NIOSH Worker Well-Being

 Questionnaire (WellBQ)
NIOSH Worker Well-Being Questionnaire (WellBQ) 

(Version 1)

Ramya Chari, PhD

Chia-Chia Chang, MPH, MBA

Steven L. Sauter, PhD

Elizabeth L. Petrun Sayers, PhD

Wenjing Huang, PhD

Gwenith G. Fisher, PhD

Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health
ii

NIOSH WellBQ

This document is in the public domain and may be freely copied or reprinted.

Disclaimer

Mention of any company or product does not constitute endorsement by the National Institute 

for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention 

(CDC). In addition, citations of websites external to CDC/NIOSH do not constitute CDC/NIOSH 

endorsement of the sponsoring organizations or their programs or products. Furthermore, CDC/

NIOSH is not responsible for the content of these websites. All web addresses referenced in this 

document were accessible as of the publication date.

Get More Information

Find NIOSH products and get answers to workplace safety and health questions:

1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348

CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh

Monthly NIOSH eNews: cdc.gov/niosh/eNews

Suggested Citation

NIOSH [2021]. NIOSH worker well-being questionnaire (WellBQ). By Chari R, Chang CC, Sauter 

SL, Petrun Sayers EL, Huang W, Fisher GG. Cincinnati, OH: U.S. Department of Health and Human 

Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety 

and Health, DHHS (NIOSH) Publication No. 2021-110 (revised 5/2021), https://doi.org/10.26616/

NIOSHPUB2021110revised52021. 

DHHS (NIOSH) Publication No. 2021-110 (revised 5/2021)

DOI: https://doi.org/10.26616/NIOSHPUB2021110revised52021

May 2021

This document was revised to update spelling and minor edits to formatting. No substantive changes 

were made to the information contained in this document.
NIOSH WellBQ

1

Table of Contents

Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Overview of the NIOSH WellBQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

How the NIOSH WellBQ Can Be Used. 

Development of the NIOSH WellBQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Content of the NIOSH WellBQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Optional Items. 

Administering the NIOSH WellBQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Data Privacy and Ethics  

Item References and Permissions  

Coding and Scoring Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Data Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

NIOSH WellBQ Codebook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

NIOSH WellBQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

NIOSH WellBQ Item Source Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  59
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NIOSH WellBQ

Acknowledgments

Development of the National Institute for Occupational Safety and Health Worker Well-Being 

Questionnaire (NIOSH WellBQ) Version 1 was made possible through the time, expertise, and 

support provided by the research team listed below.

NIOSH

Steven L. Sauter, PhD

Chia-Chia Chang, MPH, MBA

L. Casey Chosewood, MD, MPH

Paul A. Schulte, PhD

Anita L. Schill, PhD, MPH, MA

The RAND Corporation

Ramya Chari, PhD

Elizabeth L. Petrun Sayers, PhD

Wenjing Huang, PhD

Vivian Towe, PhD

Lori Uscher-Pines, PhD

Jennifer Cerully, PhD

Colorado State University

Gwenith G. Fisher, PhD

NIOSH extends special thanks to the panel of experts who shared their expertise in the 

development of the worker well-being conceptual framework; the quality assurance review team 

at RAND; the NIOSH working group; and the external reviewers.
NIOSH WellBQ

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Overview of the NIOSH WellBQ

The National Institute for Occupational Safety and Health Worker Well-Being Questionnaire 

(NIOSH WellBQ) provides an integrated assessment of worker well-being across multiple 

spheres, including individuals’ quality of working life, circumstances outside of work, and 

physical and mental health status. The questionnaire measures “worker” well-being as a holistic 

construct rather than simply “workplace” or “work-related” well-being. The NIOSH WellBQ is 

intended to help researchers, employers, workers, practitioners, and policymakers understand 

the well-being of workers and target interventions to improve worker well-being, among other 

applications.

The questionnaire comprises the five domains of worker well-being identified by NIOSH and 

the RAND Corporation in Expanding the Paradigm of Occupational Safety and Health: A New 

Framework for Worker Well-being1

: (1) work evaluation and experience; (2) workplace policies 

and culture; (3) workplace physical environment and safety climate; (4) health status; and (5) 

home, community, and society. Please see that article for a discussion of the approach toward 

development of the worker well-being concept and the NIOSH WellBQ. 

The five domains of worker well-being.

How the NIOSH WellBQ Can Be Used

The NIOSH WellBQ has many potential applications. It is designed to capture multiple facets 

of well-being to both broadly characterize the well-being of workers and inspect specific 

aspects of worker well-being. The questionnaire is designed to acquire data to develop a better 

understanding of the overall well-being of workers across the workforce as a whole, or within 

various worker subpopulations (e.g., among different occupational or industry sectors, at an 

organizational level, or among different demographic groupings of workers), and to identify 

aspects of worker well-being in need of special attention. As data are accumulated through 

widespread use of the NIOSH WellBQ in a diversity of settings, we anticipate that practitioners 

and policymakers will be able to establish benchmarks, norms, or targets for worker well-being 

across different working populations, occupations, and industries. The questionnaire may also 

1Chari R, Chang CC, Sauter SL, Petrun Sayers EL, Cerully JL, Schulte P, Schill AL, Uscher-Pines L. [2018]. Expanding the 

paradigm of occupational safety and health: a new framework for worker well-being. J Occup Environ Med 60(7):589–

593.
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NIOSH WellBQ

be used for surveillance of changes in worker well-being in relation to economic conditions, 

societal trends, or changing governmental or organizational policies. Likewise, the NIOSH 

WellBQ can be used for applied research to investigate effects of deliberate interventions to 

influence worker well-being and associated outcomes, such as organizational performance, 

worker disability, and health care costs at the organizational or societal level.
NIOSH WellBQ

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Development of the NIOSH WellBQ

The NIOSH WellBQ was created by NIOSH and researchers at the RAND Corporation with 

funding from NIOSH. The design and content of the questionnaire were guided by a new 

conceptual framework that identifies the five domains of worker well-being. This framework was 

derived from an in-depth, multi-disciplinary literature review of well-being theories, research, 

and measurement tools by the RAND Corporation. Conditions of interest within each domain, 

which in turn defined the types of questions posed within each domain, were identified with 

assistance from a scientific panel with expertise in well-being and occupational safety and 

health. 

The items in the questionnaire were strategically selected on the basis of their relevance to the 

five domains of worker well-being. Most of the items are adopted from existing instruments. 

After a draft questionnaire was created, cognitive testing was conducted on a convenience 

sample of employed individuals. Approval to field-test the questionnaire was then obtained 

from the Office of Management and Budget (OMB) on June 1, 2018 (OMB Control Number 

0920-1234). The draft questionnaire was fielded on a probability-based sample by an 

internet-based survey administration service, following an initial pre-test of the questionnaire. 

Participants in the field test completed the draft questionnaire in approximately 20 minutes. 

Data from 975 respondents were analyzed to create multi-question scales, conduct factor 

analysis and other psychometric testing, conduct tests of concurrent validity, and eliminate lessproductive items. Some items were revised to improve clarity, and a few items were eliminated 

from the piloted tool. The final questionnaire can be completed in approximately 15 minutes.
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NIOSH WellBQ

Content of the NIOSH WellBQ

The NIOSH WellBQ is designed to collect information across the five domains of worker wellbeing while minimizing burden to respondents. Because the questionnaire is meant to 

comprehensively assess worker well-being, NIOSH recommends administering the NIOSH 

WellBQ as a whole. Users who are interested in only specific topics may wish to administer other 

instruments, such as those listed in the NIOSH WellBQ Item Source Table. 

The worker well-being topics covered by the questionnaire are detailed below. 

NIOSH WellBQ Section 1. Work Evaluation and Experience (16 items)

y Job Satisfaction 

y Wage Satisfaction 

y Benefits Satisfaction 

y Advancement Satisfaction 

y Supervisor Support

y Coworker Support 

y Job Security 

y Job Autonomy 

y Time Paucity/Work Overload 

y Meaningful Work 

y Work-related Positive Affect

y Work-related Negative Affect 

y Work-related Fatigue

y Job Engagement 

NIOSH WellBQ Section 2. Workplace Policies and Culture (14 items)

y Supportive Work Culture 

y Management Trust 

y Health Culture at Work 

y Availability of Job Benefits 

y Availability of Health Programs at Work

y Work to Non-work Conflict

y Non-work to Work Conflict

y Workplace/Schedule Flexibility 

NIOSH WellBQ Section 3. Workplace Physical Environment and Safety Climate (10 items)

y Overall Workplace Safety 

y Workplace Safety Climate

y Physical Work Environment Satisfaction

y Discrimination
NIOSH WellBQ

7

y Work-related Sexual Harassment

y Work-related Physical Violence

y Work-related Bullying

NIOSH WellBQ Section 4. Health Status (23 items)

y Overall Health 

y Days of Poor Physical Health 

y Chronic Health Conditions

y Insomnia 

y Days of Poor Mental Health 

y Overall Stress 

y Poor Mental Health 

y Physical Activity 

y Tobacco Use

y Alcohol Consumption

y Risky Drinking

y Healthy Diet

y Sleep Hours

y Sleepy at Work

y Cognitive Functioning Limitations

y Work Limitations 

y Productivity 

y Work-related Injury 

y Injury Consequence

NIOSH WellBQ Section 5. Home, Community, and Society (5 items)

y Life Satisfaction 

y Financial Insecurity 

y Support Outside of Work

y Activities Outside of Work 

Optional Items

Complementing the worker well-being items are 15 optional ones pertaining to employment 

circumstances and worker demographics. These sample items were selected on the basis of their 

common use in population and occupational health questionnaires. Users may exclude, add, 

or edit items, depending on the questionnaire application. We recommend that these items be 

placed at the end, following the NIOSH WellBQ.
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NIOSH WellBQ

OPTIONAL: Employment Circumstances (5 items)

y Work Arrangement

y Work Status

y Job Tenure

y Occupation

y Industry or Business

OPTIONAL: Demographic Information (10 items)

y Age

y Education

y Ethnicity

y Race

y Sex 

y Sexual Orientation

y Household Income

y Head of Household

y Marital Status

y Number of Dependents
NIOSH WellBQ

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Administering the NIOSH WellBQ

Here are the NIOSH-suggested instructions for participants.

“Welcome! Thank you for agreeing to fill out the National Institute for Occupational Safety and 

Health Worker Well-Being Questionnaire, which is known as the NIOSH WellBQ. This survey 

asks about aspects of your job and workplace, your health, and your life outside of work. The 

information will help provide a better understanding of how workers in your organization are 

doing and identify ways to improve worker well-being.

You can choose not to participate. On any question, you can choose not to give an answer. 

There are no right or wrong answers. Just base your answers on what you think. Some questions 

might not apply to your situation. In these cases, you can choose ‘Does not apply’ if it is one 

of the answer choices. Please try to complete the survey in one sitting. It will take about 15 

minutes to complete.

If you have more than one job, please answer questions as they apply to your main job.”

Data Privacy and Ethics 

Users should ensure that participants’ privacy is protected and that human subject protection 

policies, when applicable, are followed and communicated to participants. Protecting 

confidentiality and privacy is an essential element of a Total Worker Health® approach. There 

should be procedures in place to obtain informed consent from participants and ensure that 

their information is secure throughout the data collection, analysis, and reporting process. 

Consultation with a relevant Institutional Review Board should occur before administration of 

the questionnaire in a research protocol.

The following information may be useful to provide to participants: 

y Purpose of questionnaire administration

y Procedures involved 

y Risks/benefits to completing the questionnaire

y Anonymity/conditionality offered to respondents 

y Compensation (if any) 

y Right to withdraw

y Contact information for questions or concerns

Resources for information on research ethics are available at the NIOSH WellBQ webpage.

Item References and Permissions 

This instrument may be freely reproduced, reprinted, or distributed. Many of the items have 

been adopted, with permission when necessary, from existing questionnaires. NIOSH obtained 

permission for using items for the purpose of this instrument. Permissions to adopt some items 

for this instrument do not allow fees to be charged for their use. The codebook provides specific 

use stipulations for each item when necessary. Please contact NIOSH Total Worker Health staff at 

twh@cdc.gov if you have questions.

Please see the NIOSH WellBQ Item Source Table for the full list of sources for questionnaire 

items. 

