Free Burnout Risk Check Template

Quick answer

Burnout signals long before it crashes: score exhaustion, distancing and efficacy, see which driver slipped, and bring the suggested adjustments into your 1:1 — it is a self-check, not a clinical diagnosis.

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About this template

Burnout rarely arrives without signals: exhaustion that rest does not clear, growing distance from the work and people, and a quiet loss of effectiveness. This self-check asks employees to score those three dimensions honestly, shows where the strain concentrates, and produces an AI report with concrete workload and recovery adjustments for the manager conversation. It is a prevention tool, not a clinical assessment.

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Template at a Glance

Template	Burnout Risk Check
Category	HR & People Ops
Format	Scored assessment with personalized AI PDF report
Time to complete	About 6 minutes per response
What you get	A personalized AI report (printable PDF) for every response, plus the raw answers
Best for	Employees · People managers · HR teams
Cost	Free to copy and customize on FormLM

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What's Included

Everything you need to run this template.

1

Three-dimension check

Exhaustion, distancing and reduced efficacy — the classic signals.

2

Early-warning indication

A clear personal signal to start a conversation with.

3

Driver breakdown

Load, recovery and autonomy shown separately.

4

Adjustment suggestions

Concrete workload actions for the manager 1:1.

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How It Works

From copy to deliverable in four steps.

1

Use this template

Copy it and set the check cadence.

2

Self-check

Employees answer privately in about six minutes.

3

Get the report

Each response yields an indication and its drivers.

4

Talk and adjust

Manager and employee agree on one or two changes.

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Who Is This For

Pick your role — see how it fits your workflow.

1

Employees

Notice the slide before it becomes a crash.

2

People managers

Bring structure to the wellbeing 1:1.

3

HR teams

Watch aggregated signals across teams, anonymously.

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Key Features

What makes this template work as a professional deliverable.

Exhaustion, cynicism and efficacy dimensions
Personal early-warning indication
Driver breakdown: load, recovery, autonomy
Suggested adjustments for the 1:1
Periodic reuse to watch drift
Free to copy and customize

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Sample Questions Inside

A preview of real questions — the full version adds scoring and a personalized report per respondent.

I feel drained even before the workday starts (1–5)
I catch myself distancing from colleagues or work (1–5)
My workload is recoverable between days (1–5)
I have control over how and when I work (1–5)
I still feel effective at what I do (1–5)
Which one thing would reduce the pressure most? (open)
What support would you actually use? (open)

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Frequently Asked Questions

What does this check measure?

The three classic burnout signals — exhaustion, distancing and reduced effectiveness — plus the drivers behind them.

Is this a diagnosis?

No. It is a structured self-check for early warnings and conversation-starting, not a medical or psychological assessment.

Who sees the answers?

Individual results stay with the employee; teams see anonymized patterns. Set visibility when you launch.

How often should people run it?

Every quarter, or after major load changes — frequent enough to catch drift, rare enough to stay meaningful.

Is it free?

Yes. Copy the template into your FormLM workspace and adjust the items.

What does the AI report include?

A risk indication, the dominant drivers and two or three concrete adjustments to try before the next check.

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Methods & terminology behind this template

eNPS Likert scale Retention risk assessment guide Employee engagement guide

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Related HR templates

Employee Engagement Survey Team Pulse Survey Employee Satisfaction Survey Employee Suggestion Box Retention Risk Assessment Exit Interview Form