SVMH/STAGE-28 Mental Health Portal (Sept 22)

Mental Health and Wellbeing Survey

Thank you for providing your consent to participate in the STAGE-28 survey at St Vincent’s Hospital Melbourne. If you wish to withdraw at any time, please let us know, and your data will be traced and, where possible, deleted. Contact details, further information and how to raise concerns appear on the Participant Information which can be downloaded here.

Agree to consent

Agree

Disagree

If you do not agree to consent please do not continue completing the questions.

Create your unique Code/ID: *

Two initials plus 4-digit birthday and month For example: for Joe Smith born 24/08/77 enter: ‘JS2408’

Email address: *

Age:

Gender:

Do you identify as Aboriginal or Torres Strait Islander?

Yes

No

Were you, or one of your parents, born overseas?

Yes

No

Do you speak a language other than English?

Yes

No

Years of Service at SVHM:

What is your work/job role at St Vincent’s Hospital?

Which setting do you work in?

Inpatient

Outpatient

Community

My work does not involve direct patient care

What is your typical work shift?

Days

Nights

A combination

Are you qualified in your patient area?

Yes

No

Not applicable

Are you a STAR peer support member?

Yes

No

Are you a graduate student?

Yes

No

In the last 12 months did you…

..work in Covid-19 related areas?

Yes

No

Prefer not to disclose

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..work from home?

Yes

No

Prefer not to disclose

Paragraph

Were you ever quarantined?

Yes

No

Prefer not to disclose

Paragraph

Did you care for a patient with Covid-19?

Yes

No

Prefer not to disclose

Paragraph

Did you care for anyone who died?

Yes

No

Prefer not to disclose

Paragraph

Did you contract Covid-19 yourself?

Yes

No

Prefer not to disclose

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In the last few weeks what has contributed to you feeling better about your work or role?

In the last few weeks what has contributed to you feeling worse about your work or role?

Is there anything you would like to see change ahead of future major incidents, including Covid-19?

SVHM/STAGE-28 Mental health Portal

Demographics

Mental Health and Wellbeing Survey

In the last 12 months did you…