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Health and Wellbeing 3 Month Questionnaire
Module 6 - 3 Month Followup
Name
First
Last
Knowledge
How would you rate your level of knowledge on: (0 - Don't Know, 1 - Very Low, 5 - Very High)
What is meant by health and well-being
0
1
2
3
4
5
(0 - Don't Know, 1 - Very Low, 5 - Very High)
Improving and maintaining your health and well-being
0
1
2
3
4
5
(0 - Don't Know, 1 - Very Low, 5 - Very High)
Coping strategies for stress
0
1
2
3
4
5
(0 - Don't Know, 1 - Very Low, 5 - Very High)
Confidence
How would you rate your level of confidence on: (0 - Don't Know, 1 - Very Low, 5 - Very High)
Identifying factors that can negatively impact your health and well-being
0
1
2
3
4
5
(0 - Don't Know, 1 - Very Low, 5 - Very High)
Identifying resources and tools that contribute to overall well-being
0
1
2
3
4
5
(0 - Don't Know, 1 - Very Low, 5 - Very High)
Implementation
To what degree have you implemented the knowledge/skills you’ve gained from the Safer Gambling module in your daily work situations?
Not at all
Very little
Somewhat
A lot
Has the implementation generally been successful/impactful?
Yes
No
How?
Have you encountered any barriers in trying to implement the knowledge/skills you’ve gained from the training?
Yes
No
If yes, what were the barriers
Did you recommend this Safer Gambling module to any friends/colleagues?
Yes
No
If so, Why?
How would you rate your overall experience with the Safer Gambling module?
Very Good
Good
Neutral
Not Good
Not Very Good At All