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