QUESTIONNAIRE

(Adapted from Burnout: Maslach, C., & Jackson, S.E. (1981). The Measurement of Experienced
Burnout. Journal of Organizational Behavior, 2(2).99-113
Revised by: Godoy, A. & Allen, N. (2017))

I. PROFILE

AGE:
SEX:____Male ____Female
Years in Service:

II. WORKPLACE ATTITUDES

Mark the box that most accurately reflects your response. Use a scale where 0= never
and 6= everyday. Please check only one box for each statement.

NEVER A FEW ONCE A A FEW ONCE A A FEW EVERY

TIMES MONTH TIMES WEEK TIMES DAY
PER PER PER
YEAR MONTH WEEK
0 1 2 3 4 5 6
EE1. I feel emotionally drained by
my job.
EE2. At the end of the workday I
feel used up.
EE3. I feel fatigued when I get up in
the morning and have to face
another day in the job.
EE4. Working with people all day
long requires a great deal of effort.
EE5. I feel burned out from my
work.
EE6. I feel frustrated by my work.
EE7. I feel work too hard at my job.
EE8. It stresses me too much to
work in direct contact with people.
EE9. I feel like I’m at the end of my
rope.
DP1. I feel I treat some clients
impersonally, as if they are objects.
DP2. I have become more
insensitive to people since I’ve been
working.
DP3. I’m afraid that this job is
hardening me emotionally.
DP4. I really don’t care about what
happens to some of my clients.
DP5. I have the impression that my
clients make me responsible for
some of their problems.
PA1. I am easily able to understand
that my clients feels.
PA2. I look after my clients’
problems very effectively.
PA3. Through my work, I feel that I
have a positive influence on people.
PA4. I feel full of energy.
PA5. I am easily able to create a
relaxed atmosphere with my clients.
PA6. I feel refreshed when I have
worked closely with my clients.
PA7. I accomplish many worthwhile
things in this job.
PA8. In my work, I handle
emotional problems very calmly.
III. Spirituality
Please indicate how much you agree with the following statements. Use a scale where
1= Strongly Disagree, 3= Neutral and 5= Strongly Agree. Please check only one box
for each statement.

Strongly Disagree Neutral Agree Strongly

Disagree 2 3 4 Aagree
1 5
S1. In the future, science will be
able to explain everything.
S2. I can find meaning in times of
hardship.
S3. A person can be fulfilled
without pursuing an active spiritual
life.
S4. I am thankful for all that has
happened to me.
S5. Spiritual activities have not
helped me become closer to other
people.
S6. Some experiences can be
understood only through one’s
spiritual beliefs.
S7. A spiritual force influences the
events in my life.
S8. My life has a purpose.
S9. Prayers do not really change
what happens.
S10. Participating in spiritual
activities helps me forgive other
people.
S11.My spiritual beliefs continue to
evolve.
S12. I believe there is power greater
than myself.
S13. I probably will not re-examine
my spiritual belief.
S14. My spiritual life fulfills me in
ways that material possessions do
not.
S15. Spiritual activities have not
helped me develop my identity.
S16. Meditation does not help me
feel more in touch with my inner
spirit.
S17. I have a personal relationship
 with a power greater than me.
S18. I have felt pressured to accept
spiritual beliefs that I do not agree
with.
S19. Spiritual activities help me
draw closer to a power greater than
myself.
S20. When I wrong someone, I
make an effort to apologize.
S21. When I am ashamed of
something I have done, I tell.
S22. I solve all my problems
without using spiritual resources.
S23. I examine my actions to see if
they reflect my values.

S24. During Last Week I prayed… (only check one):

_____ 10 or more times
_____ 7-9 Times
_____ 4-6 Times
_____ 1-3 Times
_____ 0 Times

S25. During Last Week I meditated… (only check one):

_____ 10 or more times
_____ 7-9 Times
_____ 4-6 Times
_____ 1-3 Times
_____ 0 Times

S26. Last MONTH, I participated in spiritual activities with at least one other
person… (only check one):
_____ More than 15 times
_____ 11-15 Times
_____ 6-10 Times
_____ 1-5 Times
_____ 0 Times