Stress Management Report Form AM3

STRESS MANAGEMENT REPORT FORM (AM3)

Stress Management report form – AM3
What is stress?
Stress is the adverse reaction people have to excessive pressures or other types of demand placed on them. There is a clear distinction between pressure, which can create a ‘buzz’ and be a motivating factor, and stress which can occur when this pressure becomes excessive and prolonged. If left unaddressed stress may lead to ill health. The main symptoms of stress are:

Lack of concentration at home and work
Impaired sleep
Feeling tense, keyed up, on edge, worrying about things
Feeling depressed, bouts of crying

Palpitations, headache, backache, breathing difficulties
Panic attacks
Poor appetite
Decreased energy, fatigue

There are a number of things you can do yourself to alleviate symptoms of stress. If your well-being is adversely affected you may wish to visit your GP. For additional support please see attached list of support agencies.
When should I complete this form?
If you believe that you are displaying symptoms of stress, whether or not you have been absent from work, and you believe the symptoms are:
a)Work-related, you must complete this form to enable the situation to be reviewed and see if reasonable steps can be taken to resolve the problems.
b)Not work-related i.e. personal reasons and / or life events, you may wish to complete this form to enable your situation to be reviewed and see if reasonable steps can be taken to relieve the pressure for example by temporarily changing shifts to enable you to provide care / support at home.
Please note that the following information is confidential and any information provided will be used to identify any sources of pressure and will allow priority issues to be identified and action taken accordingly. On completion please forward to HR (in a sealed envelope).
Name. / Dept.
Employee Number / Contact number
Email Address / Line manager name.
Would you be prepared to discuss your concerns with your Line Manager? / Yes / No
If NO to the previous question,
Would you discuss your concerns with an HR Adviser? / Yes / No
Do you believe your symptoms to be work-related? / Yes / No
Please note that if you wish you can arrange this confidential service by telephoning the Employee Helpline on 0800 882 4102. Your call will always be answered by an advisor who will offer help and support in a professional, friendly and non-judgemental manner.
If YES to the previous question, do you consider it is due to:
Unacceptable behaviour by your Line Manager / Yes / No
Unacceptable behaviour by your colleagues / Yes / No
Unacceptable behaviour of others / Yes / No
Excessive workload demands / Yes / No
Lack of control over the way you do your job / Yes / No
Confusion over your role or conflicting roles. / Yes / No
Other reason. Please detail.
Briefly describe the reason(s) you consider has brought on work related stress:
USEFUL CONTACT DETAILS
The following list includes organisations, internet sites, email addresses and telephone numbers that may be of benefit to you at this time.
Human Resources / / 01835 825052/53
Cruse (Bereavement Care) / / 0870 167 1677
mailto:
Eating Disorders Association / / 0845 634 1414
mailto:
Gingerbread (one parent families) / / 0800 018 4318
Health Information Services / 0800 665 544
Marriage Counselling (Scotland) / 0131 225 5006
MIND / / 0845 766 0163
Narcotics Anonymous / / 020 7730 0009
NHS 24 / 0800 334 488
NHS Direct / / 0845 4647
Pain Concern UK / / 01620 822572
mailto:
Relate – National HQ (Relationships) / / 01788 573241
Samaritans / / 08457 909090
mailto:
Scottish Association for Mental Health / 0131 225 5006
Stresswatch Scotland / / 01563 574144
Terence Higgins Trust / 0845 1221 200
Alcoholics Anonymous / 0845 769 7555

AM3 – September 2014