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Work Performance Questionnaire Baseline

Copyright 2002, World Health Organization work Performance Questionnaire Baseline A. YOUR work A1. Are you currently in any of the following work situations? For each Yes response, record how long you have been in this situation (for example, 3 weeks or 5 months or 7 years). How long have you been in this situation? (Circle only one) Yes No Enter Number Weeks Months Years a. Unemployed and looking for work ?.. 1 2 _____ 1 2 3 b.

write the number of days you spent in each of the following work situations. In the past 7 days, how many days did you… NUMBER OF DAYS a. …miss an entire work day because of problems with your physical or mental health? _____ b. …miss an entire work day for any other reason (including vacation)? _____

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