Community Partner Burnout Survey

1. I feel I am an incompetent person

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

2. I do not feel like I am making a change at work

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

3. I am not a good person

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

4. I feel like I do not have enough time to spend with my friends

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

5. My relationships with family members have been negatively impacted by my work at The Center

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

6. I feel like my job at The Center is negatively impacting my personal life

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

7. Due to my job, I feel tired most of the time

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

8. Due to my job, I feel overstressed

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

9. Due to my job, I feel tightness in my back and shoulders

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

10. Due to my job, I become physically ill

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

11. I feel like I need a vacation

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

12. I feel drained after work

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

13. I have chronic feelings of general fatigue

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

14. I feel depressed

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

15. I feel stressed by the size of my workload

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

16. I feel bogged down by the system in my workplace

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

17. I feel negative energy from my coworkers

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

18. I often feel irritated in my workplace

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

19. I feel that there is too much emphasis on paperwork in my workplace

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

20. I have little empathy for the folx I serve

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

21. I have become callous towards folx I serve

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

22. I am no longer concerned about the welfare of those I serve

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

23. I am relieved when clients do not show up for appointments or meetings are cancelled

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

24. I am relieved when clients do not show up for sessions

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

25. I have little empathy for my clients

Completely agree Somewhat agree Neither agree or disagree Somewhat disagree Completely disagree

26. What are your needs from this space?

27. What would help you feel better in your work place?

Please let us know any other areas of burnout you may be experiencing.