where I am in my career.

 

I am developing the necessary skills to achieve my career goals.

 

I balance work with play and other aspects of my life.

 

How much do you agree with each of the following statements? (1 being strongly disagree and 5 strongly agree)

I generally feel very good about my health.

 

I exercise at least three times a week.

 

I protect myself and others from getting ill (e.g., wash my hands, cover my cough, etc.).

 

I get enough sleep and feel vibrant throughout the day.

 

I listen to my body; when there is something wrong, I seek needed assistance.

 

I maintain healthy eating habits.

 

How much do you agree with each of the following statements? (1 being strongly disagree and 5 strongly agree)

I have a healthy social life.

 

I feel supported and respected in my close relationships.

 

I participate in a variety of social activities.

 

I am able to maintain healthy relationships with my friends and loved ones.

 

I feel a sense of belonging to a group or community.

 

I have someone I can talk to about my private feelings.

 

How much do you agree with each of the following statements? (1 being strongly disagree and 5 strongly agree)

My life has purpose.

 

I take time to think about what’s important in life—who I am, what I value, where I fit in, and where I am going.

 

I have found a balance between meeting my needs and those of others.

 

I engage in acts of caring and goodwill without expecting something in return.

 

I feel like my life has purpose and meaning.

 

I experience love, joy and fulfillment.

 

How much do you agree with each of the following statements? (1 being strongly disagree and 5 strongly agree)

Most days I feel burned out.

 

I have negative thoughts about my job.

 

I feel misunderstood or unappreciated by my co-workers.

 

I feel that I am not getting what I want out of my job.

 

I am easily irritated by small problems, or by my co-workers and team.

 

I feel emotionally drained often.

 
Done