Stress Survey Questionnaire

A stress survey questionnaire contains information that relates to an individual’s reaction to different situations presented in life. Through a well defined stress survey questionnaire, doctors and psychiatrists can even find solutions for stress management. This type of questionnaire also helps people under stress to identify their problem areas and thus provides them with the necessary direction.

Stress Survey Questionnaire Sample

Name of the individual: ________________________________

Age: ______ Sex: _______  Occupation: ______________________

Address: ______________________________________

City: ________________ State: ___________________  Zip: _________________

Telephone: ____________________  Fax: ____________________________

Email: _________________________

Q1. Which of the following symptoms have you noticed in the last few months?

a)   Insomnia

b)   Fatigue

c)   Hypertension

d)   Dry mouth

e)   Compulsive eating

f)    Muscle ache

g)   Headache

h)   Anxiety

i)     Addictive behavior

j)    Irritable behavior

Q2. How much fun experience is there in your everyday life?

a)   Quite a lot

b)   A few fun moments

c)   Occasional moments

d)   None at all

Q3. What according to you contributes the most stress in your everyday life?

a)   Job

b)   Education

c)   Family

d)   Children

e)   Driving

f)    Crowded places

Q4. Do you sleep well?

a)   Yes

b)   No

Q5. How often do you exercise or participate in physical activity?

a)   Once a day

b)   Once in two or three days

c)   Once in a week

d)   A few days in a month

e)   No exercise at all

Q6. What do you do when you feel stressed?

a)   Take pre-emptive action

b)   Take a break

c)   Take the day off

d)   Watch a movie

e)   Keep myself pre-occupied

f)    Exercise

g)   Do nothing special

Q7. When you are stressed, what type of behavioral attitude do you have?

a)   Positive

b)   Negative

c)   Calm

d)   Anxious

e)   Angry

f)    Depressed

Q8. Do you let your stress affect your family life?

a)   Yes

b)   No

Q9. Do you let your stress affect your work life?

a)   Yes

b)   No