Person Organizational Quality Assessment_BSL

OMB Control #: 1103-XXXX OMB
Expiration Date: XX/XX/XXXX
Following is a list of words that describe feelings people sometimes have. Please CHECK THE BOX which reflects
how frequently you have felt the following during the LAST MONTH.
Not Once In Some Fairly
At All A While Times Often

Often

Very
Often Always

1. Resentful
2. Fatiqued
3. Annoyed
4. Sad
5. Body aches (joint pain, backaches, etc.)
6. Headaches
7. Rapid heartbeats
8. Depressed
9. Exhausted
10. Blue
11. Appreciative
12. Relaxed
13. Anxious
14. Tired
15. My sleep is inadequat
16. Thankful
17. Indigestion, heartburn or stomach upset
18. Calm
19. Cynical
20. Muscle Tension
21. Grateful
22. Worried
23. Unhappy
24. Uneasy
25. Angry
26. Peaceful
27. Over the last month my health has been:
Excellent

Good

Average

Fair

Poor

28. Check the box on the line below that indicates how stressed you have been in the past month:
Most stressed
Most calm I've
I've ever been
ever been

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OMB Control #: 1103-XXXX OMB
Expiration Date: XX/XX/XXXX
Following is a list of statements that describe the way people sometimes feel or think about themselves. Please
CHECK THE BOX which reflects how frequently you have felt or thought the following during the LAST MONTH.
Not Once In Some Fairly
At All A While Times Often

Often

Very
Often Always

29. My life is deeply fulfilling
30. Dynamic
31. I get upset easily
32. I find it difficult to calm down after I've been upset
33. I feel loved by my spouse/partner
34. I feel optimistic about the future
35. I wake up and look forward to each day
36. Motivated
37. I am pleased with my life
38. I sometimes have urges to break, throw or smash things
39. I sometimes have a short fuse
40. Enthusiastic
We are asking about your feelings and experiences over the LAST MONTH. Please CHECK THE BOX which
reflects how much you AGREE or DISAGREE with the following statements as they apply to you, your job and place
of employment during the LAST MONTH.
Strongly
Slightly
Disagree Disagree Disagree Neutral

Slightly
Agree

Agree

Strongly
Agree

41. I am satisfied with my life
42. I am satisfied with my job
43. There is tension between management and staff
44. I feel there is never enough time
45. I feel pressed for time
46. The pace of life is too fast and I can't keep up
47. I feel like leaving this organization
48. I feel conflict between work and personal priorities
49. It takes a lot of effort to sustain my performance level
50. I feel like quitting my job
51. I work with people who don't get along with each other
52. I'm aware of power struggles between co-workers that
damage morale

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