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