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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<title>Encuesta de Estres</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head>
<body>
<table width="100%" border="0" cellspacing="0" cellpadding="4">
<tr>
<td width="25%"> </td>
<td width="50%" bgcolor="#0099CC">
<div align="center"><font color="#FFFFFF" size="3" face="Verdana, Arial, Helvetica, sans-serif"><strong>Encuesta
del Nivel de Estres (DAMA)</strong></font></div></td>
<td width="25%"> </td>
</tr>
<tr>
<td width="25%"> </td>
<td width="50%"><form name="form1" method="post" action="">
<table width="100%" border="0" cellspacing="0" cellpadding="2">
<tr>
<td colspan="5"> <table width="100%" border="0" cellspacing="0" cellpadding="2">
<tr>
<td><div align="right"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><strong>Nombre:</strong>
</font></div></td>
<td width="70%"> <font size="2" face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" name="textfield2">
</font></td>
</tr>
<tr>
<td><div align="right"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Cargo:
</font></div></td>
<td width="70%"> <font size="2" face="Verdana, Arial, Helvetica, sans-serif">
<input type="text" name="textfield">
</font></td>
</tr>
<tr>
<td><div align="right"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Edad:
<input name="textfield3" type="text" size="5">
</font></div></td>
<td width="70%"><div align="center"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Escolaridad:
<select name="select">
<option value="0">Primaria</option>
<option value="1">Bachillerato</option>
<option value="2">Técnico</option>
<option value="3">Profesional</option>
<option value="4">Post-Grado</option>
</select>
</font></div></td>
</tr>
<tr>
<td><div align="right"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Sexo:
<select name="select2">
<option value="F">Femenino</option>
<option value="M">Masculino</option>
</select>
</font></div></td>
<td width="70%"><div align="center"><font size="2" face="Verdana, Arial, Helvetica, sans-serif">Estado
Civil:
<select name="select3">
<option value="0">Soltero</option>
<option value="1">Casado</option>
<option value="2">Unión Libre</option>
<option value="3">Separado</option>
<option value="4">Vuido</option>
</select>
</font></div></td>
</tr>
</table></td>
</tr>
<tr bgcolor="#A8D3FF">
<td colspan="5"> </td>
</tr>
<tr>
<td><div align="center"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><strong>Pregunta</strong></font></div></td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td><div align="center"><font size="1" face="Verdana, Arial, Helvetica, sans-serif">S
= Siempre, C = Casi Siempre, V = A Veces, N = Nunca</font></div></td>
<td width="5%" bgcolor="#666666"> <div align="center"><strong><font color="#FFFFFF" face="Verdana, Arial, Helvetica, sans-serif">S</font></strong></div></td>
<td width="5%" bgcolor="#666666"> <div align="center"><strong><font color="#FFFFFF" face="Verdana, Arial, Helvetica, sans-serif">C</font></strong></div></td>
<td width="5%" bgcolor="#666666"> <div align="center"><strong><font color="#FFFFFF" face="Verdana, Arial, Helvetica, sans-serif">V</font></strong></div></td>
<td width="5%" bgcolor="#666666"> <div align="center"><strong><font color="#FFFFFF" face="Verdana, Arial, Helvetica, sans-serif">N</font></strong></div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">1.
Presenta dolores en el cuello y espalda, o tensión muscular.<br>
</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var1" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var1" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var1" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var1" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">2.
Siente náuseas, quemazón, acidez, problemas digestivos,
o del colon.</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var2" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var2" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var2" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var2" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">3.
Ha sentido problemas para respirar</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var3" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var3" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var3" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var3" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">4.
Ha tenido dolores de cabeza.</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var4" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var4" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var4" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var4" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">5.
Ha tenido trastornos del sueño: somnolencia del día
o insomnio en la noche</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var5" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var5" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var5" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var5" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">6.
Ha sentido palpitaciones (taquicardia)</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var6" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var6" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var6" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var6" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">7.
Ha experimentado cambios importantes en el apetito</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var7" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var7" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var7" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var7" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">8.
Ha sentido que su actividad o deseo sexual han disminuido</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var8" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var8" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var8" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var8" type="radio" value="0" checked>
</div></td>
</tr>
<tr bgcolor="#F0F0F0">
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif"> </font></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">1.
Ha tenido dificultad con sus relaciones familiares<br>
</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var9" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var9" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var9" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var9" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">2.
