Fatigue Management Survey 1. What roster do you currently work? * 5×2 7×7 8×6 14×7 other If you choose “Other” above (Specify) 2. Do you like your roster? * Yes No If “No” (Specify) 3. What roster would you prefer to work? * 5×2 7×7 8×6 14×7 Other If you choose “Other” above (Specify) 4. Generally, how fatigued do you feel at work? * Very Rested Good Slightly Tired Fatigued 5. Please rate the factor “Workload” which contribute to your fatigue at work: from 1 to 6 (1 being the highest factor and 6 being the lowest) * 1 2 3 4 5 6 6. Please rate the factor “Environment” which contribute to your fatigue at work: from 1 to 6 (1 being the highest factor and 6 being the lowest) * 1 2 3 4 5 6 7. Please rate the factor “Lifestyle” which contribute to your fatigue at work: from 1 to 6 (1 being the highest factor and 6 being the lowest) * 1 2 3 4 5 6 8. Please rate the factor “Medical disorders” which contribute to your fatigue at work: from 1 to 6 (1 being the highest factor and 6 being the lowest) * 1 2 3 4 5 6 9. Please rate the factor “Roster” which contribute to your fatigue at work: from 1 to 6 (1 being the highest factor and 6 being the lowest) * 1 2 3 4 5 6 10. Any other relevant comments: Submit