Items that were drawn or adapted from the public domain or that were created by the research 

team are denoted as such in the codebook and the NIOSH WellBQ Item Source Table; no 
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NIOSH WellBQ

restrictions apply to the use of these items. Please note the suggested citation for the NIOSH 

WellBQ on page ii of this document.

Coding and Scoring Instructions 

Single-question measures are coded according to the value associated with each response 

option, or as specified for open data fields. Multi-question scales are scored as specified in 

the codebook in italics (i.e., by calculating the sum or average of individual question values). 

Suggested variable names are also given for each question (indicated in bold brown) as well as 

names for scales (in bold blue) for use when creating data files. The responses “Don’t know” and 

“Does not apply” should be coded as -88 and -99, respectively, to distinguish these from one 

another and from applicable responses, although users may wish to adopt a different coding 

convention for these two responses (e.g., -8 and -9). 
NIOSH WellBQ

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Data Interpretation

The NIOSH WellBQ is a new instrument whose qualities are supported by extensive 

psychometric analyses based upon a large pilot study. As with all new instruments, the NIOSH 

WellBQ has limitations at this stage of development. The limitations will be addressed through 

accumulation of data and development of information in the future. For example, the available 

information is not sufficient to establish norms for measures across worker populations and 

industry and occupational sectors. Similarly, the available information is not sufficient to 

develop algorithms for creation of summary scores to characterize worker well-being. Applying 

the NIOSH WellBQ in a variety of workplace settings and among various worker populations will 

provide the information needed to address these limitations.

In the meantime, inferences regarding the status of worker well-being, intervention needs, 

intervention effects, etc., can be drawn from review of responses to questions and scale scores 

and from profiles of these values and scores across NIOSH WellBQ measures of interest. For 

immediate applications of the NIOSH WellBQ, please see the earlier discussion on “How the 

NIOSH WellBQ Can Be Used.” In summary, users may apply the NIOSH WellBQ for the following 

purposes:

y To set benchmarks internal to an organization or workforce 

y To examine changes over time or assess the impact of interventions 

y To compare results between groups within the same facility or workforce or across 

organizations or working populations.

It is important to note, however, that the design of the NIOSH WellBQ does not permit absolute 

or clinical judgements of worker well-being, nor are there firm thresholds for scores that would 

signal actions to affect worker well-being.

Please see the NIOSH WellBQ webpage for resources that may be useful for improving worker 

well-being on the basis of applying the instrument. For guidance on development of actions or 

interventions after using the NIOSH WellBQ, please see Fundamentals of Total Worker Health

Approaches. 

NIOSH will develop further guidance for scoring and interpretation as new analysis arises from 

further research. Please check the NIOSH WellBQ webpage for updates.
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NIOSH WellBQ

NIOSH WellBQ Codebook

Section 1: Work Evaluation and Experience 

The questions in this section ask how you feel about different aspects of your job. If you 

have more than one job, please answer questions as they apply to your main job.

Job Satisfaction JOBSAT

Q1. Overall, I am ____ with my job.

1 Not at all satisfied

2 Not too satisfied

3 Somewhat satisfied

4 Very satisfied

Item adapted from public domain source.

Wage Satisfaction WAGESAT

Q2. I am ____ with my wages.

1 Not at all satisfied

2 Not too satisfied

3 Somewhat satisfied

4 Very satisfied

*Item adapted from original wording for use in this questionnaire with permission from Dr. Scott Macdonald, 

with the provision that fees may not be charged for its use. 

Benefits Satisfaction BENSAT

Q3. I am ____ with the benefits provided by my employer.

1 Not at all satisfied

2 Not too satisfied

3 Somewhat satisfied

4 Very satisfied

-99 Does not apply 

Item adapted from public domain source.

Advancement Satisfaction ADVNCSAT

Q4. I am ____ with my chances for advancement on the job.

1 Not at all satisfied

2 Not too satisfied

3 Somewhat satisfied

4 Very satisfied

*This item is adapted from the Minnesota Satisfaction Questionnaire (MSQ), from Vocational Psychology 

Research, University of Minnesota. The MSQ is available under a Creative Commons AttributionNonCommercial 4.0 International License. The MSQ may be used for research or clinical work free of charge 

and without written consent, provided that you acknowledge Vocational Psychology Research, University of 

Minnesota, as the source of the material in your reproduced materials (printed or electronic). The license 

does not allow for commercial use or reproduction for sale. The MSQ may be used without cost, however, for 

employee surveys, provided that the survey is implemented within an organization and that no charges are 
NIOSH WellBQ

13

made for its use. Please visit the following website to review specified conditions of free use for the MSQ in 

detail: http://vpr.psych.umn.edu/ All conditions of use for the MSQ apply to use of this item.

Supervisor Support SUPSUPP

Q5. I can count on my supervisor for support when I need it.

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

Item adapted from public domain source.

Coworker Support COWSUPP

Q6. I can count on my coworkers for support when I need it.

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

Item adapted from public domain source.

Job Security JOBSECUR

Q7. I feel my job is secure.

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

*Refer to permission details for item 2.

Job Autonomy AUTONOMY

Q8. I am given a lot of freedom to decide how to do my own work.

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

Item drawn from public domain source.
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NIOSH WellBQ

Time Paucity/Work Overload TIMOVRLD

Q9. I never seem to have enough time to get everything done on my job.

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

Item adapted from public domain source.

Meaningful Work WKMEANAV

Calculate the average of the following two items (Q10, Q11): 

Q10. The work I do is meaningful to me. WKMEAN

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

*Item adapted from original wording for use in this questionnaire with permission from Dr. Michael Steger, 

with the provision that fees may not be charged for its use. 

Q11. The work I do serves a greater purpose. WKPUR

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

*Refer to permission details for item 10. 
NIOSH WellBQ

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Work-related Positive Affect (POSAFFAV) and Work-related Negative Affect 

(NEGAFFAV)

Calculate the average of the four positive affect items (Q12A–12D). 

Calculate the average of the four negative affect items (Q12E–12H). 

Q12A–Q12H. How often do you experience these feelings when you are working

Never Almost never 

(a few times a 

year or less)

Rarely

(once a month 

or less)

Sometimes

(a few times a 

month)

Often

(once a 

week)

Very often

(a few times 

a week)

Always

(every day)

1 2 3 4 5 6 7

Work-related Positive Affect

A.Enthusiastic

 POSENTHU

B. Energetic

 POSENERG

C. Content

 POSCONT

D. At ease

 POSEASE

Work-related Negative Affect

E. Anxious 

 NEGANXUS

F. Angry 

 NEGANGRY

G. Gloomy

 NEGGLOOM

H. Discouraged

 NEGDISCR

*These items are adapted from a copyrighted scale developed by Dr. Paul Spector. Dr. Spector has granted 

permission for use of these items in this questionnaire. However, Dr. Spector does not allow use of his scales 

for commercial purposes. Commercial use means you are charging someone a fee to provide a service that 

includes use of his scales. This restriction applies to these items. Please visit Dr. Spector’s website (https://

paulspector.com/.) to review conditions of free use in detail. Dr. Spector agreed to waive the requirement that 

data obtained from use of his scales in the NIOSH WellBQ be shared with him, but users are encouraged to 

voluntarily share data for these items with him when possible.
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NIOSH WellBQ

Work-related Fatigue WKFATIG

Q13. How often do you experience fatigue when you are working?

1 Never

2 Almost never (a few times a year or less)

3 Rarely (once a month or less)

4 Sometimes (a few times a month)

5 Often (once a week)

6 Very often (a few times a week)

7 Always (every day)

*Refer to permission details for item 12.

Job Engagement ENGAGEAV

Calculate the average of the following three items (Q14-16): 

Q14. My work inspires me. ENGINSPR

1 Never

2 Almost never (a few times a year or less)

3 Rarely (once a month or less)

4 Sometimes (a few times a month)

5 Often (once a week)

6 Very often (a few times a week)

7 Always (every day)

*This item is adapted from a copyrighted scale developed by Dr. Wilmar Schaufeli. Dr. Schaufeli has granted 

permission for use of this item in this questionnaire. However, Dr. Schaufeli does not allow use of his scales 

for commercial purposes. Commercial use means you are charging someone a fee to provide a service that 

includes use of his scales. This restriction applies to this item. Please visit Dr. Schaufeli’s website (https://www.

wilmarschaufeli.nl/downloads/) to review conditions of free use in detail. Dr. Schaufeli agreed to waive the 

requirement that data obtained from use of his scales in the NIOSH WellBQ be shared with him, but users 

are encouraged to voluntarily share data for this item with him when possible.

Q15. I am immersed in my work. ENGIMMRS

1 Never

2 Almost never (a few times a year or less)

3 Rarely (once a month or less)

4 Sometimes (a few times a month)

5 Often (once a week)

6 Very often (a few times a week)

7 Always (every day)

*Refer to permission details for item 14.
NIOSH WellBQ

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Q16. When I get up in the morning, I feel like going to work. ENGGOWR

1 Never

2 Almost never (a few times a year or less)

3 Rarely (once a month or less)

4 Sometimes (a few times a month)

5 Often (once a week)

6 Very often (a few times a week)

7 Always (every day)

*Refer to permission details for item 14.

Section 2: Workplace Policies and Culture

The questions in this section ask how you feel about your organization and about benefits 

and health programs available at work. If you have more than one job, please answer

questions as they apply to your main job. 

Supportive Work Culture SUPCULAV

Calculate the average of the following five items (Q17-21): 

Q17. At my organization, I am treated with respect. SPCLRES

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

Item adapted from public domain source.

Q18. My organization values my contributions. SPCLEVA

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

*Item adapted from original wording for use in this questionnaire with permission from Dr. Robert 

Eisenberger, with the provision that fees may not be charged for its use. 

Q19. My organization cares about my general satisfaction at work. SPCLSA

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

*Refer to permission details for item 18.
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NIOSH WellBQ

Q20. My organization is willing to extend resources in order to help me perform my job to the

best of my ability. SPCLRESR

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

*Refer to permission details for item 18.

Q21. I receive recognition for a job well done. SPCLREC

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

*Refer to permission details for item 2.

Management Trust MGMTTRST

Q22. I trust the management at my organization.

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

Item adapted from public domain source.

Health Culture at Work HLCULAV

Calculate the average of the following two items (Q23, Q24):

Q23. My organization is committed to employee health and well-being. HLCLCOM

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

*Item adapted from original wording for use in this questionnaire with permission from Dr. Zandra Zweber, 

with the provision that fees may not be charged for its use. 

Q24. My organization encourages me and provides opportunities to engage in healthy

behaviors, such as being physically active, eating a healthy diet, living tobacco free, and 

managing my stress. HLCULBEH

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

*Refer to permission details for item 23.
NIOSH WellBQ

19

Availability of Job Benefits BENFSUM

Calculate the sum of the following 14 items (Q25A-25N): 

Q25A–Q25N. Are the following benefits offered by your employer

Yes No Don't Know Does not apply

1 0 -88 -99

A. Health insurance BENINSR

B. Assistance with education/tuition BENEDUC

C. Retirement (employer contributions to retirement 

 savings) BENRETIR

D. Paid maternity leave BENMATER

E. Paid paternity leave BENPATER

F. Paid sick leave BENSICKL

G. Other paid caregiving leave (for example, to care 

 for sick family members) BENCARGV

H. Paid disability leave BENDISABL

I. Paid vacation days BENVACAT

J. Other paid leave (for example, bereavement, 

 emergency, jury duty) BENOTHER

K. Ability to take unpaid leave BENUNPAY

L. Transit options (such as help with transportation 

 to and from work) BENTRANS

M. On-site medical care BENMEDIC

N. Employee assistance programs (such as programs

 that help workers with personal or work-related

 problems) BENEAP

New items.
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NIOSH WellBQ

Availability of Health Programs at Work HLPGSUM

Calculate the sum of the following seven items (Q26A–26G): 

Q26A–Q26G. Are the following health and wellness programs or services available to you at the

place where you work? 

Yes No Don't know Does not apply

1 0 -88 -99

A. Health education and promotion programs (wellness programs) HLPGEDUC

B. On-site fitness centers or gym membership discounts (includes a gym and/or 

 space for group classes) HLPGFIT

C. Common spaces or activity hubs (areas for group activities, such as socializing, 

 exercise classes, etc.) HLPGHUBS

D. Smoking cessation programs HLPGSMOK

E. Alcohol and substance programs HLPGALC

F. Stress management programs HLPGSTRS

G. Access to healthy lunch and snack options HLPGSNAC

New items.

