People's problems sometimes affect their ability to do certain day-to-day tasks in their lives. To rate your problems, look at each section and determine on the scale provided (0 to 8) how much your problem impairs your ability to carry out the activity.
WORK
Not at all - 0
Slightly - 2
Definitely - 4
Markedly - 6
Very severely - 8
HOME MANAGEMENT - Cleaning, tidying, shopping, cooking, looking after home/children, paying bills etc.
Not at all - 0
Slightly - 2
Definitely - 4
Markedly - 6
Very severely - 8
SOCIAL LEISURE ACTIVITIES - With other people, e.g. parties, outings, entertaining etc.
Not at all - 0
Slightly - 2
Definitely - 4
Markedly - 6
Very severely - 8
PRIVATE LEISURE ACTIVITIES - Done alone, e.g. reading, gardening, sewing, hobbies, walking etc.
Not at all - 0
Slightly - 2
Definitely - 4
Markedly - 6
Very severely - 8
FAMILY AND RELATIONSHIPS - Form and maintain close relationships with others including the people that I live with.
Not at all - 0
Slightly - 2
Definitely - 4
Markedly - 6
Very severely - 8
In case you have answered Definitely/Markedly/Very Severely to any of the above questions, please state the reason in the box below:
Thank you for filling "Work and Social Adjustment Screener
Please add your five rating scores above to understand your current severity, as per below ranges:
Above 20: Moderately severe or Severe impairment
Between 10 and 20: Moderate, Significant functional impairment
Below 10: None or Mild impairment
Do share any other feedback in the box below, and press “submit”: The anonymous results will be aggregated and shared with the HR team for further action.
