1 SF-8

2 WLQ 1.In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following? (Mark one box on each line a. through e.) All of the Time (100%) Most of the Time Some of the Time (About 50%) A Slight Bit of the Time None of the Time (0%) Does Not Apply to My Job a. work the required number of hours 11 22 33 44 55 00 b. get going easily at the beginning of the workday 11 22 33 44 55 00 c. start on your job as soon as you arrived at work 11 22 33 44 55 00 d. do your work without stopping to take breaks or rests 11 22 33 44 55 00 e. stick to a routine or schedule 11 22 33 44 55 00 These questions ask you to rate the amount of time you had difficulty handling certain parts of your job. Please read and answer every question. Then choose a response.  Mark the “Does Not Apply to My Job” box only if the question describes something that is not part of your job.  If you have more than one job, report on your main job only. Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book. Time limitations

3 WLQ All of the Time (100%) Most of the Time Some of the Time (About 50%) A Slight Bit of the Time None of the Time (0%) Does Not Apply to My Job a. walk or move around different work locations (for example, go to meetings) 11 22 33 44 55 00 b. lift, carry, or move objects at work weighing more than 10 lbs 11 22 33 44 55 00 sit, stand, or stay in one position for longer than 15 minutes while working 11 22 33 44 55 00 d.repeat the same motions over and over again while working 11 22 33 44 55 00 e.bend, twist, or reach while working 11 22 33 44 55 00 f.use hand-held tools or equipment (for example, a phone, pen, keyboard, computer mouse, drill, hairdryer, or sander)..... 11 22 33 44 55 00 These questions ask you to rate the amount of time you were able to handle certain parts of your job without difficulty. 2. In the past 2 weeks, how much of the time were you ABLE TO DO the following without difficulty caused by physical health or emotional problems? Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book. Physical limitations

4 These questions ask about difficulties you may have had at work. 3.In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following? (Mark one box on each line a. through f.) All of the Time (100%) Most of the Time Some of the Time (About 50%) A Slight Bit of the Time None of the Time (0%) Does Not Apply to My Job a. keep your mind on your work 11 22 33 44 55 00 b. think clearly when working 11 22 33 44 55 00 c. do work carefully 11 22 33 44 55 00 d. concentrate on your work 11 22 33 44 55 00 e. work without losing your train of thought 11 22 33 44 55 00 f. easily read or use your eyes when working 11 22 33 44 55 00 WLQ Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book. Mental limitations

5 WLQ The next questions ask about difficulties in relation to the people you came in contact with while working. These may include employers, supervisors, coworkers, clients, customers, or the public. 4.In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following? (Mark one box on each line a. through c.) All of the Time (100%) Most of the Time Some of the Time (About 50%) A Slight Bit of the Time None of the Time (0%) Does Not Apply to My Job a. speak with people in-person, in meetings or on the phone 11 22 33 44 55 00 b. control your temper around people when working.... 11 22 33 44 55 00 c. help other people to get work done 11 22 33 44 55 00 These questions ask about how things went at work overall. 5.In the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following? (Mark one box on each line a. through e.) All of the Time (100%) Most of the Time Some of the Time (About 50%) A Slight Bit of the Time None of the Time (0%) Does Not Apply to My Job a. handle the workload..... 11 22 33 44 55 00 b. work fast enough 11 22 33 44 55 00 c finish work on time 11 22 33 44 55 00 d. do your work without making mistakes 11 22 33 44 55 00 e. feel you’ve done what you are capable of doing..... 11 22 33 44 55 00 Please do not duplicate, distribute or use without complying with the guidelines of use outlined by the developers in the Gold Book. Interpersonal limitations Output limitations

6 Average Before and After SF-8 Scale Score Results: sample

7 Average Before and After SF-8 Summary Score Results : sample Best: 58.6, 59.3 Worst: 19.5, 17.9

8 WLQ Survey Results: sample 8.8% 6.9% 9.4% 9.6% 7.9% 5.5% 5.4% 8.3% 7.4% 0% 2% 4% 6% 8% 10% 12% FirstLastFirstLastFirstLastFirstLastFirstLast Physical Demands*Time ManagementMental/Interpersonal Demands* Output DemandsOverall WLQ Score* Percent of Impairment * P-Value Significance≤ 0.05