Work to Non-work Conflict WNWCONF

Q27. How often do the demands of your job interfere with your personal life

1 Never

2 Almost never (a few times a year or less)

3 Rarely (once a month or less)

4 Sometimes (a few times a month)

5 Often (once a week)

6 Very often (a few times a week)

7 Always (every day)

Item adapted from public domain source.

Non-work to Work Conflict NWWCONF

Q28. How often do the demands of your personal life interfere with your work on the job?

1 Never

2 Almost never (a few times a year or less)

3 Rarely (once a month or less)

4 Sometimes (a few times a month)

5 Often (once a week)

6 Very often (a few times a week)

7 Always (every day)

Item adapted from public domain source.
NIOSH WellBQ

21

Workplace/Schedule Flexibility FLEXAV

Calculate the average of the following two items (Q29, Q30): 

Q29. I have the freedom to vary my work schedule. FLEXSCH

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

*Item adapted from original wording for use in this questionnaire with permission from Dr. Kristen M. 

Shockley, with the provision that fees may not be charged for its use. 

Q30. I have the freedom to work wherever is best for me—either at home or at my organization

FLEXLOC

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

-99 Does not apply

*Refer to permission details for item 29.

Section 3: Workplace Physical Environment and Safety Climate 

The questions in this section ask about physical characteristics of your work environment 

and safety conditions where you work. If you have more than one job, please answer questions

as they apply to your main job.

Overall Workplace Safety SAFEOVER

Q31. Overall, how safe do you think your workplace is?

1 Very unsafe

2 Somewhat unsafe

3 Somewhat safe

4 Very safe

Item adapted from public domain source.
22

NIOSH WellBQ

Workplace Safety Climate SAFCLMAV

Calculate the average of the following six items (Q32A-32F): 

Q32A–Q32F. Please indicate how much you agree or disagree with each of the following

statements about safety practices at your workplace.

Strongly 

disagree

Somewhat

disagree

Somewhat 

agree 

Strongly

agree

Does not

apply

1 2 3 4 -99

A. Management reacts quickly to solve

 the problem when told about safety 

 hazards. SCREACTS

B. Management insists on thorough and 

 regular safety audits and inspections. 

 SCAUDITS

C. Management provides all the equipment 

 needed to do the job safely. SCEQUIPT

D. Management invests a lot of time and 

 money in safety training for workers. 

 SCTRAING

E. Management listens carefully to 

 workers’ ideas about improving safety. 

 SCLISTEN

F. Management gives safety personnel 

 the power they need to do their job. 

 SCPOWER 

*Items are adapted from original wording for use in this questionnaire with permission from Dr. Dov Zohar, 

with the provision that fees may not be charged for their use. 

Physical Work Environment Satisfaction WRKENVAV

Calculate the average of the following four items (Q33A-33D): 

Q33A–Q33C. On my present job, this is how I feel about the following topics:

Not at all

satisfied 

Not too satisfied Somewhat 

satisfied

Very satisfied 

1 2 3 4

A. The environmental conditions (heating, lighting, 

 ventilation, etc.) WKENCOND

B. The physical surroundings (for example, building 

 infrastructure, work area layout, design) WKENPHYS

C. The pleasantness of the work environment

 WKENPLES
NIOSH WellBQ

23

Q33D. The accommodations for disabilities and/or special needs (wheelchair ramps, lactation

rooms, etc.) WKENACOM

1 Not at all satisfied

2 Not too satisfied

3 Somewhat satisfied

4 Very satisfied

-99 Does not apply

*For permission details for items 33A–33C, refer to item 4. 

Item 33D is new. 

Discrimination DISCAV

Calculate the average of the following three items (Q34-36): 

Q34. I feel discriminated against in my job because of my age. DISCAG

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

Item adapted from public domain source.

Q35. I feel discriminated against in my job because of my race or ethnic origin. DISCRAC

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

Item adapted from public domain source.

Q36. I feel discriminated against in my job because of my gender. DISCGEN

1 Strongly disagree

2 Somewhat disagree

3 Somewhat agree

4 Strongly agree

Item adapted from public domain source.

Work-related Sexual Harassment SEXHARAS

Q37. In the past 12 months, were you sexually harassed by anyone while you were on the job?

1 Yes

0 No

Item adapted from public domain source.
24

NIOSH WellBQ

Work-related Physical Violence PHYSVIOL

Q38. In the past 12 months, were you exposed to physical violence while you were on the job?

1 Yes

0 No

*This item is adapted from the Copenhagen psychosocial questionnaire – COPSOQ II. The COPSOQ is 

available under a Creative Commons Attribution-NonCommercial 4.0 International License. Under this 

license the COPSOQ is free to use if it is properly referenced and no fees are charged for its use. Please visit 

the following website to review specified conditions of free use for the COPSOQ in detail: https://nfa.dk/

da/Vaerktoejer/Sporgeskemaer/Copenhagen-Psychosocial-Questionnaire-COPSOQ-II/Engelsk-udgave. All 

conditions of use for the COPSOQ II apply to use of this item.

Work-related Bullying CONFLAV

Calculate the average of the following two items (Q39, Q40): 

Q39. In the past 12 months, were you bullied, threatened, or harassed in any other way by

anyone while you were on the job? CONFBULY

1 Yes

0 No

Item adapted from public domain source.

Q40. In the past 12 months, have you been in a situation where any of your superiors or

coworkers put you down or were condescending to you, made demeaning remarks about you, 

or addressed you in unprofessional terms? CONFPTDN

1 Yes

0 No

-99 Does not apply 

*Item adapted from original wording for use in this questionnaire with permission from Dr. Lilia Cortina and 

Dr. Vicki Magley, with the provision that fees may not be charged for its use. 

Section 4: Health Status 

The questions in this section ask about your physical and mental health and health-related 

behaviors

Overall Health HLTHOVER

Q41. Would you say that in general, your health is poor, fair, good, very good, or excellent?

1 Poor

2 Fair

3 Good

4 Very good

5 Excellent 

Item adapted from public domain source.
NIOSH WellBQ

25

Days of Poor Physical Health PHYSHLDY

Q42. Now, thinking about your physical health, which includes physical illness and injury, during

the past 30 days, for how many days was your physical health not good?

Enter number of days (0–30) 

Item adapted from public domain source.

Chronic Health Conditions HLTHSUM

Suggested scoring: Calculate the sum of the following nine items (Q43A–43I). Code Never as 0; code In the 

past and Have currently as 1. 

Q43A–Q43I. Have you ever had any of the following

Never In the past Have

currently

0 1 2

A. Arthritis HLTHARTH

B. Other musculoskeletal disorders (for example, back pain, neck pain, other pain) 

 HLTHMUSC

C. Asthma HLTHASTH

D. Lung disease, other than asthma (for example, chronic obstructive pulmonary disease 

 [COPD], chronic bronchitis, emphysema) HLTHLUNG

E. Cancer HLTHCANC

F. Depression HLTHDEPR

G. Diabetes HLTHDIAB

H. Heart disease HLTHHRT

I. High blood pressure HLTHBP

*Items 43A and 43C–43H are adapted from original wording for use in this questionnaire with permission 

from Dr. Karen Moseley, with the provision that fees may not be charged for their use. 

Items 43B and 43I are new.

Insomnia INSOMNIA

Suggested scoring: Code Never as 0; code In the past and Have currently as 1.

Q44. Have you ever had chronic insomnia?

0 Never

1 In the past

2 Have currently

*Refer to permission details for item 43A.
26

NIOSH WellBQ

Days of Poor Mental Health MENTHLDY

Q45. Now, thinking about your mental health, which includes stress, depression, anxiety, and

problems with emotions, during the past 30 days, for how many days was your mental health 

not good? 

Enter number of days (0–30) 

Item adapted from public domain source.

Overall Stress STRSAV

Calculate the average of the following four items (Q46A-46D): 

Q46A–Q46D. How often do you experience stress with regard to the following topics

Never Almost never

(a few times a

year or less)

Rarely

(once a month 

or less)

Sometimes

(a few times a 

month)

Often

(once a 

week)

Very often

(a few times 

a week)

Always

(every day)

1 2 3 4 5 6 7

A. Your health

 STRSHLTH

B. Your finances 

 STRSMONY

C. Your family or social 

 relationships

 STRSFMLY

D. Your work

 STRSWORK

*Refer to permission details for item 43A.

Poor Mental Health MNHLAV

Calculate the average of the following four items (Q47-50):

Q47. Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or

hopeless? MNHLDOWN

1 Not at all 

2 Several days

3 More than half the days

4 Nearly every day

*Item drawn from the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). The PHQ scales 

were developed by Drs. Robert L. Spitzer, Janet B.W. Williams, and Kurt Kroenke and colleagues. The PHQ 

scales are free to use and in the public domain.
NIOSH WellBQ

27

Q48. Over the last 2 weeks, how often have you been bothered by little interest or pleasure in

doing things? MNHLPLES

1 Not at all 

2 Several days

3 More than half the days

4 Nearly every day

*Refer to permission details for item 47.

Q49. Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or

on edge? MNHLNERV

1 Not at all 

2 Several days

3 More than half the days

4 Nearly every day

*Refer to permission details for item 47.

Q50. Over the last 2 weeks, how often have you been bothered by not being able to stop or

control worrying? MNHLWORY

1 Not at all 

2 Several days

3 More than half the days

4 Nearly every day

*Refer to permission details for item 47.

Physical Activity EXERAV

Calculate the average of the following two items (Q51, Q52):

Q51. In a typical week, how many days do you get at least 20 minutes of high intensity physical

activity? (High intensity activity lasts at least 10 minutes and increases your heart rate, makes 

you sweat, and may make you feel out of breath; examples are running, fast cycling, and 

strenuous, continuous lifting of heavy objects.) EXERVIG

Enter number of days (0–7) 

*Refer to permission details for item 43A.

Q52. In a typical week, how many days do you get at least 30 minutes of moderate intensity

physical activity? (Moderate intensity activity lasts at least 10 minutes and requires more effort 

than is needed for typical everyday tasks; examples are brisk walking, gardening, and continuous 

lifting of light objects.) EXERMOD

Enter number of days (0–7) 

*Refer to permission details for item 43A.
28

NIOSH WellBQ

Tobacco Use TOBUSE

Suggested scoring: Calculate the sum of the following five items (Q53A–53E). Code Never and Not any more

as 0; code Some days and Daily as 1. 

Q53A-Q53E. Do you use any of the following tobacco products

Never Not any more Some days Daily

1 2 3 4

A. Cigarettes SMOKCIGT

B. Cigars SMOKCIGR

C. Pipes SMOKPIPE

D. Smokeless tobacco SMOKLESS

E. Electronic cigarettes SMOKELEC

*Refer to permission details for item 43A.

Alcohol Consumption ALCDRINK

Suggested scoring: For males, code more than 14 drinks as 1 and code 14 or fewer as 0. For females, code 

more than 7 drinks as 1 and code 7 or fewer as 0. 

Q54. How many drinks of alcoholic beverages do you have in a typical week? (One drink = one

beer, glass of wine, shot of liquor, or mixed drink.) 

Enter number of drinks

*Refer to permission details for item 43A.

Risky Drinking RSKDRINK

Suggested scoring: Code Never as 0 and the responses 2–4 as 1.

Q55. During the past year, how often have you had more than four drinks if you are a male, or

more than three drinks if you are a female, on any single day? (One drink = one beer, glass of wine, 

shot of liquor, or mixed drink.) 

1 Never

2 Once (1 day)

3 A few times (2-3 days)

4 Often (more than 3 days)

*Refer to permission details for item 43A.
NIOSH WellBQ

29

Healthy Diet NUTRITN

Q56. Think of the foods that are a part of your normal diet. How many servings of fruits and

vegetables do you eat in a normal day? 

(One serving is any of the following: 1 cup raw leafy greens [about the size of a small fist]; 1⁄2 cup 

of other vegetables [cooked or raw]; 1 medium piece of fruit [about the size of a baseball]; 1/2 cup 

chopped, cooked, or canned fruit; or 3⁄4 cup vegetable or fruit juice.) 

1 Less than 1 serving

2 1 serving

3 2 servings

4 3 servings

5 4 servings

6 5 or more servings

*Refer to permission details for item 43A.

Sleep Hours SLEEPQTY

Suggested scoring: Code 6 or fewer hours and 9 or more hours as 1; code 7 hours and 8 hours as 0.

