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STRESS SELF ASSESSMENT TEST
Check any that apply to you in the past year
 

(Print out
& complete)

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Death of a spouse
Divorce
Marital Separation
Jail term
Death of family member
Personal injury or illness
Marriage
Fired at work
Marital reconciliation
Retirement
Change in health in family member
Pregnancy
Sex Difficulties
Business adjustment
Change in financial status
Death of a close friend
Change in a different line of work
Change in number of arguments with spouse
Mortgage over one year’s net salary
Foreclosure on mortgage or loan
Change in responsibilities at work
Son or Daughter leaving home
Trouble with in-laws
Outstanding personal achievement
Spouse begins or stops work
Begin or end school
Change in living conditions
Revision in personal habits
Trouble with the boss
Change in work hours or conditions
Change in residence
Change in schools
Change in recreation
Change in church activities
Change in social activities
Mortgage or loan less than one year’s net salary
Change in sleeping habits
Change in number of family get togethers
Vacation
Christmas
Minor traffic violation
100
73
65
63
63
53
50
47
45
45
44
40
39
39
38
37
36
35
31
30
29
29
29
28
26
26
25
24
23
20
20
20
19
19
19
17
16
15
13
12
11
TOTAL _________

If you accumulate a score is over 300 points within one year, you have an 80% chance of a serious change in your health within the next year. It will take up to twelve months to manifest due to what is known as the “incubation period.”

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Participants should consult with their qualified health care provider regarding implementation of concepts or information gained from this website. The information on this website should not be construed as medical or health advice.