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