Q57. How many hours of sleep do you usually get at night? If you are a shift worker, how many

hours of sleep do you get a day?

1 6 or fewer hours

2 7 hours

3 8 hours

4 9 or more hours

*Refer to permission details for item 43A.

Sleepy at Work WKSLEEPY 

Q58. In the past 7 days, how often have you felt sleepy while at work

1 Never

2 Rarely

3 Sometimes

4 Usually

5 Always 

*Refer to permission details for item 43A.

Cognitive Functioning Limitations COGLIM

Q59. Because of a physical, mental, or emotional condition, do you have serious difficulty

concentrating, remembering, or making decisions? 

1 Not at all

2 Slightly

3 Moderately

4 Extremely

-99 Does not apply/do not have condition

Item adapted from public domain source.
30

NIOSH WellBQ

Work Limitations WORKLIM

Q60. Are you limited in the kind or amount of work you can do because of a physical, mental, or

emotional problem? 

1 Not at all

2 Slightly

3 Moderately

4 Extremely

-99 Does not apply/do not have problem

Item adapted from public domain source.

Productivity PRODAV

Calculate the average of the following four items (Q61A-61D):

Q61A–Q61D. In the past month

Never Almost

never

(one time a 

month)

Rarely

(once a 

week or

less)

Sometimes

(a few times

a week)

Often 

(once a day)

Very often

(a few times a

day)

Always 

(every

hour)

1 2 3 4 5 6 7

A. How often did you

 not concentrate 

 enough on your work? 

 PRODCONC

B. How often did you find 

 yourself not working as 

 carefully as you should?

 PRODCARE

C. How often did you not

 work at times when 

 you were supposed 

 to be working?

 PRODWORK

D. How often did you get less 

 done than other workers?

 PRODLESS

*Items are adapted from original wording for use in this questionnaire with permission from Dr. Ronald 

Kessler, with the provision that fees may not be charged for their use. 

Work-related Injury WKINJURY

Q62. During the past 12 months, did you experience any work-related injuries?

1 Yes

0 No 

New item.
NIOSH WellBQ

31

Injury Consequence INJEFFECT

Q63. If you experienced any work-related injuries in the past 12 months, did any of them require

any first aid or medical treatment, change in job activities, or lost time from work? 

1 Yes

0 No 

-99 Does not apply/was not injured in the past 12 months 

New item.

Section 5: Home, Community, and Society 

The questions in this section ask about your experiences, feelings, and activities outside of 

work

Life Satisfaction LIFESAT

Q64. In general, how satisfied are you with your life

1 Not at all satisfied

2 Not too satisfied

3 Somewhat satisfied

4 Very satisfied

Item adapted from public domain source.

Financial Insecurity FINAV

Calculate the average of the following two items (Q65, Q66): 

Q65. How worried are you right now about not being able to maintain the standard of living you

enjoy? FINSTDD

1 Not worried at all

2 Not too worried

3 Moderately worried

4 Very worried 

Item adapted from public domain source.

Q66. How worried are you right now about not having enough income to pay your normal monthly

bills? FINBILLS

1 Not worried at all

2 Not too worried

3 Moderately worried

4 Very worried 

Item adapted from public domain source.
32

NIOSH WellBQ

Support Outside of Work NWKSUPP

Q67. How often do you get the social and emotional support you need from friends, family, or

others outside of work?

1 Never

2 Rarely

3 Sometimes

4 Always

Item adapted from public domain source.

Activities Outside of Work NWKENSUM

Suggested scoring: Calculate the sum of the following seven items (Q68A-68G). Code Never (1) to Rarely (3) 

as 0; code Sometimes (4) to Always (7) as 1.

Q68A–Q68G. In general, how often do you take part in any of the following activities outside of

work?

Never Almost never

(a few times a 

year or less)

Rarely

(once a month 

or less)

Sometimes

(a few times 

a month)

Often

(once a 

week)

Very often

(a few times

a week)

Always 

(every

day)

Does not

apply 

1 2 3 4 5 6 7 -99

A. Voluntary or 

 charitable activities 

 NWKVOLUN

B. Domestic

 caregiving activities 

 (for example, 

 children, elderly or 

 disabled relatives/

 friends, but not in 

 a volunteer or 

 charity setting) 

 NWKCAREG

C. Home maintenance

 tasks (for example, 

 cooking, cleaning,

 repairs)

 NWKMAINT

D. Socializing

 with friends, 

 family, others

 NWKSOCIA

E. Taking training or

 education courses

 NWKTRAIN
NIOSH WellBQ

33

Never Almost never

(a few times a 

year or less)

Rarely

(once a month 

or less)

Sometimes

(a few times 

a month)

Often

(once a 

week)

Very often

(a few times

a week)

Always 

(every

day)

Does not

apply 

F. Sporting, cultural,

 or leisure activities

 NWKSPORT

G. Relaxation or 

 planned solitary 

 activities

 NWKRELAX

*Items 68A, 68B, 68E, and 68F are adapted from the 6th European Working Conditions Survey (EWCS). 

Permission to use items from the EWCS is not necessary, as described on the survey website https://www.

eurofound.europa.eu/sites/default/files/page/field_ef_documents/6th_ewcs_2015_final_source_master_

questionnaire.pdf. However, published or disseminated materials containing these items must acknowledge 

the source of the data, and copies of this material must be shared with Sophia MacGoris (smg@eurofound.

europa.eu) at the European Foundation for the Improvement of Living and Working Conditions, Wyattville 

Road, Loughlinstown, Co. Dublin, Ireland. Please visit the website listed above to review specified conditions 

of use in detail.

Items 68C, 68D, and 68G are new.

Optional items

Employment Information

The questions in this section ask about your current working arrangements, occupation, 

and the industrial sector in which you are working. If you have more than one job, please

answer questions as they apply to your main job.

Work Arrangement WKARRANG

E1. How would you describe your work arrangement in your job

1 I am an independent contractor, an independent consultant, or a freelance worker.

2 I am on call and work only when called to work.

3 I am paid by a temporary agency.

4 I work for a contractor who provides workers and services to others under contract.

5 I am a regular, permanent employee. 

Item drawn from public domain source. 

Work Status WKSTATUS

E2. Is your job full-time or part-time

1 Full-time 

2 Part-time

New item. 
34

NIOSH WellBQ

Job Tenure JOBTEN

E3. How long have you worked in your job?

1 Less than 1 year

2 1–5 years

3 6–10 years

4 10–20 years

5 More than 20 years

New item.

Occupation OCCUP

E4. Select the occupation that best describes the kind of work you do in your job.

1 Architecture and Engineering 

2 Arts, Design, Entertainment, Sports, and Media 

3 Building and Grounds Cleaning and Maintenance 

4 Business and Financial Operations 

5 Computer and Mathematical 

6 Community and Social Service 

7 Construction and Extraction 

8 Education Instruction and Library

9 Farming, Fishing, and Forestry 

10 Food Preparation and Serving Related 

11 Healthcare Practitioners and Technical 

12 Healthcare Support

13 Installation, Maintenance, and Repair

14 Legal

15 Life, Physical, and Social Science 

16 Management 

17 Material Moving 

18 Military Specific 

19 Office and Administrative Support 

20 Personal Care and Service 

21 Production 

22 Protective Service 

23 Sales and Related 

24 Transportation 

25 Other (Please specify): _______________________________

Item adapted from public domain source.
NIOSH WellBQ

35

Industry or Business INDUSTRY

E5. Select the kind of industry or business you work in for your job

1 Arts, Entertainment, and Recreation 

2 Accommodation and Food Services 

3 Administrative and Support and Waste Management 

4 Agriculture, Forestry, Fishing, and Hunting 

5 Construction

6 Educational Services

7 Finance and Insurance

8 Health Care and Social Assistance

9 Information

10 Management of Companies and Enterprises

11 Manufacturing

12 Military 

13 Mining, Quarrying, and Oil and Gas Extraction 

14 Other Services, Except Public Administration 

15 Public Administration 

16 Professional, Scientific, and Technical Services

17 Real Estate and Rental and Leasing

18 Retail Trade

19 Transportation and Warehousing

20 Utilities

21 Wholesale Trade

22 Other (Please specify): _______________________________

Item drawn from public domain source.

Demographic Information

The questions in this section ask for basic information about yourself.

Age AGE

D1. What is your age?

1 18–29

2 30–44

3 45–64

4 65 and older

This is a NIOSH-suggested item and response options for collection of demographic data. 

Education EDUC

D2. What is the highest level of school you have completed or the highest degree you have

received? 

1 Less than high school

2 High school/GED

3 Some college

4 Bachelor’s degree or higher 

This is a NIOSH-suggested item and response options for collection of demographic data.
36

NIOSH WellBQ

Ethnicity ETHNICITY

D3. Do you consider yourself to be Hispanic or Latino?

1 Yes

2 No

7 Refused

9 Don’t know

Item drawn from public domain source. 

Race RACE 

D4. What race or races do you consider yourself to be? Please select one or more of these

categories.

1 White

2 Black/African American

3 American Indian

4 Alaska Native

5 Native Hawaiian

6 Other Pacific Islander

7 Asian

8 Some other race

97 Refused

99 Don’t know

Item drawn from public domain source. 

Sex SEX

D5. Are you male or female

1 Male

2 Female

7 Refused

9 Don’t know

Item drawn from public domain source. 

Sexual Orientation SEXORI

D6. Do you think of yourself as gay/lesbian or gay; straight, that is, not gay/lesbian; bisexual;

something else; or you don’t know the answer? 

1 Gay/lesbian

2 Straight, that is, not gay/lesbian

3 Bisexual

4 Something else

5 I don’t know the answer

7 Refused

9 Don’t know

Item drawn from public domain source. 
NIOSH WellBQ

37

Household Income HHINCOME

D7. What was your entire household income last year, before taxes

1 <$20,000

2 $20,000 to $34,999

3 $35,000 to $49,999

4 $50,000 to $74,999

5 $75,000 to $99,999

6 $100,000 to $149,999

7 $150,000 to $199,999

8 $200,000 or more

This is a NIOSH-suggested item and response options for collection of demographic data.

Head of Household HHHEAD

D8. Are you the head of your household

1 Yes

0 No

This is a NIOSH-suggested item and response options for collection of demographic data.

Marital Status MARSTAT

D9. What is your current marital status?

1 Married or living with partner

2 Widowed

3 Divorced 

4 Separated 

5 Never married

This is a NIOSH-suggested item and response options for collection of demographic data.

Dependents DEPEND

Calculate the sum of the following four items (D10A-D10D): 

D10. How many dependents currently live in your household? Please enter the total number in

each age category.

A. Total number of household members age 0 to 5 NDEP05

B. Total number of household members age 6 to 12 NDEP612

C. Total number of household members age 13 to 17 NDEP1317

D. Total number of household members age 18 or older NDEP18UP

These are NIOSH-suggested items and response options for collection of demographic data.
38

NIOSH WellBQ

NIOSH WellBQ

National Institute for Occupational Safety and Health

Worker Well-Being Questionnaire 

(NIOSH WellBQ)

Version 1

Welcome! Thank you for agreeing to fill out the National Institute for Occupational Safety and 

Health Worker Well-Being Questionnaire, which is known as the NIOSH WellBQ. This survey 

asks about aspects of your job and workplace, your health, and your life outside of work. The 

information will help provide a better understanding of how workers in your organization are 

doing and identify ways to improve worker well-being.

You can choose not to participate. On any question, you can choose not to give an answer. 

There are no right or wrong answers. Just base your answers on what you think. Some questions 

might not apply to your situation. In these cases, you can choose “Does not apply” if it is one 

of the answer choices. Please try to complete the survey in one sitting. It will take about 15 

minutes to complete.

If you have more than one job, please answer questions as they apply to your main job.
NIOSH WellBQ

39

The questions in this section ask how you feel about different aspects of your job. If you 

have more than one job, please answer questions as they apply to your main job.

Q1. Overall, I am ____ with my job

	 Not at all satisfied

	 Not too satisfied

	 Somewhat satisfied

	 Very satisfied

Q2. I am ____ with my wages

	 Not at all satisfied

	 Not too satisfied

	 Somewhat satisfied

	 Very satisfied

Q3. I am ____ with the benefits provided by my employer.

