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