‘Can I make a stress at work claim’ Questionnaire
- Who is/was your employer?
- What is/was your role and job description?
- When did you start that role?
- When did you first suffer illness due to stress at work?
- What symptoms did you have?
- Are you still suffering symptoms?
- What do you think caused you to suffer work related stress?
- Did you tell your employer about the symptoms of stress you were experiencing?
- If you did tell your employer: (a) Did you do so verbally or in writing (b) When did you tell them? (c) What was their response?
- Did you ask your employer to take any specific steps to avoid you continuing to suffer work related stress? If so, what were these and what response did you receive?
- Were you experiencing any stressful events that were not work related (such as a relationship breakdown or bereavement) which could have made you “vulnerable” to stress related illnesses. If so, was your employer aware of these events?
- Have you previous suffered mental health difficulties such as stress, depression or anxiety? If so, was your employer aware of this?
- When did you first go to your doctor about your work related stress?
- When did you take your first period of sick leave due to the work related stress?
- If you have taken several periods of sick leave due to work related stress, did your employer agree after each period that you were fit to return to work?
- Have you attended any formal ‘return to work’ meetings or had an occupational health referral?
- Have any changes been made by your employer to your working practices to improve the things identified as causing stress? If so, please give details of these changes and your comments on whether they were sufficient to avoid further problems.
- Is there any thing your employer could have done to help you, which they failed to do?
- Did your employer offer you counselling, therapy or other support services? If so, what was the outcome?
- What medical treatment are you receiving at the moment?
- What are your current symptoms? How do they impact on your ability to work?
- Are there any further factors that might be relevant?