	 Not at all satisfied

	 Not too satisfied

	 Somewhat satisfied

	 Very satisfied

	 Does not apply 

Q4. I am ____ with my chances for advancement on the job

	 Not at all satisfied

	 Not too satisfied

	 Somewhat satisfied

	 Very satisfied

Q5. I can count on my supervisor for support when I need it

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply

Q6. I can count on my coworkers for support when I need it

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply
40

NIOSH WellBQ

Q7. I feel my job is secure

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

Q8. I am given a lot of freedom to decide how to do my own work

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

Q9. I never seem to have enough time to get everything done on my job

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

Q10. The work I do is meaningful to me

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

Q11. The work I do serves a greater purpose

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree
NIOSH WellBQ

41

Q12. How often do you experience these feelings when you are working

Never Almost never

(a few times a 

year or less)

Rarely

(once a month 

or less)

Sometimes

(a few times a 

month)

Often

(once a 

week)

Very often

(a few times a 

week)

Always

(every day)

A. Enthusiastic

B. Energetic 

C. Content

D. At ease

E. Anxious

F. Angry

G. Gloomy

H. Discouraged 

Q13. How often do you experience fatigue when you are working

	 Never

	 Almost never (a few times a year or less)

	 Rarely (once a month or less)

	 Sometimes (a few times a month)

	 Often (once a week)

	 Very often (a few times a week)

	 Always (every day)

Q14. My work inspires me.

	 Never

	 Almost never (a few times a year or less)

	 Rarely (once a month or less)

	 Sometimes (a few times a month)

	 Often (once a week)

	 Very often (a few times a week)

	 Always (every day)

Q15. I am immersed in my work

	 Never

	 Almost never (a few times a year or less)

	 Rarely (once a month or less)

	 Sometimes (a few times a month)

	 Often (once a week)

	 Very often (a few times a week)

	 Always (every day)
42

NIOSH WellBQ

Q16. When I get up in the morning, I feel like going to work

	 Never

	 Almost never (a few times a year or less)

	 Rarely (once a month or less)

	 Sometimes (a few times a month)

	 Often (once a week)

	 Very often (a few times a week)

	 Always (every day)

The questions in this section ask how you feel about your organization and about benefits 

and health programs available at work. If you have more than one job, please answer

questions as they apply to your main job.

Q17. At my organization, I am treated with respect

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply

Q18. My organization values my contributions

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply

Q19. My organization cares about my general satisfaction at work

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply

Q20. My organization is willing to extend resources in order to help me perform my job to the

best of my ability.

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply
NIOSH WellBQ

43

Q21. I receive recognition for a job well done.

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

Q22. I trust the management at my organization

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply

Q23. My organization is committed to employee health and well-being

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply

Q24. My organization encourages me and provides opportunities to engage in healthy

behaviors, such as being physically active, eating a healthy diet, living tobacco free, and 

managing my stress.

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply
44

NIOSH WellBQ

Q25. Are the following benefits offered by your employer?

Yes No Don't know Does not apply 

A. Health insurance

B. Assistance with education/tuition

C. Retirement (employer contributions to retirement 

 savings)

D. Paid maternity leave

E. Paid paternity leave

F. Paid sick leave

G. Other paid caregiving leave (for example, to care

 for sick family members)

H. Paid disability leave

 I. Paid vacation days

J. Other paid leave (for example, bereavement, 

 emergency, jury duty)

K. Ability to take unpaid leave

L. Transit options (such as help with transportation 

 to and from work)

M. On-site medical care

N. Employee assistance programs (such as programs 

 that help workers with personal or work-related 

 problems)

Q26. Are the following health and wellness programs or services available to you at the place

where you work? 

Yes No Don't know Does not apply 

A. Health education and promotion programs 

 (wellness programs)

B. On-site fitness centers or gym membership 

 discounts (includes a gym and/or space for group 

 classes)

C. Common spaces or activity hubs (areas for group 

 activities, such as socializing, exercise classes, etc.)

D. Smoking cessation programs

E. Alcohol and substance programs

F. Stress management programs

G. Access to healthy lunch and snack options
NIOSH WellBQ

45

Q27. How often do the demands of your job interfere with your personal life

	 Never

	 Almost never (a few times a year or less)

	 Rarely (once a month or less)

	 Sometimes (a few times a month)

	 Often (once a week)

	 Very often (a few times a week)

	 Always (every day)

Q28. How often do the demands of your personal life interfere with your work on the job

	 Never

	 Almost never (a few times a year or less)

	 Rarely (once a month or less)

	 Sometimes (a few times a month)

	 Often (once a week)

	 Very often (a few times a week)

	 Always (every day)

Q29. I have the freedom to vary my work schedule

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

Q30. I have the freedom to work wherever is best for me—either at home or at my organization

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

	 Does not apply

The questions in this section ask about physical characteristics of your work environment 

and safety conditions where you work. If you have more than one job, please answer

questions as they apply to your main job.

Q31. Overall, how safe do you think your workplace is

	 Very unsafe

	 Somewhat unsafe

	 Somewhat safe

	 Very safe
46

NIOSH WellBQ

Q32. Please indicate how much you agree or disagree with each of the following statements

about safety practices at your workplace.

Strongly

disagree

Somewhat 

disagree

Somewhat 

agree

Strongly

agree

Does 

not

apply

A. Management reacts quickly to solve the problem 

 when told about safety hazards.

B. Management insists on thorough and regular safety 

 audits and inspections.

C. Management provides all the equipment needed to 

 do the job safely.

D. Management invests a lot of time and money in 

 safety training for workers.

E. Management listens carefully to workers’ ideas about 

 improving safety.

F. Management gives safety personnel the power they 

 need to do their job.

Q33. On my present job, this is how I feel about the following topics

Not at all

satisfied

Not too satisfied Somewhat 

satisfied

Very satisfied 

A. The environmental conditions (heating, lighting, 

 ventilation, etc.)

B. The physical surroundings (for example, building 

 infrastructure, work area layout, design)

C. The pleasantness of the work environment

Q33D. The accommodations for disabilities and/or special needs (wheelchair ramps, lactation

rooms, etc.)

	 Not at all satisfied

	 Not too satisfied

	 Somewhat satisfied

	 Very satisfied

	 Does not apply

Q34. I feel discriminated against in my job because of my age

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree
NIOSH WellBQ

47

Q35. I feel discriminated against in my job because of my race or ethnic origin.

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

Q36. I feel discriminated against in my job because of my gender

	 Strongly disagree

	 Somewhat disagree

	 Somewhat agree

	 Strongly agree

Q37. In the past 12 months, were you sexually harassed by anyone while you were on the job

	 Yes

	 No

Q38. In the past 12 months, were you exposed to physical violence while you were on the job

	 Yes

	 No

Q39. In the past 12 months, were you bullied, threatened, or harassed in any other way by

anyone while you were on the job?

	 Yes

	 No

Q40. In the past 12 months, have you been in a situation where any of your superiors or

coworkers put you down or were condescending to you, made demeaning remarks about you, 

or addressed you in unprofessional terms?

	 Yes

	 No

	 Does not apply 

The questions in this section ask about your physical and mental health and health-related 

behaviors

Q41. Would you say that in general, your health is poor, fair, good, very good, or excellent

	 Poor

	 Fair

	 Good

	 Very good

	 Excellent 
48

NIOSH WellBQ

Q42. Now, thinking about your physical health, which includes physical illness and injury, during

the past 30 days, for how many days was your physical health not good? 

Enter number of days (0–30) 

Q43. Have you ever had any of the following

Never In the past Have currently

A. Arthritis

B. Other musculoskeletal disorders (for example, back pain, neck

 pain, other pain)

C. Asthma

D. Lung disease, other than asthma (for example, chronic 

 obstructive pulmonary disease [COPD], chronic bronchitis, 

 emphysema)

E. Cancer

F. Depression

G. Diabetes

H. Heart disease

I. High blood pressure

Q44. Have you ever had chronic insomnia

	 Never

	 In the past

	 Have currently

Q45. Now, thinking about your mental health, which includes stress, depression, anxiety, and

problems with emotions, during the past 30 days, for how many days was your mental health 

not good? 

Enter number of days (0–30) 

Q46. How often do you experience stress with regard to the following topics

Never Almost never

(a few times a 

year or less)

Rarely

(once a month 

or less) 

Sometimes

(a few times a 

month)

Often 

(once a 

week)

Very often

(a few times a 

week)

Always

(every day)

A. Your health

B. Your finances

C. Your family or social 

 relationships

D. Your work
NIOSH WellBQ

49

Q47. Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or

hopeless?

	 Not at all 

	 Several days

	 More than half the days

	 Nearly every day

Q48. Over the last 2 weeks, how often have you been bothered by little interest or pleasure in

doing things?

	 Not at all 

	 Several days

	 More than half the days

	 Nearly every day

Q49. Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or

on edge?

	 Not at all 

	 Several days

	 More than half the days

	 Nearly every day

Q50. Over the last 2 weeks, how often have you been bothered by not being able to stop or

control worrying?

	 Not at all 

	 Several days

	 More than half the days

	 Nearly every day

Q51. In a typical week, how many days do you get at least 20 minutes of high intensity physical

activity? (High intensity activity lasts at least 10 minutes and increases your heart rate, makes 

you sweat, and may make you feel out of breath; examples are running, fast cycling, and 

strenuous, continuous lifting of heavy objects.)

Enter number of days (0–7) 

Q52. In a typical week, how many days do you get at least 30 minutes of moderate intensity

physical activity? (Moderate intensity activity lasts at least 10 minutes and requires more effort 

than is needed for typical everyday tasks; examples are brisk walking, gardening, and continuous 

lifting of light objects.)

Enter number of days (0–7) 
50

NIOSH WellBQ

Q53. Do you use any of the following tobacco products

Never Not any more Some days Daily 

A. Cigarettes

B. Cigars

C. Pipes

D. Smokeless tobacco

E. Electronic cigarettes

Q54. How many drinks of alcoholic beverages do you have in a typical week? (One drink = one

beer, glass of wine, shot of liquor, or mixed drink.)

Enter number of drinks

Q55. During the past year, how often have you had more than four drinks if you are a male, or

more than three drinks if you are a female, on any single day? (One drink = one beer, glass of 

wine, shot of liquor, or mixed drink.)

	 Never

	 Once (1 day)

	 A few times (2 or 3 days)

	 Often (more than 3 days)

Q56. Think of the foods that are a part of your normal diet. How many servings of fruits and

vegetables do you eat in a normal day? 

(One serving is any of the following: 1 cup raw leafy greens [about the size of a small fist]; 1⁄2 

cup of other vegetables [cooked or raw]; 1 medium piece of fruit [about the size of a baseball]; 

1/2 cup chopped, cooked, or canned fruit; or 3⁄4 cup vegetable or fruit juice.)

	 Less than 1 serving

	 1 serving

	 2 servings

	 3 servings

	 4 servings

	 5 or more servings

Q57. How many hours of sleep do you usually get at night? If you are a shift worker, how many

hours of sleep do you get a day? 

	 6 or fewer hours

	 7 hours

	 8 hours

	 9 or more hours
NIOSH WellBQ

51

Q58. In the past 7 days, how often have you felt sleepy while at work

	 Never

	 Rarely

	 Sometimes

	 Usually

	 Always 

Q59. Because of a physical, mental, or emotional condition, do you have serious difficulty

concentrating, remembering, or making decisions?

	 Not at all

	 Slightly

	 Moderately

	 Extremely

	 Does not apply/do not have condition

Q60. Are you limited in the kind or amount of work you can do because of a physical, mental, or

emotional problem?

	 Not at all

	 Slightly

	 Moderately

	 Extremely

	 Does not apply/do not have problem

Q61. In the past month

Never Almost never

(one time a 

month)

Rarely

(once a 

week or 

less)

Sometimes

(a few times a 

week)

Often

(once a 

day)

Very often 

(a few times 

a day)

Always 

(every hour)

A. How often did you

 not concentrate

 enough on your work? 

B. How often did you find 

 yourself not working as

 carefully as you should?

C. How often did you not 

 work at times when you 

 were supposed to be 

 working?

D. How often did you get 

 less done than other

 workers?
52

NIOSH WellBQ

Q62. During the past 12 months, did you experience any work-related injuries

	 Yes

	 No 

Q63. If you experienced any work-related injuries in the past 12 months, did any of them require

any first aid or medical treatment, change in job activities, or lost time from work? 

