Select Staffing Survey

  1. If you did not like your job, would you fake a work-related injury so you could have an

excuse to change jobs?

  • I definitely would
  • I probably would
  • I probably would not
  • I definitely would not
  1. How would your friends describe your current use of illegal, non-prescription drugs?
  • Out of control
  • A little out of control, but still manageable
  • Recreational use only
  • Does not use
  1. How often, in an average month, do you find that transportation problems (car problems, traffic jams, bus schedules, etc.) make you late for work?
  • Never
  • 1 or 2 times
  • 1 to 5 times
  • More than 5 times
  1. How often have you ignored safety rules to get your work done on time?
  • More than 5 times
  • 3 to 5 times
  • 1 or 2 times
  • Never
  1. In the past two years, how often have you had to physically hurt a co-worker to get him/her

to leave you alone?

  • More than 4 times
  • 3 or 4 times
  • 1 or 2 times
  • Never
  1. Please check the category that best describes your current use of meth (for example: crank,

speed, crystal-meth, ice, chalk, glass, etc.).

  • Heavy, but controlled
  • Recreational use only
  • Very light use (less than 3 or 4 times a year)
  • Do not use
  1. Sometimes I call in sick for work even when I am not sick.
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. If a friend of yours offered you some illegal drugs, would you take them?
  • I definitely would
  • I probably would
  • I probably would not
  • I definitely would not
  1. In the past year, how many times have you ignored safety rules because they were making your job

harder?

  • 5 or more times
  • 3 or 4 times
  • 1 or 2 times
  • Never
  1. How often do you report for work in a condition where you feel your work performance may be

hurt by alcohol?

  • Never
  • Rarely
  • Sometimes
  • Frequently
  1. If someone disrespects you, how likely is it that you would hit that person?
  • I definitely would
  • I probably would
  • I probably would not
  • I definitely would not
  1. I often do things without thinking that I later regret.
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. If you had other important things you needed to do, would you fake a work-related injury so that

you could take some time off from work?

  • I definitely would
  • I probably would
  • I probably would not
  • I definitely would not
  1. If you had to take a urinalysis (urine test, drug test) for illegal drugs today, do you think you would

pass the test?

  • I would definitely not pass the test
  • I might not pass the test due to recreational drug use
  • If I did not pass the test today, I would later in the week
  • I would definitely pass the test
  1. How often have you turned in a timecard or reported hours that showed you worked more time

than you actually did?

  • Frequently
  • Occasionally
  • Once or twice
  • Never
  1. How many times in the last three months have you arrived to work late?
  • 10 or more times
  • 7 to 9 times
  • 4 to 6 times
  • 0 to 3 times
  1. I waste a lot of time day dreaming at work.
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. When you are scheduled to be at a meeting, do you usually:
  • Arrive a few minutes early
  • Arrive exactly on time
  • Arrive a few minutes late
  • Get there when you feel like it
  1. How many times have you turned in a false claim to an insurance company?
  • More than 3 times
  • 2 or 3 times
  • Once
  • Never
  1. Please check the category that best describes your current use of marijuana (for example: pot, grass

weed, hashish, etc.)

  • Heavy, but controlled
  • Recreational use only
  • Very light use (less than 3 or 4 times a year)
  • Do not use
  1. What is the total dollar value of items or property you have taken without permission from

employers over the past two years?

  • $201 or more
  • $51 to $200
  • $10 to $50
  • None
  1. During the past five years, how many struggles or fights (for example: pushing, shoving, hitting)

have you had at work with other employees?

  • None
  • Only 1
  • 2 or 3
  • 4 or more
  1. Please check the category that best describes your current use of cocaine (for example: coke, snow, etc.).
  • Heavy, but controlled
  • Recreational use only
  • Very light use (less than 3 or 4 times a year)
  • Do not use
  1. If you had other important things you needed to do, would you fake an illness so that you could

leave work early?

  • I definitely would
  • I probably would
  • I probably would not
  • I definitely would not
  1. If someone insults you he/she is asking for a punch in the mouth or worse.
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. I make things difficult for people I don’t like.
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. I am a very trustworthy person.
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. If you needed money badly, would you fake a work-related injury to collect workers’ compensation?
  • I definitely would
  • I probably would
  • I probably would not
  • I definitely would not
  1. How often do you currently use illegal drugs at work or just before going to work?
  • Never
  • Only once in a while
  • On a regular basis
  • Almost daily
  1. During an average month, how many times do you have to leave work to take care of non-medical,

personal matters?

  • 5 or more times
  • 3 or 4 times
  • 1 or 2 times
  • Never
  1. I am not nearly as productive as I could be:
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. In some situations I would cheat if I were sure I wouldn’t get caught.
  • I definitely would
  • I probably would
  • I probably would not
  • I definitely would not
  1. Please check the category that best describes your current use of non-prescription illegal

amphetamines (for example: meth, crank, speed, etc.).

  • Heavy, but controlled
  • Recreational use only
  • Very light use (less than 3 or 4 times a year)
  • Do not use
  1. If someone challenges me to fight, I have no problem stepping up to that challenge.
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. How often have you inflated the amount of your loss when claiming insurance money?
  • Frequently
  • Occasionally
  • Once or twice
  • Never
  1. Which best describes your current use of illegal non-prescription drugs at work?
  • I never go to work with illegal drugs in my system
  • I rarely go to work with illegal drugs in my system
  • I occasionally go to work with illegal drugs in my system
  • I frequently go to work with illegal drugs in my system
  1. I get into a lot of arguments at work.
  • I strongly disagree
  • I disagree
  • I agree
  • I strongly agree
  1. How many times have you faked a job-related injury?
  • Never
  • 1 or 2 times
  • 3 to 5 times
  • More than 5 times
  1. Please check the category that best describes your current use of illegal drugs (for example: meth,

crystal, ecstasy, heroin, morphine, crack, etc.).

  • Heavy, but controlled
  • Recreational use only
  • Very light use (less than 3 or 4 times a year)
  • Do not use
  1. If you felt you were being treated unfairly by your boss or the company you worked for, would you

fake a work-related injury to get even?

  • I definitely would
  • I probably would
  • I probably would not
  • I definitely would not
  1. In the past week, how often have you used illegal, non-prescription drugs?
  • More than 5 times
  • 3 or 5 times
  • 1 or 2 times
  • Never

Thank you for taking this survey, you are now finished.