書類 · 日本語
ストレスチェック票
Mandatory workplace stress assessment form as required under Japan's Industrial Safety and Health Act.
- Form type
- stress
- Language
- Japanese (日本語)
- Archive source
- AMDA-IMIC Japan forms library, 2013–2024
About This Form
This page documents the ストレスチェック票 as provided in Japanese through AMDA-IMIC's multilingual forms library. The form is used for: mandatory workplace stress assessment form as required under japan's industrial safety and health act..
Since 2015, Japan's Industrial Safety and Health Act has required employers with 50 or more workers to conduct annual stress checks for all employees. The standardized questionnaire measures job demands, job control, and workplace social support, then produces a score identifying workers at high risk. Foreign workers are entitled to take the stress check in their preferred language. Results are handled confidentially — only the worker and their physician see individual scores, and employers receive only aggregate data.
For the original administrative forms in active use, contact the relevant Japanese institution directly — a hospital, employer, local health center, or labor bureau — depending on which form is needed. This reference documents the structure and purpose of the forms as they were used during the 2013–2024 period when AMDA-IMIC was operating.
Form Sections and Fields
The following sections and fields appear in the Japanese version of this form. Field labels are rendered here in English for reference; the original form presents them in Japanese (日本語).
- Section A — Work demands (6 items): workload volume, work pace, task complexity, physical demands, attention required, responsibility level
- Section B — Job control (3 items): autonomy in task order, autonomy in work method, opportunity to use skills
- Section C — Workplace support (3 items): supervisor support, colleague support, perceived understanding
- Section D — Psychological distress (13 items): anxiety, irritability, fatigue, depression, sleep quality, and somatic complaints
- Section E — Wellbeing (3 items): vitality, interpersonal satisfaction, sense of achievement
- Scoring note: high-stress classification when Section D score exceeds threshold AND Sections B+C support score is low
- Worker's name (optional, handled per employer's anonymization policy)
- Department and occupation type
- Date of completion
How to Obtain This Form
The forms documented on this site were originally distributed by AMDA-IMIC through its consultation service and language-specific subdomains. Since the center closed in 2024, the forms are no longer distributed through that channel. Equivalent forms for current use are available from the relevant Japanese institution: municipal health centers issue administrative forms, hospitals provide their own registration and appointment materials, and the Labor Standards Inspection Office supplies labor insurance documentation.