	 Yes

	 No

	 Does not apply/was not injured in the past 12 months 

The questions in this section ask about your experiences, feelings, and activities outside of 

work

Q64. In general, how satisfied are you with your life

	 Not at all satisfied

	 Not too satisfied

	 Somewhat satisfied

	 Very satisfied

Q65. How worried are you right now about not being able to maintain the standard of living you

enjoy?

	 Not worried at all

	 Not too worried

	 Moderately worried

	 Very worried 

Q66. How worried are you right now about not having enough income to pay your normal

monthly bills?

	 Not worried at all

	 Not too worried

	 Moderately worried

	 Very worried 

Q67. How often do you get the social and emotional support you need from friends, family, or

others outside of work?

	 Never

	 Rarely

	 Sometimes

	 Always
NIOSH WellBQ

53

Q68. In general, how often do you take part in any of the following activities outside of work

Never Almost never

(A few times a 

year or less)

Rarely

(Once a month 

or less)

Sometimes 

(A few times 

a month)

Often 

(Once a 

week)

Very often 

(A few times 

a week)

Always 

(Every day) 

Does 

not apply

A. Voluntary or charitable

 activities 

B. Domestic caregiving

 activities (for example, 

 children, elderly or

 disabled relatives/ friends,

 but not in a volunteer 

 or charity setting)

C. Home maintenance tasks

 (for example, cooking, 

 cleaning, repairs)

D. Socializing with friends,

 family, others

E. Taking training or 

 education courses

F. Sporting, cultural, or 

 leisure activities

G. Relaxation or planned

 solitary activities

You have completed the NIOSH WellBQ. Thank you for your time
54

NIOSH WellBQ

Optional Items

The questions in this section ask about your current working arrangements, occupation, 

and the industrial sector in which you are working. If you have more than one job, please

answer questions as they apply to your main job.

E1. How would you describe your work arrangement in your job?

	 I am an independent contractor, an independent consultant, or a freelance worker.

	 I am on call and work only when called to work.

	 I am paid by a temporary agency.

	 I work for a contractor who provides workers and services to others under contract.

	 I am a regular, permanent employee. 

E2. Is your job full-time or part-time?

	 Full-time 

	 Part-time

E3. How long have you worked in your job?

	 Less than 1 year

	 1–5 years

	 6–10 years

	 10–20 years

	 More than 20 years
NIOSH WellBQ

55

E4. Select the occupation that best describes the kind of work you do in your job

	 Architecture and Engineering 

	 Arts, Design, Entertainment, Sports, and Media 

	 Building and Grounds Cleaning and Maintenance 

	 Business and Financial Operations 

	 Computer and Mathematical 

	 Community and Social Service 

	 Construction and Extraction 

	 Education Instruction and Library

	 Farming, Fishing, and Forestry 

	 Food Preparation and Serving Related 

	 Healthcare Practitioners and Technical 

	 Healthcare Support

	 Installation, Maintenance, and Repair

	 Legal

	 Life, Physical, and Social Science 

	 Management 

	 Material Moving 

	 Military Specific

	 Office and Administrative Support 

	 Personal Care and Service 

	 Production 

	 Protective Service 

	 Sales and Related 

	 Transportation 

	 Other (Please specify): _______________________________
56

NIOSH WellBQ

E5. Select the kind of industry or business you work in for your job

	 Arts, Entertainment, and Recreation 

	 Accommodation and Food Services 

	 Administrative and Support and Waste Management 

	 Agriculture, Forestry, Fishing, and Hunting 

	 Construction

	 Educational Services

	 Finance and Insurance

	 Health Care and Social Assistance

	 Information

	 Management of Companies and Enterprises

	 Manufacturing

	 Military

	 Mining, Quarrying, and Oil and Gas Extraction 

	 Other Services, Except Public Administration 

	 Public Administration 

	 Professional, Scientific, and Technical Services

	 Real Estate and Rental and Leasing

	 Retail Trade

	 Transportation and Warehousing

	 Utilities

	 Wholesale Trade

	 Other (Please specify): _______________________________
NIOSH WellBQ

57

The questions in this section ask for basic information about yourself.

D1. What is your age

	 18–29

	 30–44

	 45–64

	 65 and older

D2. What is the highest level of school you have completed or the highest degree you have

received? 

	 Less than high school 

	 High school/GED

	 Some college

	 Bachelor’s degree or higher 

D3. Do you consider yourself to be Hispanic or Latino

	 Yes

	 No

	 Refused

	 Don’t know

D4. What race or races do you consider yourself to be? Please select one or more of these

categories.

	 White

	 Black/African American

	 American Indian

	 Alaska Native

	 Native Hawaiian

	 Other Pacific Islander

	 Asian

	 Some other race

	 Refused

	 Don’t know

D5. Are you male or female

	 Male

	 Female

	 Refused

	 Don’t know
58

NIOSH WellBQ

D6. Do you think of yourself as gay/lesbian or gay; straight, that is, not gay/lesbian; bisexual;

something else; or you don’t know the answer?

	 Gay/lesbian

	 Straight, that is, not gay/lesbian

	 Bisexual

	 Something else

	 I don’t know the answer

	 Refused

	 Don’t know

D7. What was your entire household income last year, before taxes

	 <$20,000

	 $20,000 to $34,999

	 $35,000 to $49,999

	 $50,000 to $74,999

	 $75,000 to $99,999

	 $100,000 to $149,999

	 $150,000 to $199,999

	 $200,000 or more

D8. Are you the head of your household?

	 Yes

	 No

D9. What is your current marital status

	 Married or living with partner

	 Widowed

	 Divorced 

	 Separated 

	 Never married

D10. How many dependents currently live in your household? Please enter the total number in 

each age category. 

A. Total number of household members age 0 to 5 

B. Total number of household members age 6 to 12 

C. Total number of household members age 13 to 17 

D. Total number of household members age 18 or older 
NIOSH WellBQ

59

NIOSH WellBQ Item Source Table 

NIOSH WellBQ Item Source

Section 1: Work Evaluation and Experience

Job Satisfaction

Q1. Overall, I am ____ with my job.

 Not at all satisfied

 Not too satisfied

 Somewhat satisfied

 Very satisfied

Centers for Disease Control and Prevention [2010]

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan.

Wage Satisfaction

Q2. I am ___ with my wages.

 Not at all satisfied

 Not too satisfied

 Somewhat satisfied

 Very satisfied

Macdonald S, Maclntyre P [1997]. The generic job

satisfaction scale: scale development and its 

correlates. Employee Assistance Quarterly 13(2):1-

16.

Benefits Satisfaction 

Q3. I am ___ with the benefits provided by my employer. 

 Not at all satisfied

 Not too satisfied

 Somewhat satisfied

 Very satisfied

 Does not apply

Centers for Disease Control and Prevention [2010]. 

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan.

Advancement Satisfaction

Q4. I am ___ with my chances for advancement on the job.

 Not at all satisfied

 Not too satisfied

 Somewhat satisfied

 Very satisfied

 Vocational Psychology Research (VPR), University 

of Minnesota [1977]. Minnesota Satisfaction 

Questionnaire Long Form 1977, http://vpr.psych.

umn.edu/
60

NIOSH WellBQ

NIOSH WellBQ Item Source

Supervisor Support

Q5. I can count on my supervisor for support when I need it.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Centers for Disease Control and Prevention [2010]. 

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972

-1973 surveys. Ann Arbor, MI: The University of 

Michigan.

Caplan RD, Cobb S, French JRP Jr, Van Harrison 

R, Pinnneau SR Jr [1975]. Job demands and 

worker health: main effects and occupational 

differences. DHEW (NIOSH) Publication No.

 75-160.

Coworker Support

Q6. I can count on my coworkers for support when I need it.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Centers for Disease Control and Prevention [2010]. 

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html. 

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan. 

Caplan RD, Cobb S, French JRP Jr, Van Harrison 

R, Pinnneau SR Jr [1975]. Job demands and 

worker health: main effects and occupational 

differences. DHEW (NIOSH) Publication No.

 75-160.

Job Security

Q7. I feel my job is secure.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Macdonald S, Maclntyre P [1997]. The generic 

job satisfaction scale: scale development and its 

correlates. Employee Assistance Quarterly 13(2):1-

16.
NIOSH WellBQ

61

NIOSH WellBQ Item Source

Job Autonomy

Q8. I am given a lot of freedom to decide how to do my own work. 

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Centers for Disease Control and Prevention [2010].

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html. 

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan.

Time Paucity/Work Overload

Q9. I never seem to have enough time to get everything done on my job. 

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Centers for Disease Control and Prevention [2010]. 

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan. 

 Meaningful Work

Q10. The work I do is meaningful to me.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Steger MF, Dik BJ, Duffy RD [2012]. Measuring 

meaningful work: the Work and Meaning 

Inventory (WAMI). J Career Assessment 20(3):322-

337. 

Q11. The work I do serves a greater purpose.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Steger MF, Dik BJ, Duffy RD [2012]. Measuring

 meaningful work: the Work and Meaning 

Inventory (WAMI). J Career Assessment 20(3):322-

337. 
62

NIOSH WellBQ

NIOSH WellBQ Item Source

Work-related Positive and Work-related Negative Affect

Q12. [Grid] How often do you experience these feelings when you are working?

Statements in row:

A. Enthusiastic

B. Energetic 

C. Content

D. At ease

E. Anxious

F. Angry

G. Gloomy

H. Discouraged 

Responses in column:

 Never

 Almost never (a few times a year or less)

 Rarely (once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

Van Katwyk PT, Fox S, Spector PE, Kelloway EK 

[2000]. Using the Job-related Affective Well-being 

Scale (JAWS) to investigate affective responses to 

work stressors. J Occup Health Psych 5(2):219-230. 

Work-related Fatigue

Q13. How often do you experience fatigue when you are working? 

 Never

 Almost never (a few times a year or less)

 Rarely (once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

Van Katwyk PT, Fox S, Spector PE, Kelloway EK 

[2000]. Using the Job-related Affective Well-being 

Scale (JAWS) to investigate affective responses to 

work stressors. J Occup Health Psych 5(2):219-230.

Job Engagement

Q14. My work inspires me. 

 Never

 Almost never (a few times a year or less)

 Rarely (once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

Schaufeli WB, Bakker AB, Salanova M [2006]. The 

measurement of work engagement with a short 

questionnaire: a cross-national study. Educational 

and Psychological Measurement 66(4):702-716.
NIOSH WellBQ

63

NIOSH WellBQ Item Source

Q15. I am immersed in my work.

 Never

 Almost never (a few times a year or less)

 Rarely (once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

Schaufeli WB, Bakker AB, Salanova M [2006]. The

measurement of work engagement with a short 

questionnaire: a cross-national study. Educational 

and Psychological Measurement 66(4):702-716.

Q16. When I get up in the morning, I feel like going to work.

 Never

 Almost never (a few times a year or less)

 Rarely (once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

Schaufeli WB, Bakker AB, Salanova M [2006]. The

measurement of work engagement with a short 

questionnaire: a cross-national study. Educational 

and Psychological Measurement 66(4):702-716.

Section 2: Workplace Policies and Culture

Supportive Work Culture 

Q17. At my organization, I am treated with respect.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Centers for Disease Control and Prevention [2010].

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html. 

Q18. My organization values my contributions.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Eisenberger R, Huntington R, Hutchinson S, Sowa 

D [1986]. Perceived organizational support. J Appl 

Psychol 71(3):500-507, http://classweb.uh.edu/

eisenberger/perceived-organizational-support/.

Q19. My organization cares about my general satisfaction at work.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Eisenberger R, Huntington R, Hutchinson S, Sowa 

D [1986]. Perceived organizational support. J Appl 

Psychol 71(3):500-507, http://classweb.uh.edu/

eisenberger/perceived-organizational-support/.
64

NIOSH WellBQ

NIOSH WellBQ Item Source

Q20. My organization is willing to extend resources in order to help me perform 

my job to the best of my ability.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Eisenberger R, Huntington R, Hutchinson S, Sowa

D [1986]. Perceived organizational support. J Appl

 Psychol 71(3):500-507, http://classweb.uh.edu/

eisenberger/perceived-organizational-support/.

Q21. I receive recognition for a job well done. 

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Macdonald S, Maclntyre P [1997]. The generic job

satisfaction scale: scale development and its 

correlates. Employee Assistance Quarterly 13(2):1-

16.

Management Trust

Q22. I trust the management at my organization.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Centers for Disease Control and Prevention [2010].

