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