Productivity & Burnout Index (PBI)
Name
First Name
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Administration
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Aviation and Aerospace
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Business Name/Job Title
Work Environment
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Office-based
Remote
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Other
Please select today's date.
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Month
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Day
Year
Date
Gender
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Prefer not to answer
Productivity: How would you rate your level of productivity now?
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Burnout: How would you rate your degree of burnout now?
None
1
2
3
4
Very High
5
1 is None, 5 is Very High
Task Management: How effectively do you manage your daily tasks?
Not effective
1
2
3
4
Very effective
5
1 is Not effective, 5 is Very effective
Time Management: How often do you complete your work tasks within the allocated time?
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Focus and Concentration: How frequently do you find yourself getting distracted during work hours?
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Emotional Exhaustion: How often do you feel emotionally drained from your work?
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Depersonalization: Do you often find yourself feeling disconnected from your work?
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
Work-Life Balance: How satisfied are you with your current work-life balance?
Very Dissatisfied
1
2
3
4
Dissatisfied
5
1 is Very Dissatisfied , 5 is Dissatisfied
Quality of Sleep: Rate the quality of your sleep on a typical night
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor , 5 is Excellent
Quality of Diet: Rate the quality of your eating habits on a typical day
Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
Fitness: How often do you exercise currently (in number of days per week)?
1
2
3
4
5
6
7
1 is , 7 is
Current Stress Level: On a scale of 1-10, how would you rate your typical stress level?
None
1
2
3
4
5
6
7
8
9
High Stress
10
1 is None, 10 is High Stress
Motivation Factors: What factors most motivate you to be productive at work?
Self-Evaluation: How do you currently manage challenges related to productivity?
Burnout Symptoms: Describe any symptoms of burnout or excessive stress you have experienced
Self-Evaluation: How do you currently manage challenges related to burnout?
Productivity Challenges: What are the biggest challenges you face in being productive?
Video upload of reflection on this challenge (i.e. how this challenge impacted/influenced your day-to-day habits & productivity, difficult parts, easy parts, what your next steps may be after this to continue to grow, etc).
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