Stress Test Daily Stress Checklist How are your mind and body affected by the common sources of stress? Please take your time to consider each item on this checklist, and mark those items that you currently experience. Relationship Stress I have recently experienced a loss of friendship I experience everyday stress because of my relationship with an immediate family member I feel excluded by my family I am grieving from the death of a friend I experience everyday stress because of my relationship with a member of my extended family I am grieving from a death of a family member (not spouse or child) I am grieving from the death of a child Caregiver Stress I am the primary caregiver in my family with one or more children I am the caregiver of child, sibling, or parent with special needs I am responsible for caring for an aging family member or members Social Stress I feel stressed by the number of social committments I have I often feel lonely, alone, or isolated Financial Stress I am in conflict with my spouse or family over our financial decisions I am anxious about my financial situation I can honestly say I live above my means, and I do not know what to do about it I am responsible for the primary income for my family I am in a conflict with a co-worker/business partner over finances Physical Stress I engage in long distance endurance running, swimming, biking, etc. I regularly lift and transport young children I have recently been in a car accident (including "minor" fender benders) My walk/run unevenly wears the soles of my shoes I am recovering from a surgery or surgeries I do not have a regular stretch or movement routine I do not have a regular exercise program I regularly aid in lifting and transporting an aged family member or relative My work or hobbies require a lot of repetitive motion I am carrying more weight than I want I am still experiencing symptoms from a mild traumatic brain injury I have recently fallen or stumbled or slipped My footwear is not supportive for the demands I place on my feet I use electronic devices for more than an hour per day My sleep quality is poor because I cannot fall asleep or stay asleep I have chronic foot, ankle, knee, or hip degeneration or injury that changes the way I walk or run My work station ergonomics are poor I need to replace my mattress I engage in physical exercise and wonder if I am using the proper form I am still experiencing symptoms from a neck injury/whiplash Chemical Stress I am addicted to nicotine I do not currently use water purification in my home I do not currently use air filtration or air purification in my home I am currently withdrawing from caffeine I have hobbies that increase my exposure to chemicals I have seasonal allergies I have food allergies I drink more than I probably should I am currently overcoming an addiction to recreational drugs I am on two or more regular medications I am exposed to industrial stength chemicals in my home I am currently withdrawing from nicotine I am exposed to industrial strength chemicals in my workplace I rely on over the counter pain relievers I live near a high traffic area (freeway or main thoroughfare) I eat more sugar than I probably should I am addicted to caffeine I regularly use recreational drugs I have tested positive for a gene mutation that reduces my natural detoxification ability I know I have nutritional deficiencies Career Stress My work environment is physically or emotionally draining I am not adequately paid for my position I am asked to cover shortcoming of other workers, or short-staffing situations I am in conflict with my boss I feel like I could be fired at any minute I am in conflict with my co-workers I do not get enough vacation time My work is not very satisfying There is little opportunity for advancement in my current position I spend too much time at work Life Transition Stress I am grieving the death of my spouse I am in the process of purchasing or selling a home I am moving or expanding a business I am getting married I am getting divorced I am having a baby I am moving/recently moved away from family and close friends Email* Enter Email Confirm Email Please enter your email to receive a copy of your information, and your score. Keep in mind that most email is not HIPAA safe. All information provided via this web form is confidential, and your email will not be shared or sold or distributed in any way. Name* First CommentsThis field is for validation purposes and should be left unchanged.