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