Date of Assessment: [Date]

Introduction & Instructions

Welcome to the Mental Health Assessment for [Your Company Name]. This instrument is designed to evaluate your mental wellbeing against a set of criteria or standards. We understand that mental health is a complex and nuanced subject, so please be assured that your responses will remain private and confidential.

You will encounter a variety of question types including multiple-choice questions, short answer questions, and others. Please answer each question as honestly and accurately as possible, considering how you have been feeling over the recent weeks. There are no right or wrong answers.

Section 1: Self-Perception

1. During the past week, how often have you felt happy?

• Never

• Rarely

• Sometimes

• Often

• Almost always

2. How would you rate your self-esteem currently?

• Very low

• Low

• Moderate

• High

• Very high

Short Answer:

Please describe a recent situation that significantly affected your mood or feelings. ___________________________________________________________________

Section 2: Interpersonal Relationships

1. How satisfied are you with the relationships in your life currently?

• Not at all satisfied

• Slightly satisfied

• Somewhat satisfied

• Very satisfied

• Extremely satisfied
  

2. How often do you feel isolated or alone?

• Never

• Rarely

• Sometimes

• Often

• Almost always

Short Answer:

Provide a brief explanation of a recent interaction that left you feeling emotionally affected, positively or negatively. ______________________________________________

Section 3: Coping with Stress

1. How often do you feel overwhelmed by stress or anxiety?

• Never

• Rarely

• Sometimes

• Often

• Almost always
  

2. What are your main sources of stress? (Select all that apply)

• Work/Job

• Finances

• Relationships

• Health

• Other

Short Answer:

Please describe your typical response when you face a high-stress situation. ________________________________________________________________________________

Please note, this assessment is not a diagnostic tool, but a means for [YOUR COMPANY NAME] to better understand and support employee mental wellbeing. If you are experiencing acute mental health issues, we strongly encourage you to seek professional help and inform the relevant person(s) within the organization.

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