Stress Questionnaire


CSC Stress Questionnaire

Stress is the cost of living that affects everyone and everything we do. Excessive stress levels can cause health problems, disrupt our emotional stability and cloud our thinking. Uncontrolled stress hurts our performance at work and hampers our ability to manage a home and family. Most of all, unnecessary tension can lessen the joy we find in living each and every moment. But we can learn to meet the demands of our lives in a more positive and constructive way.

This questionnaire is designed to give you a sense of what stress means. Please answer Yes or No to each of the items below. Add 1 point for a Yes answer to items 1 to 9 and 1 point for a No answer to items 10-12.


  1.  Do you worry about the future?                                                                                Yes ___  /  No ___

  2.  Do you sometimes have trouble falling asleep?                                                 Yes ___  /  No ___

  3.  Do you often reach for a cigarette, a drink, or a tranquilizer in order

        to reduce tension?                                                                                                     Yes ___  /  No ___

  4.  Do you become irritated over basically insignificant matters ?                          Yes ___  /  No ___

  5.  Do you have less energy than you seem to need or would like to have?         Yes ___  /  No ___

  6.  Do you have too many things to do and not enough time to do them?             Yes ___  /  No ___

  7.  Do you have headaches or stomach problems?                                                  Yes ___  /  No ___

  8.  Do you feel pressure to accomplish or to get things done?                               Yes ___  /  No ___

  9.  Are you very concerned about being either well-liked or successful?               Yes ___  /  No ___

10.  Do you perform well enough in life to satisfy your basic needs?                       Yes ___  /  No ___

11.   Do you get satisfaction from the small joys or simple pleasures of life?        Yes ___  /  No ___

12.  Are you able to really relax and have fun?                                                                Yes ___  /  No ___

      Total score (sum of all 12 items):               __________

     What your score means

If your score is 4 or more, you may be under significant stress and you could benefit by participating in a stress management program.