Burnout. A survey for women.

This survey aims to assess the prevalence of burnout among all women, regardless of age, race, motherhood-status and employment-status. We aim to identify contributing factors and evaluate support systems in order to generate recommendations for individuals and organizations.

Confidentiality Assurance:

Your responses are confidential and will only be used for research purposes. No personally identifiable information will ever be disclosed.

Your Contribution Matters:

Your participation is instrumental in advancing our understanding of burnout among women and informing potential solutions. At the end of this research, we will share the findings with you via email.

Thank you for your time and consideration!

Sign in to Google to save your progress. Learn more
Demographic Information
Do you identify as a woman?
Clear selection
Age
Where have you lived for the longest time during the past five years?
Marital Status
Employment Status
Number of children
Age of youngest child
Burnout - An assessment
On a scale of 1 (not at all) to 10 (completely), how close to burnout are you currently?
Clear selection
How many times have you described yourself as 'Burnt Out' over the past 15 years?
Compare your proximity to feeling 'burnt out' now to what you experienced before the Covid-19 Pandemic.

Has your proximity to burnout increased or decreased since pre-Covid?
What are the biggest contributing factors to your answer above?
Are you currently on medication or medical treatment for burnout symptoms?
Clear selection
What words do you most attribute to the concept of 'burnout'? Select all that apply.
What words did we not include in the list above that can describe that feeling of being 'burnt out'?
What do you see as the main causes of Burnout
Have you ever sought medical or professional help for burnout? 
Clear selection
In general, how satisfied are you with your life right now?
Severely Dissatisfied
Extremely Satisfied
Clear selection
What changes or initiatives do you believe would be most beneficial in reducing burnout among women?
Your response is completely anonymous. If you'd like a copy of the results of the study sent to you, please add your email address below.
THANK YOU!
We appreciate the time you took to answer our questions. With your input we can create and share better tools to help women deal with burnout.

For more on the work we do, visit www.mormentum.me

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report