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9
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1
What was your loss?
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Spouse
Child
Sibling
Health/Mobility
Parent
Divorce
Retirement/Empty Nest
Pet
Multiple
Other
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2
After your loss, how soon did you return to work?
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Right away
2-4 Weeks
3 Months
6 Months
9 Months
1 Year
2 Years
3 Years
Didn't go back
Other
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3
What strategies did you use to cope with your loss?
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Journalling
Talking with a friend
Relaxing with a glass of wine
Emotional Eating
Exercise
Walking in nature
Counselling
Working
Keeping to myself
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4
What did you have to avoid when you returned to work?
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Co-workers
Boss
Overtime
Paperwork
Computer work
Socializing outside of work
Interruptions
Deadlines
Meetings
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5
What was easy when you returned to work?
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Having co-workers around me
Having the support of my boss
Keeping busy
Losing myself in my work
Having a routine every day
Doing what I love to do
Feeling accomplished
Not having to be at home
Turning my phone off & the world
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6
What was difficult when you returned to work?
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Concentration
Focus
Speaking to people
Dealing with my boss
Socializing
Deadlines
Memory
Making decisions
Distractions/Interruptions
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7
What is your biggest challenge with your grief?
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Always crying
Can't focus enough to go back to work
I want to be left alone
I want to know when the pain will end
I just want to get on with my life
Worried about my kids
Can't keep up with life's demands
I'm always angry and irritable
I'm good, I just want to check in
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8
Name
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First Name
Last Name
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9
Email
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example@example.com
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10
Lead Type
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