Stress Self Assessment Questionnaire

The primary aim of a stress self assessment questionnaire is to help an individual to identify the levels of stress they are going through and how best they can cope up with it. Any form of self assessment is always good because it opens the mind to the various possible solutions and makes an individual aware of their strengths and weaknesses. This is exactly what a stress self assessment questionnaire also does.

Stress Self Assessment Questionnaire Sample

Name of the individual: ________________________________

Age: ______ Sex: _______  Occupation: ______________________

Address: ______________________________________

City: ________________ State: ___________________  Zip: _________________

Telephone: ____________________  Fax: ____________________________

Email: _________________________

Q1. What is your current level of stress on a scale of 1 to 5?

1-Low level

2 – Medium

3 – Controllable

4 – High level

5 – Very high and uncontrollable

Q2. In the last one month how often you felt that you were not in control of your life?

a)   Once

b)   Twice

c)   Less than 5 times

d)   5-10 times

e)   More than 10 times

Q3. In the last 2 weeks, how often did you feel confident about handling your personal problems?

a)   Very often

b)   Fairly often

c)   Sometimes

d)   Never

Q4. How often do you feel that things are not going along the way you want them to?

a)   Very often

b)   Fairly often

c)   Sometimes

d)   Never

Q5. Are you suffering from a case of low morale?

a)   Yes

b)   No

Q6. Do you feel you are depressed?

a)   Yes

b)   No

Q7. Which of the following stress symptoms do you have?

a)   Headache

b)   Upset stomach

c)   Sleeping problems

d)   Anxiety

e)   Lack of focus

f)    Over eating

g)   Increased alcohol consumption

h)   Fatigue

i)     Change in sexual drive

j)    Irritable

k)   Anger

Category: Stress Questionnaire

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