WPAI

Work Productivity and Activity Impairment Questionnaire:

General Health V2.0 (WPAI:GH)

productividad en el trabajo y el impedimento de las actividades

The following questions ask about the effect of your health problems on your ability to work and perform regular activities. By health problems we mean any physical or emotional problem or symptom. Please fill in the blanks or circle a number, as indicated.

SubID

NAME

First Name

Last Name

DATE OF BIRTH

Formato MM-DD-AAAA es decir mes-dia-año

YYYY

1-Are you currently employed (working for pay)?

If NO, check “NO” and skip to question 6.

2-How many hours did you miss from work because of your health problems?

During the past seven days Include hours you missed on sick days, times you went in late, left early, etc., because of your health problems. Do not include time you missed to participate in this study.

3-How many hours did you miss from work because of any other reason, such as vacation, holidays, time off to participate in this study?

During the past seven days

4-How many hours did you actually work?

During the past seven days (If “0”, skip to question 6.)

5-How much did your health problems affect your productivity while you were working?

During the past seven days Think about days you were limited in the amount or kind of work you could do, days you accomplished less than you would like, or days you could not do your work as carefully as usual. If health problems affected your work only a little, choose a low number. Choose a high number if health problems affected your work a great deal.

6-How much did your health problems affect your ability to do your regular daily activities, other than work at a job?

During the past seven days By regular activities, we mean the usual activities you do, such as work around the house, shopping, childcare, exercising, studying, etc. Think about times you were limited in the amount or kind of activities you could do and times you accomplished less than you would like. If health problems affected your activities only a little, choose a low number. Choose a high number if health problems affected your activities a great deal.

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