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html. 

Health Culture at Work

Q23. My organization is committed to employee health and well-being.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Zweber ZM, Henning RA, Magley VJ [2016]. A 

practical scale for Multi-Faceted Organizational 

Health Climate Assessment. J Occup Health Psychol

21(2):250-259.

Q24. My organization encourages me and provides opportunities to engage 

 in healthy behaviors, such as being physically active, eating a healthy diet, 

 living tobacco free, and managing my stress.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Zweber ZM, Henning RA, Magley VJ [2016]. A 

practical scale for Multi-Faceted Organizational 

Health Climate Assessment. J Occup Health Psychol

21(2):250-259.
NIOSH WellBQ

65

NIOSH WellBQ Item Source

Availability of Job Benefits 

Q25. [Grid] Are the following benefits offered by your employer?

Statements in row:

A. Health insurance

B. Assistance with education/tuition

C. Retirement (employer contributions to retirement savings)

D. Paid maternity leave

E. Paid paternity leave

F. Paid sick leave

G. Other paid caregiving leave (for example, to care for sick family 

 members)

H. Paid disability leave

I. Paid vacation days

J. Other paid leave (for example, bereavement, emergency, jury duty)

K. Ability to take unpaid leave

L. Transit options (such as help with transportation to and from work)

M. On-site medical care

N. Employee assistance programs (such as programs that help workers

 with personal or work-related problems)

Responses in column:

 Yes

 No

 Don’t know

 Does not apply

New item 
66

NIOSH WellBQ

NIOSH WellBQ Item Source

Availability of Health Programs at Work

Q26. [Grid] Are the following health and wellness programs or services available 

 to you at the place where you work?

Statements in row:

 Health education and promotion programs (wellness programs)

 On-site fitness centers or gym membership discounts (includes a gym 

and/or space for group classes)

 Common spaces or activity hubs (areas for group activities, such as 

socializing, exercise classes, etc.)

 Smoking cessation programs

 Alcohol and substance programs

 Stress management programs

 Access to healthy lunch and snack options

Responses in column:

 Yes

 No

 Don’t know

 Does not apply

New item 

Work to Non-work Conflict 

Q27. How often do the demands of your job interfere with your personal life?

 Never

 Almost never (a few times a year or less)

 Rarely (once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

Centers for Disease Control and Prevention [2010]. 

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan.

Non-work to Work Conflict

Q28. How often do the demands of your personal life interfere with your work 

on the job?

 Never

 Almost never (a few times a year or less)

 Rarely (once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

Centers for Disease Control and Prevention [2010]. 

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html. 

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan.
NIOSH WellBQ

67

NIOSH WellBQ Item Source

Workplace/Schedule Flexibility 

Q29. I have the freedom to vary my work schedule.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Shockley KM, Allen TD [2007]. When flexibility 

helps: another look at the availability of flexible 

work arrangements and work–family conflict. J 

Vocational Behavior 71;479-493.

Q30. I have the freedom to work wherever is best for me—either at home or at 

my organization. 

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Shockley KM, Allen TD [2007]. When flexibility 

helps: another look at the availability of flexible 

work arrangements and work–family conflict. J 

Vocational Behavior71;479-493.

Section 3: Workplace Physical Environment and Safety Climate 

Overall Workplace Safety 

Q31. Overall, how safe do you think your workplace is?

 Very unsafe

 Somewhat unsafe

 Somewhat safe

 Very safe

Centers for Disease Control and Prevention [ND]. 

CDC NHWP Health and Safety Climate Survey 

(INPUTS) user manual. National Center for Chronic 

Disease Prevention and Health Promotion, https://

www.cdc.gov/workplacehealthpromotion/toolsresources/pdfs/NHWP_INPUTS_Manual.pdf.
68

NIOSH WellBQ

NIOSH WellBQ Item Source

Workplace Safety Climate 

Q32. [Grid] Please indicate how much you agree or disagree with each of the 

 following statements about safety practices at your workplace.

Statements in row:

A. Management reacts quickly to solve the problem when told about safety 

 hazards.

B. Management insists on thorough and regular safety audits and 

 inspections.

C. Management provides all the equipment needed to do the job safely.

D. Management invests a lot of time and money in safety training for 

 workers.

E. Management listens carefully to workers’ ideas about improving safety.

F. Management gives safety personnel the power they need to do their job.

Responses in column:

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

 Does not apply

Zohar D, Luria G [2005]. A multilevel model of 

safety climate: cross-level relationships between 

organization and group-level climates. J Applied 

Psychol 90(4):616–628.

Physical Work Environment Satisfaction

Q33A-33C. [Grid] On my present job, this is how I feel about the following topics:

Statements in row:

A. The environmental conditions (heating, lighting, ventilation, etc.)

B. The physical surroundings (for example, building infrastructure, work 

 area layout, design)

C. The pleasantness of the work environment

Statements in column:

 Not at all satisfied

 Not too satisfied

 Somewhat satisfied

 Very satisfied

Vocational Psychology Research (VPR), University 

of Minnesota [1977]. Minnesota Satisfaction 

Questionnaire Long Form 1977, http://vpr.psych.

umn.edu/
NIOSH WellBQ

69

NIOSH WellBQ Item Source

Q33D. The accommodations for disabilities and/or special needs (wheelchair 

ramps, lactation rooms, etc.)

 Not at all satisfied

 Not too satisfied

 Somewhat satisfied

 Very satisfied

 Does not apply

New item

 Discrimination 

Q34. I feel discriminated against in my job because of my age.

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Centers for Disease Control and Prevention [2010].

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan.

Q35. I feel discriminated against in my job because of my race or ethnic origin. 

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Centers for Disease Control and Prevention [2010].

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan.

Q36. I feel discriminated against in my job because of my gender. 

 Strongly disagree

 Somewhat disagree

 Somewhat agree

 Strongly agree

Centers for Disease Control and Prevention [2010].

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Quinn RP, Staines GL [1979]. The 1977 Quality of 

Employment Survey: descriptive statistics, with 

comparison data from the 1969-70 and the 1972-

1973 surveys. Ann Arbor, MI: The University of 

Michigan.
70

NIOSH WellBQ

NIOSH WellBQ Item Source

Work-related Sexual Harassment 

Q37. In the past 12 months, were you sexually harassed by anyone while you 

were on the job?

 Yes

 No

Centers for Disease Control and Prevention [2010]. 

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Work-related Physical Violence

Q38. In the past 12 months, were you exposed to physical violence while you 

were on the job?

 Yes

 No

National Research Centre for the Working 

Environment (NRCWE) [2005)]. Copenhagen 

Psychosocial Questionnaire—COPSOQ II. 

https://nfa.dk/da/Vaerktoejer/Sporgeskemaer/

Copenhagen-Psychosocial-Questionnaire-COPSOQII/Engelsk-udgave.

Work-related Bullying 

Q39. In the past 12 months, were you bullied, threatened, or harassed in any 

other way by anyone while you were on the job?

 Yes

 No

Centers for Disease Control and Prevention [2010].

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html.

Q40. In the past 12 months, have you been in a situation where any of your 

superiors or coworkers put you down or were condescending to you, made 

demeaning remarks about you, or addressed you in unprofessional terms?

 Yes

 No

 Does not apply 

Cortina LM, Magley VJ, Williams JH, Langhout RD 

[2001]. Incivility in the workplace: incidence and 

impact. J Occup Health Psychol 6(1):64. 

Section 4: Health Status 

Overall Health 

Q41. Would you say that in general, your health is poor, fair, good, very good, or 

excellent?

 Poor

 Fair

 Good

 Very good

 Excellent 

Centers for Disease Control and Prevention [2014].

Behavioral Risk Factor Surveillance System 

Questionnaire, http://www.cdc.gov/brfss/

questionnaires/pdf-ques/2014_brfss.pdf.
NIOSH WellBQ

71

NIOSH WellBQ Item Source

Days Poor Physical Health

Q42. Now, thinking about your physical health, which includes physical illness 

and injury, during the past 30 days, for how many days was your physical 

health not good? 

Enter number of days (0–30) 

Centers for Disease Control and Prevention [2014]. 

Behavioral Risk Factor Surveillance System 

Questionnaire, http://www.cdc.gov/brfss/

questionnaires/pdf-ques/2014_brfss.pdf.

Chronic Health Conditions

Q43. [Grid] Have you ever had any of the following?

Statements in row:

A. Arthritis

B. Other musculoskeletal disorders (for example, back pain, neck pain, 

 other pain)

C. Asthma

D. Lung disease, other than asthma (for example, chronic obstructive 

 pulmonary disease [COPD], chronic bronchitis, emphysema)

E. Cancer

F. Depression

G. Diabetes

H. Heart disease

I. High blood pressure

Responses in column:

 Never

 In the past

 Have currently

Items 43A and 43C–H: Health Enhancement 

Research Organization and Population Health 

Alliance [2015]. Program measurement and 

evaluation guide: core metrics for employee health

management, https://hero-health. org/wp

content/uploads/2015/02/HERO-PHA-MetricsGuide-FINAL.pdf.

Items 43B and 43I are new.

Insomnia 

Q44. Have you ever had chronic insomnia?

 Never

 In the past

 Have currently

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics

for employee health management, https://herohealth. org/wp-content/uploads/2015/02/HEROPHA-Metrics-Guide-FINAL.pdf.

Days of Poor Mental Health 

Q45. Now, thinking about your mental health, which includes stress, depression, 

anxiety, and problems with emotions, during the past 30 days, for how 

many days was your mental health not good?

Enter number of days (0–30) 

Centers for Disease Control and Prevention [2014]. 

Behavioral Risk Factor Surveillance System 

Questionnaire, http://www.cdc.gov/brfss/

questionnaires/pdf-ques/2014_brfss.pdf.
72

NIOSH WellBQ

NIOSH WellBQ Item Source

Overall Stress 

Q46. [Grid] How often do you experience stress with regard to the following 

topics? 

Statements in row:

A. Your health

B. Your finances

C. Your family or social relationships

D. Your work

Responses in column:

 Never

 Almost never (a few times a year or less)

 Rarely (once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics 

for employee health management, https://herohealth.org/wp-content/uploads/2015/02/HEROPHA-Metrics-Guide-FINAL.pdf.

Poor Mental Health 

Q47. Over the last 2 weeks, how often have you been bothered by feeling down, 

depressed, or hopeless?

 Not at all

 Several days 

 More than half the days

 Nearly everyday

Kroenke K, Spitzer RL, Williams JBW, Löwe B 

[2009]. An ultra-brief screening scale for anxiety

and depression: the PHQ-4. Psychosomatics 

50:613-621.

Q48. Over the last 2 weeks, how often have you been bothered by little interest 

or pleasure in doing things?

 Not at all

 Several days 

 More than half the days

 Nearly everyday

Kroenke K, Spitzer RL, Williams JBW, Löwe B 

[2009]. An ultra-brief screening scale for anxiety 

and depression: the PHQ-4. Psychosomatics 

50:613-621.

Q49. Over the last 2 weeks, how often have you been bothered by feeling 

nervous, anxious, or on edge?

 Not at all

 Several days 

 More than half the days

 Nearly everyday

Kroenke K, Spitzer RL, Williams JBW, Löwe B 

[2009]. An ultra-brief screening scale for anxiety 

and depression: the PHQ-4. Psychosomatics 

50:613-621.
NIOSH WellBQ

73

NIOSH WellBQ Item Source

Q50. Over the last 2 weeks, how often have you been bothered by not being able 

to stop or control worrying?

 Not at all

 Several days 

 More than half the days

 Nearly everyday

Kroenke K, Spitzer RL, Williams JBW, Löwe B

[2009]. An ultra-brief screening scale for anxiety 

and depression: the PHQ-4. Psychosomatics 

50:613-621.

Physical Activity

Q51. In a typical week, how many days do you get at least 20 minutes of high 

intensity physical activity? (High intensity activity lasts at least 10 minutes 

and increases your heart rate, makes you sweat, and may make you feel out 

of breath; examples are running, fast cycling, and strenuous, continuous 

lifting of heavy objects.)

Enter number of days (0–7) 

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics 

for employee health management, https://herohealth.org/wp-content/uploads/2015/02/HEROPHA-Metrics-Guide-FINAL.pdf.

