1
1. Overall, how would you rate your health during the past 4 weeks?
Excellent Very good Good Fair Poor Very poor
2. During the past 4 weeks, how much did physical health problems limit your usual physical activities (such as walking or climbing stairs)?
Not at all Very little Somewhat Quite a lot Could not do
physical activities
3. During the past 4 weeks, how much difficulty did you have doing your daily work, both at home and away from home, because of your physical health?
None at all A little bit Some Quite a lot Could not do daily work
4. How much bodily pain have you had during the past 4 weeks?
None Very mild Mild Moderate Severe Very Severe
5. During the past 4 weeks, how much energy did you have? Very much Quite a lot Some A little None
6. During the past 4 weeks, how much did your physical health or emotional problems limit your usual social activities with family or friends?
Not at all Very little Somewhat Quite a lot Could not do
social activities
7. During the past 4 weeks, how much have you been bothered by emotional problems (such as feeling anxious, depressed or irritable)?
Not at all Slightly Moderately Quite a lot Extremely
8. During the past 4 weeks, how much did personal or emotional problems keep you from doing your usual work, school or other daily activities?
Not at all Very little Somewhat Quite a lot Could not do
daily activities
SF-8
2
WLQ
1. In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following? (Mark one box on each line a. through e.)
All of the Time (100%)
Most of the Time
Some of the Time (About 50%)
A Slight Bit of
the Time
None of the Time
(0%)
Does Not
Apply to My Job
a. work the required number of hours
1 2 3 4 5 0
b. get going easily at the beginning of the workday
1 2 3 4 5 0
c. start on your job as soon as you arrived at work
1 2 3 4 5 0
d. do your work without stopping to take breaks or rests
1 2 3 4 5 0
e. stick to a routine or schedule 1 2 3 4 5 0
These questions ask you to rate the amount of time you had difficulty handling certain parts of your job. Please read and answer every question. Then choose a response.
Mark the “Does Not Apply to My Job” box only if the question describes something that is not part of your job. If you have more than one job, report on your main job only.
Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book.
Time limitations
3
WLQ
All of the Time
(100%)
Most of the Time
Some of the Time (About 50%)
A Slight Bit of the
Time
None of the Time
(0%)
Does Not Apply to My Job
a. walk or move around different work locations (for example, go to meetings) . . . . . . . . . .
1 2 3 4 5 0
b. lift, carry, or move objects at work weighing more than 10 lbs. . . . . . . . . . . .
1 2 3 4 5 0
sit, stand, or stay in one position for longer than 15 minutes while working . . . . . . . . . . . . . .
1 2 3 4 5 0
d.repeat the same motions over and over again while working . . . . . . . . . . . . . .
1 2 3 4 5 0
e.bend, twist, or reach while working . . . . . . . . . . . . . .
1 2 3 4 5 0
f.use hand-held tools or equipment (for example, a phone, pen, keyboard, computer mouse, drill, hairdryer, or sander) . . . . .
1 2 3 4 5 0
These questions ask you to rate the amount of time you were able to handle certain parts of your job without difficulty.
2. In the past 2 weeks, how much of the time were you ABLE TO DO the following without difficulty caused by physical health or emotional problems?
Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book.
Physical limitations
4
These questions ask about difficulties you may have had at work.
3. In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following?
(Mark one box on each line a. through f.)
All of the Time
(100%)
Most of the Time
Some of the Time (About 50%)
A Slight Bit of the
Time
None of the Time
(0%)
Does Not Apply to My Job
a. keep your mind on your work . . . . . . . . . . . . . . . . .
1 2 3 4 5 0
b. think clearly when working . . . . . . . . . . . . . .
1 2 3 4 5 0
c. do work carefully . . . . . . . 1 2 3 4 5 0
d. concentrate on your work . . . . . . . . . . . . . . . .
1 2 3 4 5 0
e. work without losing your train of thought . . . . . . . . .
1 2 3 4 5 0
f. easily read or use your eyes when working . . . . . .
1 2 3 4 5 0
WLQ
Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book.
Mental limitations
5
WLQ
The next questions ask about difficulties in relation to the people you came in contact with while working. These may include employers, supervisors, coworkers, clients, customers, or the public.
4. In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following?
(Mark one box on each line a. through c.)
All of the Time
(100%)
Most of the Time
Some of the Time (About 50%)
A Slight Bit of the
Time
None of the Time
(0%)
Does Not Apply to My Job
a. speak with people in-person, in meetings or on the phone . . . . . . . . . . . . .
1 2 3 4 5 0
b. control your temper around people when working . . . .
1 2 3 4 5 0
c. help other people to get work done . . . . . . . . . . . . .
1 2 3 4 5 0
These questions ask about how things went at work overall. 5. In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following?
(Mark one box on each line a. through e.)
All of the Time
(100%)
Most of the Time
Some of the Time (About 50%)
A Slight Bit of the
Time
None of the Time
(0%)
Does Not Apply to My Job
a. handle the workload . . . . . 1 2 3 4 5 0
b. work fast enough . . . . . . . 1 2 3 4 5 0
c finish work on time . . . . . . 1 2 3 4 5 0
d. do your work without making mistakes. . . . . . . .
1 2 3 4 5 0
e. feel you’ve done what you are capable of doing. . . . .
1 2 3 4 5 0
Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book.
Interpersonal limitations
Output limitations
6
Average Before and After SF-8 Scale Score Results:
sample
49.4% 49.6% 50.5% 50.0% 51.3% 51.1%52.6% 53.3%
49.7% 50.6% 50.6% 51.1%49.2%
51.3%49.0% 49.9%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
First Last First Last First Last First Last First Last First Last First Last First Last
GeneralHealth
PhysicalFunctioning
RolePhysical
Bodily Pain Vitality SocialFunctioning
MentalHealth
RoleEmotional
Perce
nt of
SF-8
Scale
Scor
es
7
Average Before and After SF-8 Summary Score Results : sample
52.2% 51.8%49.4%
51.7%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
First Last First Last
Physical Component Summary Mental Component Summary
Perce
nt of
SF-8
Summ
ary Sc
ores
http://www.sf-36.org/demos/SF-8.htmlBest: 58.6, 59.3
Worst: 19.5, 17.9
8
WLQ Survey Results: sample
8.8%
6.9%
9.4% 9.4%9.6%
7.9%
5.5% 5.4%
8.3%
7.4%
0%
2%
4%
6%
8%
10%
12%
First Last First Last First Last First Last First Last
Physical Demands*Time ManagementMental/Interpersonal
Demands*
Output DemandsOverall WLQ Score*
Per
cen
t o
f Im
pai
rmen
t
* P-Value Significance ≤ 0.05
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