Brief Stress Assessment Form
© C. S. Clarke, Ph.D.
The following checklist is of common major stressors. Constant daily experience with any one can cause sufficient disruption to account for the onset of physical stress symptoms. Check any three and you'd better keep a watch for immune system failures such as recurrent colds, 'flu, various stress-related infections. Check any five (especially if in the same category) and you had best take action to reduce your stressors. Check more than five? Check in with a psychology professional.
___ Fear impending unemployment.
___ Unhappy with work.
___ Unhappy with boss or organization.
___ Unhappy with co-workers.
___ Frustrated ambitions.
___ Under-rewarded (in money, status, benefits, promotions or other ways).
___ Job "Politics".
___ Too much/too little independence.
___ Too much or too little responsibility.
___ Numerous conflicting demands.
___ Too much or too little work.
___ Insufficient earnings
___ Insufficient savings or retirement fund.
___ Large debt or overdue bills.
___ Unable to get credit.
___ Cash flow difficulties (money comes in, but timing is bad).
___ On fixed income (retired, on Social Security, etc.).
___ Fighting & arguing with Spouse.
___ Physical abuse by spouse.
___ Intimidation by spouse.
___ Sexual dissatisfaction or sexless marriage.
___ Substance abuse.
___ Divorce or Separation.
___ Unable to communicate with spouse about important matters. (E.g. money, children, plans for future, essential needs.)
___ Insufficient child care resources.
___ Fighting & arguing (with you or among selves).
___ Constant money struggles (earned and unearned allowance, demands for you to
buy things for them, etc.)
___ Disobedience and defiance in important matters.
___ School difficulties: truancy, poor grades, fighting with teachers or other students, etc.
___ Substance Abuse.
___ Struggles over college plans.
Environment (Home, work and school)
___ Disordered and disorganized.
___ Dangerous neighborhood or facilities.
___ Geographic convenience of work/home/shopping/school/friends. (For example, long commute in heavy traffic to a job is very stressful).
___ Uncomfortable or unpleasant surroundings. (E.g. insufficient light, uncomfortable furnishings, dirt and disorder.)
___ Too much to do.
___ Tight schedule.
___ Too little to do.
___ Too much "waiting."
___ Too many things to do that are undesirable or unpleasant.
___ Too many things left undone.