Environmental Stress Questionnaire

Environmental stress questionnaire have been designed to identify the factors that govern the factors that control the relationship between human behavior and their immediate environment. Whether it is a family environment or work environment, there are different events and situations that increase or decrease the level of stress in an individual’s life. The environmental stress questionnaire has been created to study the impact and how environmental stress affects individuals.

Sample Environmental Stress Questionnaire:

Name of the participant: _____________________________

Work / School: _____________________________

Address: ______________________________________  City:_______________

State: __________________  Zip: ________________

Email: _____________________________

Phone Number: ____________________________

  • Which of the following environmental stressors have you come across in the last 10 years?

a)      Death in the family

b)      Accident in the family

c)      Cataclysmic events

d)     Failure in examination

e)      Consistently rejected at work/school

f)       Arguments at work / school

g)      Work overload

h)      Rapid social changes

  • Which of the following symptoms have you felt lately?

a)      Uncontrollable anger

b)      Anxiety and Nervousness

c)      Irritation and want to avoid people

d)     Sudden mood changes

e)      Low libido

f)       Depression and suicidal thoughts

g)      Aloofness and obscurity

  • Which one of the following is most affected when you are stressed?

a)      Mental disposition

b)      Emotional disposition

c)      Psychological disposition

d)     Physical disposition

  • Which one of the following aspects of your immediate environment you dislike the most?

a)      Social parties

b)      Playing sports

c)      Watching Television

d)     Homework

e)      Household chores

f)       Monthly work assessment or review

g)      Annual appraisals

h)      Commitment in Relationships

i)        Nothing in particular

  • Have you discussed your stress related problems with a psychologist?

a)      Yes

b)      No

c)      Didn’t think about it

d)     Don’t want to discuss

Category: Stress Questionnaire

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