Q52. In a typical week, how many days do you get at least 30 minutes of 

moderate intensity physical activity? (Moderate intensity activity lasts 

at least 10 minutes and requires more effort than is needed for typical 

everyday tasks; examples are brisk walking, gardening, and continuous 

lifting of light objects.)

Enter number of days (0–7) 

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics 

for employee health management, https://herohealth.org/wp-content/uploads/2015/02/HEROPHA-Metrics-Guide-FINAL.pdf.

Tobacco Use 

Q53. [Grid] Do you use any of the following tobacco products?

Statements in row:

A. Cigarettes

B. Cigars

C. Pipes

D. Smokeless tobacco

E. Electronic cigarettes

Responses in column:

 Never

 Not any more

 Some days

 Daily

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics 

for employee health management, https://herohealth.org/wp-content/uploads/2015/02/HEROPHA-Metrics-Guide-FINAL.pdf.
74

NIOSH WellBQ

NIOSH WellBQ Item Source

Alcohol Consumption

Q54. How many drinks of alcoholic beverages do you have in a typical week? 

(One drink = one beer, glass of wine, shot of liquor, or mixed drink.)

Enter number of drinks 

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics 

for employee health management, https://herohealth.org/wp-content/uploads/2015/02/HEROPHA-Metrics-Guide-FINAL.pdf.

Risky Drinking 

Q55. During the past year, how often have you had more than four drinks if you 

are a male, or more than three drinks if you are a female, on any single day? 

(One drink = one beer, glass of wine, shot of liquor, or mixed drink.)

 Never

 Once (1 day)

 A few times (2–3 days)

 Often (more than 3 days)

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics 

for employee health management, https://herohealth.org/wp-content/uploads/2015/02/HEROPHA-Metrics-Guide-FINAL.pdf.

Healthy Diet

Q56. Think of the foods that are a part of your normal diet. How many servings 

of fruits and vegetables do you eat in a normal day? 

(One serving is any of the following: 1 cup raw leafy greens [about the size of a 

small fist]; 1⁄2 cup of other vegetables [cooked or raw]; 1 medium piece of fruit 

[about the size of a baseball]; 1/2 cup chopped, cooked, or canned fruit; or 3⁄4 

cup vegetable or fruit juice.)

 Less than 1 serving

 1 serving

 2 servings

 3 servings

 4 servings

 5 or more servings

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics

 for employee health management, https://herohealth.org/wp-content uploads/2015/02/HERO

PHA-Metrics-Guide-FINAL.pdf.

Sleep Hours 

Q57. How many hours of sleep do you usually get at night? If you are a shift 

worker, how many hours of sleep do you get a day? 

 6 or fewer hours

 7 hours

 8 hours

 9 or more hours

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics

 for employee health management, https://herohealth.org/wp-content uploads/2015/02/HERO

PHA-Metrics-Guide-FINAL.pdf.
NIOSH WellBQ

75

NIOSH WellBQ Item Source

Sleepy at Work

Q58. In the past 7 days, how often have you felt sleepy while at work?

 Never

 Rarely

 Sometimes

 Usually

 Always 

Health Enhancement Research Organization and 

Population Health Alliance [2015]. Program 

measurement and evaluation guide: core metrics

 for employee health management, https://herohealth.org/wp-content uploads/2015/02/HERO

PHA-Metrics-Guide-FINAL.pdf.

Cognitive Functioning Limitations

Q59. Because of a physical, mental, or emotional condition, do you have serious 

difficulty concentrating, remembering, or making decisions?

 Not at all

 Slightly

 Moderately

 Extremely

 Does not apply/do not have condition

Centers for Disease Control and Prevention [2014]. 

Behavioral Risk Factor Surveillance System 

Questionnaire, http://www.cdc.gov/brfss/

questionnaires/pdf-ques/2014_brfss.pdf.

Work Limitations

Q60. Are you limited in the kind or amount of work you can do because of a 

physical, mental, or emotional problem?

 Not at all

 Slightly

 Moderately

 Extremely

 Does not apply/do not have problem

Centers for Disease Control and Prevention [ND]. 

National Health and Nutrition Examination Survey.

National Center for Health Statistics, https://www.

cdc.gov/nchs/nhanes/.
76

NIOSH WellBQ

NIOSH WellBQ Item Source

Productivity

Q61. [Grid] In the past month...

Responses in rows:

A. How often did you not concentrate enough on your work?

B. How often did you find yourself not working as carefully as you should? 

C. How often did you not work at times when you were supposed to be 

 working? 

D. How often did you get less done than other workers? 

Responses in column: 

 Never

 Almost never (one time a month)

 Rarely (once a week or less)

 Sometimes (a few times a week)

 Often (once a day)

 Very often (a few times a day)

 Always (every hour)

The World Health Organization Health and Work 

Performance Questionnaire (HPQ) [2010], http://

www.hcp.med.harvard.edu/hpq/info.php.

Work-related Injury 

Q62. During the past 12 months, did you experience any work-related injuries?

 Yes

 No

New item

Injury Consequence

Q63. If you experienced any work-related injuries in the past 12 months, did any 

of them require any first aid or medical treatment, change in job activities, 

or lost time from work?

 No

 Yes

 Does not apply/was not injured in the past 12 months 

New item

Section 5: Home, Community, and Society

Life Satisfaction 

Q64. In general, how satisfied are you with your life?

 Not at all satisfied

 Not too satisfied

 Somewhat satisfied

 Very satisfied

Centers for Disease Control and Prevention [2014].

Behavioral Risk Factor Surveillance System 

Questionnaire, http://www.cdc.gov/brfss/

questionnaires/pdf-ques/2014_brfss.pdf.
NIOSH WellBQ

77

NIOSH WellBQ Item Source

Financial Insecurity 

Q65. How worried are you right now about not being able to maintain the 

standard of living you enjoy?

 Not worried at all

 Not too worried

 Moderately worried

 Very worried

Centers for Disease Control and Prevention [ND].

National Health Interview Survey: NHIS Data,

Questionnaires and Related Documentation, 

http://www.cdc.gov/nchs/nhis/dataquestionnaires-documentation.htm.

Q66. How worried are you right now about not having enough income to pay 

your normal monthly bills?

 Not worried at all

 Not too worried

 Moderately worried

 Very worried 

Centers for Disease Control and Prevention [ND].

National Health Interview Survey: NHIS Data, 

Questionnaires and Related Documentation, 

http://www.cdc.gov/nchs/nhis/dataquestionnaires-documentation.htm.

Support Outside of Work 

Q67. How often do you get the social and emotional support you need from 

friends, family, or others outside of work?

 Never

 Rarely

 Sometimes

 Always

Centers for Disease Control and Prevention [2014]. 

Behavioral Risk Factor Surveillance System 

Questionnaire, http://www.cdc.gov/brfss/

questionnaires/pdf-ques/2014_brfss.pdf.
78

NIOSH WellBQ

NIOSH WellBQ Item Source

Activities Outside of Work

Q68. [Grid] In general, how often do you take part in any of the following 

activities outside of work?

Statements in row:

A. Voluntary or charitable activities

B. Domestic caregiving activities (for example, children, elderly or disabled

 relatives/friends, but not in a volunteer or charity setting)

C. Home maintenance tasks (for example, cooking, cleaning, repairs)

D. Socializing with friends, family, others

E. Taking training or education courses

F. Sporting, cultural, or leisure activities

G. Relaxation or planned solitary activities

Responses in column:

 Never

 Almost never (a few times a year or less)

 Rarely (Once a month or less)

 Sometimes (a few times a month)

 Often (once a week)

 Very often (a few times a week)

 Always (every day)

 Does not apply

Items 68A, 68B, 68E, and 68F: 

European Foundation for the Improvement of 

Living and Working Conditions [2015]. 6th 

European Working Conditions Survey (EWCS): 

questionnaire, http://www.eurofound.europa.

eu/sites/default/files/page/field_ef_

documents/6th_ewcs_2015_final_source_

master_questionnaire.pdf. (Permission is not 

needed to use items from the EWCS, as noted on 

the website.)

Items 68C, 68D, and 68G are new.
NIOSH WellBQ

79

Optional Employment Item Source

Work Arrangement

E1. How would you describe your work arrangement in your job? 

 I am an independent contractor, independent consultant, or a freelance 

worker.

 I am on call and work only when called to work.

 I am paid by a temporary agency.

 I work for a contractor who provides workers and services to others 

under contract.

 I am a regular, permanent employee.

Centers for Disease Control and Prevention [2010]. 

Quality of Worklife Questionnaire, http://www.cdc.

gov/niosh/topics/stress/qwlquest.html. 

Work Status

E2. Is your job full-time or part-time? 

 Full-time 

 Part-time

New item

Job Tenure 

E3. How long have you worked in your job?

 Less than 1 year

 1–5 years

 6–10 years

 10–20 years

 More than 20 years

New item

Occupation

E4. Select the occupation that best describes the kind of work you do in your job. 

[For full response list, please refer to the instrument]

U.S. Census Bureau [2010]. 2010 Census 

occupation codes with crosswalk. Download from 

the list at https://www.census.gov/topics/

employment/ industry-occupation/guidance/

code-lists.html.

Industry or Business

E5. Select the kind of industry or business you work in for your job. 

 [For full response list, please refer to the instrument]

U.S. Census Bureau [2012]. Census 2012 detailed

industry code list. Download from the list at 

https://www.census.gov/topics/employment/

 industry-occupation/guidance/code-lists.html.
80

NIOSH WellBQ

Optional Demographic Item Source

Age

D1. What is your age? 

 18–29

 30–44

 45–64

 65 and older

New item

Education

D2. What is the highest level of school you have completed or the highest degree 

you have received? 

 Less than high school 

 High school/GED

 Some college

 Bachelor’s degree or higher

New item

Ethnicity

D3. Do you consider yourself to be Hispanic or Latino?

 Yes

 No

 Refused

 Don’t know

Centers for Disease Control and Prevention [ND].

National Health Interview Survey: NHIS Data, 

Questionnaires and Related Documentation, 

http://www.cdc.gov/nchs/nhis/dataquestionnaires-documentation.htm.

Race

D4. What race or races do you consider yourself to be? Please select one or more 

of these categories.

 White

 Black/African American

 American Indian

 Alaska Native

 Native Hawaiian

 Other Pacific Islander

 Asian

 Some other race

 Refused

 Don’t know

Centers for Disease Control and Prevention [ND].

National Health Interview Survey: NHIS Data, 

Questionnaires and Related Documentation, 

http://www.cdc.gov/nchs/nhis/dataquestionnaires-documentation.htm.
NIOSH WellBQ

81

Optional Demographic Item Source

Sex

D5. Are you male or female?

 Male

 Female

 Refused

 Don’t know

Centers for Disease Control and Prevention [ND].

National Health Interview Survey: NHIS Data, 

Questionnaires and Related Documentation, 

http://www.cdc.gov/nchs/nhis/dataquestionnaires-documentation.htm.

Sexual Orientation

D6. Do you think of yourself as gay/lesbian or gay; straight, that is, not gay/

lesbian; bisexual; something else; or you don’t know the answer?

 Gay/lesbian

 Straight, that is, not gay/lesbian

 Bisexual

 Something else

 I don’t know the answer

 Refused

 Don’t know

Centers for Disease Control and Prevention [ND].

National Health Interview Survey: NHIS Data, 

Questionnaires and Related Documentation, 

http://www.cdc.gov/nchs/nhis/dataquestionnaires-documentation.htm.

Household Income

D7. What was your entire household income last year, before taxes?

 <$20,000

 $20,000 to $34,999

 $35,000 to $49,999

 $50,000 to $74,999

 $75,000 to $99,999

 $100,000 to $149,999

 $150,000 to $199,999

 $200,000 or more

New item

Head of Household 

D8. Are you the head of your household? 

 Yes

 No

New item
82

NIOSH WellBQ

Optional Demographic Item Source

Marital Status

D9. What is your current marital status? 

 Married or living with partner

 Widowed

 Divorced 

 Separated 

 Never married

New item

Dependents

D10. How many dependents currently live in your household? Please enter the 

 total number in each age category. 

A. Total number of household members age 0 to 5 

B. Total number of household members age 6 to 12 

C. Total number of household members age 13 to 17 

D. Total number of household members age 18 or older 

New item
NIOSH WellBQ

83
Promoting productive workplaces through safety and health research

DHHS (NIOSH) Publication No. 2021-110 (revised 5/2021)

DOI: https://doi.org/10.26616/NIOSHPUB2021110revised52021