Ha tenido dificultad para permanecer quieto o para iniciar actividades</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var10" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var10" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var10" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var10" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">3.
Ha sentido dificultad en sus relaciones con otras personas</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var11" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var11" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var11" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var11" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">4.
Ha experimentado sensación de aislamiento y desinterés</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var12" value="3">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var12" value="2">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var12" value="1">
</div></td>
<td width="5%"><div align="center">
<input name="var12" type="radio" value="0" checked>
</div></td>
</tr>
<tr bgcolor="#F0F0F0">
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif"> </font></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">1.
Ha tenido sensación de sobrecarga en el trabajo<br>
</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var13" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var13" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var13" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var13" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">2.
Ha tenido dificultad para concentrarse y olvidos frecuentes</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var14" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var14" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var14" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var14" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">3.
Ha tenido accidentes de trabajo frecuentes</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var15" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var15" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var15" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var15" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">4.
Ha experimentado sentimiento de frustración, de no hacer
lo que se quiere en la vida</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var16" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var16" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var16" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var16" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">5.
Ha sentido cansancio, tedio o desgano</font></td>
<td><input type="radio" name="var17" value="6"></td>
<td><input type="radio" name="var17" value="4"></td>
<td><input type="radio" name="var17" value="2"></td>
<td><input name="var17" type="radio" value="0" checked></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">6.
Ha experimentado disminución en el rendimiento de trabajo
o poca creatividad e iniciativa</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var18" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var18" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var18" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var18" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">7.
Ha experimentado deseos de no asistir al trabajo</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var19" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var19" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var19" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var19" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">8.
Ha experimentado bajo compromiso o poco interés con lo que
hace</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var20" value="3">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var20" value="2">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var20" value="1">
</div></td>
<td width="5%"><div align="center">
<input name="var20" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">9.
Ha tenido dificultad para tomar decisiones en el trabajo</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var21" value="3">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var21" value="2">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var21" value="1">
</div></td>
<td width="5%"><div align="center">
<input name="var21" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">10.
Ha sentido deseos de cambiar de empleo</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var22" value="3">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var22" value="2">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var22" value="1">
</div></td>
<td width="5%"><div align="center">
<input name="var22" type="radio" value="0" checked>
</div></td>
</tr>
<tr bgcolor="#F0F0F0">
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif"> </font></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
<td width="5%"> <div align="center"></div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">1.
Ha experimentado sentimientos de soledad y miedo<br>
</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var23" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var23" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var23" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var23" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">2.
Ha experimentado irritabilidad, actitudes y pensamientos negativos</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var24" value="9">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var24" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var24" value="3">
</div></td>
<td width="5%"><div align="center">
<input name="var24" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">3.
Ha tenido sentimientos de angustia, preocupación o tristeza</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var25" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var25" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var25" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var25" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">4.
Ha consumido drogas para aliviar la tensión</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var26" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var26" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var26" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var26" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">5.
Ha sentido que Ud. “no vale nada, o no sirve para nada”</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var27" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var27" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var27" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var27" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">6.
Ha consumido en exceso bebidas alcohólicas, café o
cigarrillos</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var28" value="6">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var28" value="4">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var28" value="2">
</div></td>
<td width="5%"><div align="center">
<input name="var28" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">7.
Ha tenido la sensación de estar perdiendo el equilibrio emocional
(la razón)</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var29" value="3">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var29" value="2">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var29" value="1">
</div></td>
<td width="5%"><div align="center">
<input name="var29" type="radio" value="0" checked>
</div></td>
</tr>
<tr>
<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">8.
Ha tenido comportamientos rígidos, de obstinación,
terquedad y aislamiento</font></td>
<td width="5%"><div align="center">
<input type="radio" name="var30" value="3">
</div></td>
<td width="5%"><div align="center">
<input type="radio" name="var30" value="2">
</div></td>
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<td><font size="1" face="Verdana, Arial, Helvetica, sans-serif">9.
Sensación de no poder manejar los problemas de la vida.</font></td>
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<td width="50%"><div align="center"><font size="1" face="Verdana, Arial, Helvetica, sans-serif">Departamento
Técnico Administrativo del Medio Ambiente<br>
<strong>DAMA</strong>,<em> Bogotá</em><br>
2004 </font></div></td>
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