Work-related stress is no longer a marginal topic in occupational health and safety management. It is a real, widespread risk with serious consequences for workers’ health and organisational performance. Yet many companies still treat it as a mere bureaucratic obligation — a document to fill in to avoid penalties.
The reality is quite different. Work-related stress can devastate both workers and the organisation itself, leading to burnout, declining productivity and motivation, more errors and workplace accidents, and rising absenteeism and staff turnover.
Italian legislation, through Legislative Decree 81/2008 and the European Framework Agreement on Work-Related Stress of 2004 — transposed in Italy by the Inter-Confederal Agreement of 2008 — requires the employer to assess this risk as rigorously as any other. Failing to do so, or doing so inadequately, exposes the employer to legal liability and wastes the chance to intervene before organisational distress becomes chronic and spreads across all workers.
What is the work-related stress assessment and why is it mandatory
The work-related stress risk assessment is the process by which a company identifies, analyses and manages factors linked to work design, organisation and management — as well as social relations and the working environment — that may cause stress for workers. The aim is not to measure each worker’s individual stress level, but to determine whether, and to what extent, the organisation presents factors (relating to work context and content) that systematically generate stress across the workforce.
This obligation stems from Article 28 of Legislative Decree 81/2008, which requires the employer to assess all health and safety risks, including those linked to work-related stress. The assessment is therefore not optional: it is a legal duty that must be documented in the Risk Assessment Document (DVR) and updated periodically.
Work-related stress occurs when job demands exceed a person’s ability to cope. It may stem from excessive workloads, unsustainable pace, limited decision latitude, lack of support, interpersonal conflicts or unclear roles. The consequences go beyond the individual: a stressful working environment increases errors, reduces work quality, worsens the organisational climate and drives up absenteeism costs.
The assessment should therefore not be a mere bureaucratic formality, but a genuine tool for understanding where the organisation can improve — preventing problems that would otherwise persist and worsen over time.
The INAIL methodology for work-related stress assessment
INAIL has developed a specific methodology to help companies assess work-related stress in a structured, legally compliant manner.
The INAIL methodology for assessing and managing work-related stress risk comprises a mandatory preliminary phase for all companies and, where necessary, an in-depth assessment phase.
During the preliminary phase, once the Assessment Management Group has been set up, both sentinel events and work content and context factors are analysed using dedicated checklists. If the preliminary phase reveals significant risk levels — that is, elements requiring corrective actions — the employer must plan and implement specific improvement measures. Should these prove ineffective after a reasonable period of implementation and monitoring, the process moves to the in-depth assessment phase, which investigates workers’ subjective perception of the same families of factors and indicators previously considered.
The recommended tools for this phase are structured or standardised questionnaires, focus groups and semi-structured interviews, which enable the systematic collection of workers’ views on potentially stress-inducing organisational conditions.
It is worth noting, however, that the Commission for Interpelli (art. 12 of Legislative Decree 81/2008) of the Ministry of Labour and Social Policies has clarified that the employer may also use tools typically reserved for the in-depth phase during the preliminary phase, where this allows corrective measures to be defined more precisely.
The preliminary phase of work-related stress assessment: how to begin
The preliminary phase is the first mandatory step for all companies. Its goal is to assess, on the basis of objective indicators, whether work-related stress risk conditions exist within the various homogeneous groups and how severe they are, in order to identify critical areas and intervention priorities.
The process begins with objective data collection. How many workplace accidents occurred in the past year? What is the absenteeism rate for sickness? Is staff turnover high in certain departments? Has the Occupational Physician flagged any stress-related health issues? These indicators are essential because they provide a concrete picture of the situation, independent of subjective perceptions.
The next step is to analyse organisational factors (work context and content). The INAIL checklists help evaluate aspects such as the working environment, clarity of objectives, the level of workers’ participation in decisions and managerial support. These structured questions make it possible to score each factor and pinpoint critical areas.
If the final score indicates low risk, the assessment concludes here and a periodic review is scheduled. If, however, medium or high risk emerges, the employer must plan and implement corrective actions and/or proceed to the in-depth phase where the right type of corrective measure is not yet clear.
The preliminary phase does not necessarily require external consultants, but it does demand expertise in interpreting data and assessing risk factors. Many companies choose to seek support, particularly if they lack in-house experience or want to ensure full regulatory compliance.
The in-depth phase of work-related stress assessment: when it is needed and how it works
The in-depth phase becomes necessary — and, in practice, mandatory — when corrective measures identified during the preliminary assessment prove ineffective and/or a clearer understanding of the right type of action is needed. Here the focus shifts to workers’ perception of work content and context factors.
This requires scientifically validated tools capable of investigating the main potentially stress-inducing organisational factors. Among these is the Indicator Tool questionnaire provided by INAIL, which is the Italian adaptation of the HSE Management Standards Indicator Tool. The questionnaire can be distributed anonymously to all workers or to a representative sample, depending on company size. The questions explore seven organisational dimensions: demand, control, managerial support, peer support, relationships, role and change.
Results are processed on an aggregate basis, by homogeneous groups (departments, job roles, shifts) — never at individual level — just as in the preliminary assessment. The goal is not to single out problematic individuals, but to understand which aspects of work organisation need improving.
Once the data have been analysed, discussion with the Workers’ Safety Representatives (RLS) is required and, where appropriate, with the workers themselves. This step is crucial: workers must be involved and heard.
This is where the most important part comes in: the improvement plan. Based on the findings, the company must define specific measures to reduce the risk factors identified. These may include reorganising workloads, improving internal communication, training managers in team management and clarifying roles and responsibilities. The measures must be realistic, measurable and monitored over time.
The work-related stress assessment is not an end point but a continuous process. It must be repeated periodically, especially after significant organisational changes or when new warning signs emerge.
From risk assessment to improvement plan
An accurate, methodologically sound work-related stress risk assessment is necessary but not sufficient to reduce the risk. The data collected have value only if they are analysed systematically and translated into a programme of concrete improvement measures. If the organisation merely describes the risk level without implementing coherent interventions or verifying their effectiveness over time, the regulatory obligation is not substantively fulfilled and the DVR becomes a formal document, stripped of its core purpose of protecting workers’ health.
The objective is not to “diagnose stress” in individuals, but to act on the organisational, managerial and relational factors that, if left unaddressed, can over time produce conditions harmful to health — up to and including serious outcomes such as anxiety disorders, depression or burnout. Prevention means acting in advance on the organisational causes of stress, rather than merely managing individual symptoms once the situation has already deteriorated.
Measures may take various forms. At the organisational level: rebalancing workloads, revising shifts and schedules, clarifying roles and responsibilities, improving processes and available resources, and upgrading workplace environments and ergonomics. At the relational and managerial level: training managers in team management, strengthening internal communication, and creating structured, participatory forums for discussion with workers and Workers’ Safety Representatives (RLS) on critical issues and possible solutions. At the individual level: training on work-related stress, providing listening and psychological support services where appropriate, and promoting wellbeing initiatives — always, however, as a complement to, and never a substitute for, organisational measures.
Every measure must be incorporated into a monitoring plan. After a set period — typically within one year — the same assessment tools must be used to verify whether the risk indicators show improvement. If they do, the approach can be consolidated and potentially extended; if no significant improvement is observed, the strategy must be reconsidered, priorities redefined and, where appropriate, further in-depth analysis carried out.
Companies that manage work-related stress risk seriously and systematically do not simply “get their paperwork in order” — they build healthier, more reliable working environments that retain and attract competent people. In an increasingly competitive labour market, where organisational wellbeing is a key selection criterion for workers, this represents a major strategic advantage.