What is the name of your company?
What is your role in the company?
Crew
Foremen/Supervisor/Safety
Owner
What was the topic of the toolbox talk that was just delivered?
Mental Health vs Mental Illness
Reducing Stigma
Stress
Depression vs. Anxiety
Self-Care
Awareness of Your Own Mental Health
How To Get Help
Suicide Awareness
Drug and Alcohol Use
Opioids & Other Pain Killers
Feeling Fatigued
Bullying
Yes
No
What was the level of discussion?
Very good
Good
Fair
Poor
Very poor
How did workers react to topic?
Very negative
Negative
Neutral
Positive
Very positive
Would you give this TBT again?
Definitely
Very Probably
Probably
Possibly
Probably Not
Definitely Not
Please indicate your agreement with the following statements:
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
The information is useful.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
The toolbox talk should be recommended to others in the industry.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
I plan to make changes in my behavior after learning this information.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Mental illness is a common condition.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Mental health can change over time due to many factors.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Creating healthy living conditions that can support good mental health can help prevent mental illness.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Stigma can make mental health conditions worse.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Talking openly about mental health can help reduce stigma.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
What I say impacts those around me and I will consider my words when talking to others on the worksite.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
After this toolbox talk I can recognize the signs of stress.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of stress in myself, I would be willing to seek help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of stress in myself, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of stress, I think I would notice.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of stress, I would be willing to offer help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of stress, I would know how to connect him/her to appropriate help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
After this toolbox talk I can recognize the signs of depression or anxiety.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of depression or anxiety in myself, I would be willing to seek help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of depression or anxiety in myself, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of depression or anxiety, I think I would notice.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of depression or anxiety, I would be willing to offer help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of depression or anxiety, I would know how to connect him/her to appropriate help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Self-care can help improve and maintain good mental health.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I was going through a difficult time or feeling upset, I would be willing to practice self-care.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I was going through a difficult time or feeling upset, I would be know how to practice self-care.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was going through a difficult time or feeling upset, I would be willing to recommend methods of self-care.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Awareness of your own mental health can help improve and maintain good mental health.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
After this toolbox talk I know how to check in with my mental health.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs I was struggling with my mental health, I would be willing to seek help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs I was struggling with my mental health, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I was going through a difficult time, feeling upset, or was thinking about suicide, I would be willing to seek help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I was going through a difficult time, feeling upset, or was thinking about suicide, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was going through a difficult time, feeling upset, or thinking about suicide, I think I would notice.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was going through a difficult time, feeling upset, or was thinking about suicide, I would be willing to offer help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was going through a difficult time, feeling upset, or thinking about suicide, I would know how to connect him/her to appropriate help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Talking openly about suicide can prevent suicide.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I was thinking about suicide, I would be willing to seek help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I was thinking about suicide, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of thinking about suicide, I think I would notice.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of thinking about suicide, I would be willing to offer help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of thinking about suicide, I would know how to connect him/her to appropriate help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
After this toolbox talk I can recognize signs of alcohol or substance abuse.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of alcohol or substance abuse in myself, I would be willing to seek help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of alcohol or substance abuse in myself, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of alcohol or substance abuse, I think I would notice.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of alcohol or substance abuse, I would be willing to offer help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of alcohol or substance abuse, I would know how to connect him/her to appropriate help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
After this toolbox talk I can recognize signs of opioid addiction.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of opioid addiction in myself, I would be willing to seek help
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of opioid addition in myself, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of opioid addition, I think I would notice.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of opioid addition, I would be willing to offer help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of opioid addition, I would know how to connect him/her to appropriate help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
After this toolbox talk I can recognize the signs of fatigue.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of fatigue in myself, I would be willing to seek help
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I recognized signs of fatigue in myself, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of fatigue, I think I would notice.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of fatigue, I would be willing to offer help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was showing signs of fatigue, I would know how to connect him/her to appropriate help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
After this toolbox talk I can recognize signs of bullying.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I was being bullied, I would be willing to seek help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If I was being bullied, I would know where to go for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was being bullied, I think I would notice.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was being bullied, I would be willing to offer help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
If a crewmember was being bullied, I would know how to connect him/her to appropriate help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
My current worksite supports good mental health and well-being.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Having trained peer counselors in our company would help our workers seek and find help for their mental health.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Which of these TBT topics have been delivered at your worksite?
I would like more mental health focused TBTs delivered at my worksite.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Would you like to receive Toolbox Talks on other health and wellness topics?
Yes
No
What other health and wellness topics are you interested in?
What other materials or programs would be of most use in supporting the mental health of people in your company?
Please provide your email address or cell phone number in the space provided.
This will be used as your e ntry into the raffle for the $50 gift card, and to contact the winners. Your information will not be shared or given to any other entity, such as your employer or the AGC.
Note: If you provide your cell phone you are giving us permission to text you.
email or phone number