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 am grieving from a death of a family member (not spouse or child) I feel excluded by my family I experience everyday stress because of my relationship with an immediate family member I am grieving from the death of a friend I have recently experienced a loss of friendship I experience everyday stress because of my relationship with a member of my extended family 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 a co-worker/business partner over finances 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 conflict with my spouse or family over our financial decisions I am anxious about my financial situation Physical Stress I am still experiencing symptoms from a mild traumatic brain injury My footwear is not supportive for the demands I place on my feet I use electronic devices for more than an hour per day I regularly aid in lifting and transporting an aged family member or relative My work or hobbies require a lot of repetitive motion I engage in physical exercise and wonder if I am using the proper form I am still experiencing symptoms from a neck injury/whiplash My work station ergonomics are poor I do not have a regular stretch or movement routine I regularly lift and transport young children I have recently been in a car accident (including "minor" fender benders) I am carrying more weight than I want I need to replace my mattress My sleep quality is poor because I cannot fall asleep or stay asleep I engage in long distance endurance running, swimming, biking, etc. I have recently fallen or stumbled or slipped I do not have a regular exercise program I have chronic foot, ankle, knee, or hip degeneration or injury that changes the way I walk or run I am recovering from a surgery or surgeries My walk/run unevenly wears the soles of my shoes Chemical Stress I am currently overcoming an addiction to recreational drugs I do not currently use water purification in my home I have hobbies that increase my exposure to chemicals I am addicted to nicotine I am currently withdrawing from nicotine I am on two or more regular medications I rely on over the counter pain relievers I know I have nutritional deficiencies I am addicted to caffeine I drink more than I probably should I eat more sugar than I probably should I have seasonal allergies I live near a high traffic area (freeway or main thoroughfare) I am exposed to industrial stength chemicals in my home I do not currently use air filtration or air purification in my home I regularly use recreational drugs I have food allergies I am exposed to industrial strength chemicals in my workplace I am currently withdrawing from caffeine I have tested positive for a gene mutation that reduces my natural detoxification ability Career Stress My work environment is physically or emotionally draining My work is not very satisfying There is little opportunity for advancement in my current position I spend too much time at work I do not get enough vacation time I am not adequately paid for my position I am in conflict with my boss I am asked to cover shortcoming of other workers, or short-staffing situations I feel like I could be fired at any minute I am in conflict with my co-workers Life Transition Stress I am getting divorced I am moving or expanding a business I am grieving the death of my spouse I am getting married I am having a baby I am in the process of purchasing or selling a home 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.