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