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