Form: Stress Audit

1 : Almost always
2
3
4
5 : Never
¹
1
2
3
4
5
1
I eat at least one hot, balanced meal a day.
2
I get seven to eight hours of sleep at least four nights a week.
3
I give and receive affection regularly.
4
I have at least one relative who lives close by on whom I can rely.
5
I exercise to the point of perspiration at least twice a week.
6
I am in good health (including eyesight, hearing, dental, etc.).
7
I take fewer than five alcoholic drinks per week.
8
I am the appropriate weight for my height.
9
I have an income adequate to meet basic expenses.
10
I get strength from my religious beliefs.
11
I have one or more friends to confide in about personal matters.
12
I have a network of friends and acquaintances.
13
I regularly attend club or social activities.
14
I smoke less than half a pack of cigarettes a day.
15
I am able to speak openly about my feelings when I'm angry or worried.
16
I have regular conversations with the people I live with about domestic problems, including chores, money, and daily living issues.
17
I do something for fun at least once a week.
18
I am able to organize my time effectively.
19
I drink fewer than three cups of coffee, tea, or soda a day.
20
I take quiet time for myself during the day.

The presented answer sheet is not an original form and is not intended for printing or use as a handout.

The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.