Cope, Inc.

"Stress Test"

Below is a 21-item questionnaire designed to informally assess your level of stress as well as your ability to manage it effectively. Based on your responses, you will be given basic feedback and directed to additional resources.

Please base your responses on the last 6 months.

1.	Have you noticed a change in your usual sleeping habits such as sleeping more, or an increased difficulty in falling or staying asleep?	Yes No
2.	Do you have difficulty concentrating on work activities for a long period of time?	Yes No
3.	Have you noticed changes in your typical eating habits or a change in your appetite?	Yes No
4.	Have you noticed an increase in physical symptoms such as upset stomach, headaches, or neck/back pain?	Yes No
5.	Do you find it hard to relax and have fun?	Yes No
6.	Have you found yourself more easily frustrated by co-workers or family members?	Yes No
7.	Do you feel you have had inadequate time to accomplish or balance your work and family responsibilities?	Yes No
8.	Have you noticed any changes in the way you use alcohol or prescription medicine, or have you started using other drugs?	Yes No
9.	Have you found yourself less motivated to do activities which you previously looked forward to?	Yes No

10.	Have you (or someone close to you) suffered a significant loss? i.e., death of a loved one, separation or divorce, loss of a pet, loss of a home, loss of a job, etc.)	Yes No
11.	Have you experienced a major life adjustment in the past six months such as changing jobs, ending a significant relationship, or purchasing a home?	Yes No
12.	Have you had any difficulty in the past six months meeting all of your financial responsibilities in a timely manner?	Yes No
13.	Has your work environment changed significantly in the past six months, either through physical differences, changes in staffing, or the overall culture of the workplace?	Yes No
14.	Have you found yourself in need of legal representation or with general legal questions?	Yes No
15.	Have you found yourself concerned with child care options?	Yes No
16.	Have you been concerned with "acting out" behavior by your child/adolescent?	Yes No

17.	Are you the primary care-giver of an aging parent/loved one or having difficulty finding elder-care resources?	Yes No
18.	Has the majority of time you spend with your spouse or significant other been less enjoyable than you would like?	Yes No
19.	Does communication with your co-workers leave you feeling frustrated or misunderstood?	Yes No
20.	Have you experienced a traumatic event in your workplace, (i.e. incidence of workplace violence, death of an employee, etc.)	Yes No
21.	Are you concerned about the alcohol or substance use of a family member?	Yes No

The treatment of mental and physical health issues requires direct interaction with trained healthcare professionals. This 'test' is an informal informational tool, not a formal diagnostic test. The results are provided for general informational purposes only. It should NOT be used as a substitute for seeking professional care/advice to address health issues.