Health Check Questionnaire – NAT (for Grundfos)

Answering this questionnaire is optional. You can read about our protection of your personal data here.

If there are questions you can’t or don’t want to answer, just skip to the next question.
If you would like a copy of your response sent to your email, please fill in the E-mail field below (May end up in the Spam folder).

Health check - Night
First Name / Last Name - or an Alias.
Company
Example: 1970
Optional: Your E-mail if you want a copy of your answers.
Primary shift type:
1. Health Evaluation
1. How do you think your health is, all in all?
1a. Do you find that your health challenges are aggravated by night work, e.g. compared to off/holiday periods without night work?
The next 19 partial questions are for those of you who have turned 50:
1c. How satisfied are you with your job as a whole - all things considered? (10 is best)
50+
1d. Does your work take so much of your energy that it interferes with your personal life?
50+
Scope of your night work:
1e. How often do you work at night 4 or more nights in a row?
50+
1f. How often do you work more than 9 hours at a time?
50+
1g. How often do you work less than 11 hours between two shifts during a month?
50+
1h. Night work and risk of cancer:
Yes
No
Is there hereditary cancer in the family?
Do you have (or have had) breast cancer?
Do you follow the screening program for bowel cancer?
Women: Do you follow mammography screening?
Women: Do you notice lumps?
Men: Are you aware of the symptoms for e.g. prostate cancer in the form of blood in urine or semen?
50+
All citizens between the ages of 50 and 74 receive an invitation to be screened for bowel cancer every 2 years. All women between the ages of 50 and 69 receive an invitation to be screened for breast cancer every 2 years.
Discomfort in the form of pain or discomfort that can disturb sleep:
1i. Have you been bothered by any of the types of pain or discomfort mentioned here within the past 14 days?
Very bothered
A bit bothered
No
Fatigue
Pain or discomfort in the body (eg arms, shoulders, back, hands or elsewhere)
Difficulty sleeping (frequent awakenings, difficulty getting coherent sleep)
Headache
Frequent urination (e.g. in connection with sleep) or problems with urination
50+
1j. Do you think your discomfort is aggravated by work, e.g. compared to periods when you have time off/holiday?
50+
50+
50+
2. Medicine
2a. Have you used painkillers, headache pills in the last 3 months?
2b. Have you used sedatives or nerve medicine in the last 3 months?
2c. Have you used sleeping pills in the last 3 months?
3. Alcohol
Example: 30 - (One item is a beer, a glass of wine, 2 cl spirits)
Do you have - or have you had - problems with heavy alcohol consumption?
Do you have - or have you had - problems with other drugs?
4. Smoking
4. Do you smoke daily?
5. Diet
5. How often do you usually eat fruit, salad / raw food, cooked vegetables (apart from potatoes)?
6. Physical activity and exercise
6. Which description suits you best?
7. Mental health
7a. In the last 4 weeks, how often have you slept badly and restlessly?
7b. Within the last 4 weeks, how often have you felt run down?
7c. Within the last 4 weeks, how often have you been tense?
8. Physical pain problems
8a. Have you had neck problems in the last 7 days?
8b. Have you had shoulder problems within the last 7 days?
8c. Have you had problems with your arms / elbows within the last 7 days?
8d. Have you had problems with your hand / wrist within the last 7 days?
8e. Have you had low back pain in the last 7 days?
8f. Have you had knee problems in the last 7 days?
Well-being at f.m. shift
9. Why did you choose Shift / Night shift work ?: (chose max 3 options)
10. How do you thrive with shift / night shift work?
11. Do you feel rested when you get up?
12. Can you sleep undisturbed after work?
13. Have you had one or more of the following diseases?
13a. Heart pain (angina pectoris)
13b. Hypertension
13c. Diabetes
13d. Gastric ulcer / Severe intestinal disease
13e. Depression, requiring treatment
13f. Other mental illness
13g. Lung disease (eg Asthma or Allergy)
14. Especially for women:
14a. Do you have - or have you had - Breast Cancer?
14b. Are you pregnant ?
14c. Have you had problems / inconveniences during previous pregnancies?
ENDING
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AG Sundhedsfremme ApS uses your answers, combined with the measured health data in the upcoming examination, to advise you about your health. The answer will, in anonymised form, also be included in a comprehensive report to the company, however in such a way that no individuals can be identified. When you give your consent for the above purpose, you also give AG Sundhedsfremme's nurses and statisticians the right to process your information in this questionnaire. You can always withdraw your consent by writing to ANTR@AGSundhed.dk