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WAI Online Questionnaire (short version)


 

The Work Ability Index (WAI) contains questions concerning your work, your work ability and your health. Your answers help you at the final conclusion whether measures for improving your health have to be taken and if your work ability must be improved. Please fill in the questionnaire thoroughly and answer all questions.
 

Your data will never be saved.

 

Is your work:
psychologically demanding?
physically demanding?
physically and psychologically demanding?
 
1. Current work ability compared to highest work ability ever:
  Assume that your work ability at its best has a value of 10 points. How many points would you give your current work ability?
(0 means that you currently cannot work at all)
  0 1 2 3 4 5 6 7 8 9 10
  completely unable to work   work ability at its best
 
2. Work ability in relation to demands
  How do you rate your current work ability with respect to the physical demands of your work?

 

very good

rather good

 moderate 

rather poor

very poor

  How do you rate your current work ability with respect to the mental demands of your work?
 
very good
rather good
 moderate 
rather poor
very poor
 
3.

Current diseases
In the following list, mark your current diseases or injuries. Also indicate whether a physician has diagnosed or treated these diseases.

  Yes, own opinion Yes, physician's diagnosis No
01

Injury due to an accident

(e.g. in back or limbs, or burns)

02

Musculoskeletal disease in back, limbs or other part of the body

(e.g. repeated pain in joint or muscle, sciatica, rheumatism, arthritis)

03

Cardiovascular disease

(e.g. hypertension, coronary heart disease)

04

Respiratory disease

(e.g. repeated infections of the respiratory tract, bronchial asthma, emphysema)

05

Mental disorder

(e.g. depression, “burn-out”, anxiety or insomnia)

06

Neurological or sensory disease

(e.g. hearing or visual disease, migraine, epilepsy)

07

Digestive disease / condition

(e.g. gastritis, gall stones, liver or pancreatic disease, repeated constipation)

08

Genitourinary disease

(e.g. infection in urinary tract, gynecological disease or prostate)

09

Skin disease

(e.g. allergic or other rash, varicose veins)

10

Tumour or cancer

11

Endocrine or metabolic disease

(e.g. diabetes, severe obesity or gout)

12

Blood diseases

(e.g. anemia, other blood disorder or defect)

13

Birth defects

14

Other disorder or disease

 
4.

Estimated work impairment due to diseases

  Is your illness or injury a hindrance to your current job?
Circle more than one alternative if needed.
 

There is no hindrance / I have no diseases.

I am able to do my job, but it causes some symptoms.

 I must sometimes slow down my work pace or change my work methods.

 I must often slow down my work pace or change my work methods.

Because of my condition, I feel I am able to do only part time work.

In my opinion I am entirely unable to work.

5. Illness within last year (12 months)
  During the last 12 months: how many whole days have you been off work because of:
 
none
 max. 9 days
 10 - 24 days
 25 - 99 days 
 100 - 354 days
6. Estimation of own work abiliy in 2 years
  Do you believe, according to your present state of health, that you will be able to do your current job two years from now?
 
unlikely   not certain relatively certain
7. Mental capacities
  Considering the last three months: Have you been able to enjoy your regular daily activities?
 
often  rather often  sometimes  rather seldom  never
  Considering the last three months: Have you been active and alert?
 
always rather often sometimes  rather seldom  never 
  Considering the last three months: Have you felt yourself to be full of hope about the future?
 
continuously  rather often  sometimes  rather seldom  never 
 

Before calculating your WAI, please consider the following relations:

The estimated value describes the relation between your current condition to your demands at work.

A high value means that this relation is OK; a low value indicates that this relation is out of order.

However, this does not give any hints on the reasons for the disorders.

 

 
 
 
 
 
 
 
 



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