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I. 個人基本資料 收卷日期：民國 100 年_____月____日(免填)
1 國曆生日：民國 年 月 編號： (免填) 2. 性別：(1)□男 (2)□女
3. 目前是否正在進修？(1)□無 (2)□有/研究所 (3)□有/大學 (4)□有/空大
(5)□有/推廣教育 (6)□有/其他__________
II. 家庭社會資料
1. 婚姻狀態：(1)□未婚 (2)□已婚 (3)□鰥寡 (4)□離婚 (5)□其他
2. 您有無孩子? (1)□無孩子 (2/a/b)□有孩子,______個,分別幾歲(實歲)： _____________
III. 工作經歷
1. 您從事護理工作已滿_________年
2. 您目前工作的醫療院所是？(1)□醫學中心 (2)□區域醫院 (3) □地區醫院 (4)□診所 (5)□其他______________
親愛的護理同仁您好：
本問卷是為了瞭解護理人員的身心狀況與工作的情形而編製。您的資料僅供研 究使用，研究人員具有保密之責，敬請安心填寫。非常感謝您的協助！
敬祝 平安 愉快
中山醫學大學心理學系 副教授 黃淑玲 彰化基督教醫院職業醫學科 主任 湯豐誠敬上
台中教育大學諮商與應用心理學系碩士班 研究生 許馨仁 敬上 附錄一 施測問卷
IV 中國人健康量表
V 工作滿意度
VI.工作評估
(12) 我曾經歷﹙或擔心會經歷﹚不好的工作變
附錄二 研究工具 ERI 使用同意書
From: Prof. Dr. J. Siegrist [mailto:siegrist@uni-duesseldorf.de]
Sent: 2005/8/9 [星期二] 下午 10:26 To: 106159(湯豐誠)
Subject: Re: Requesting your permission to use the questionnaire
Dear Dr. Tang,
I hereby give you permission to use our questionnaire measuring effort-reward imbalance at work (ERI) for research purposes (including intervention studies). As you know, you are not allowed to use the questionnaire for commercial purposes. You find more information on our website as follows:
www<uni-duesseldorf.de/MedicalSociology> username: <eritest> password:<
reward!>
You may know that several researchers in Taiwan are currently working with the Taiwanese version of this questionnaire. It is probably best to contact directly Dr. Yawen Cheng at the Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei (see also our paper in Int. Archives of Occupational and Environmental Health, published online 15 march 2005.
Of course, my collegues and I would be interested in getting feedback from your study, once it is running.
With kind regards J. Siegrist