Mental Health and Stress Level Assessment Form

Evaluate the mental health and stress levels of employees for workplace support and well-being.

Full Name *

Date of Birth *

Position/Job Title

Date of Assessment *

In the past month, how often have you felt stressed at work? *

How would you rate your overall mental health? *

Do you have any current mental health conditions?

If yes, please describe

Do you feel that work-related stress affects your daily life? *

What strategies do you use to manage stress?

Are there any workplace accommodations or support systems that could help manage your stress levels?

Would you be interested in talking to a mental health professional? *

Additional comments or concerns

Signature of Employee *

Date of Submission *