The primary aim of a stress index questionnaire is to help people realize the levels of stress in their life. The feedback received from the questionnaire will help individuals to find new ways to cope with the stress and finally overcome it. Stress can be acquired from workplace or from home but in all forms it is considered to be harmful and hence the stress index questionnaire is used for creating awareness among people towards stress.

Stress Index Questionnaire Sample

Name of the individual: ________________________________

Age: ______ Sex: _______  Occupation: ______________________

Address: ______________________________________

City: ________________ State: ___________________  Zip: _________________

Telephone: ____________________  Fax: ____________________________

Email: _________________________

Q1. Which of the following incidents occur on a regular basis?

a)   Arguments at work

b)   Arguments at home

c)   Neck or shoulder pains

d)   Cramps

e)   Frustration when standing in a queue

f)    No exercise or physical activity

g)   Rarely have time for myself and family

h)   Difficulty sleeping

Q2. What do you do when you are frustrated?

a)   Take out anger on the person causing frustration

b)   Take out anger on family

c)   Take out anger on others

d)   Think about it constantly

e)   Think about it in sleep

f)    Exercise or participate in physical activity

g)   Remain calm

Q3. Do you take out your stress on your spouse or child?

a)   Yes

b)   No

Q4. Do you feel uncontrollable anger when completely stressed out?

a)   Yes

b)   No

Q5. Do you feel other people are responsible for this stress?

a)   Yes

b)   No

Q6. Do you feel stressed in noisy and crowded places?

a)   Yes

b)   No

Q7. Are you taking any sleeping medication or pills?

a)   Yes

b)   No