Stress and Burnout Questionnaire

This questionnaire has been designed as a tool to pilot survey giving the warning signals of
excessive stress. Kindly relate questions to your previous 3-6 months of life.

0 For experiencing this only occasionally

1 This is true quite frequently (weekly)

2 This true often (usually daily)

1) Start the day feeling fatigued or tired [ ]

2) Change in appetite; over-eating or loss of appetite [ ]
3) Not enough hours in the day to do all the things that I must do [ ]
4) Experiencing often mood swings and difficulty in making decisions [ ]
5) Overthinking a lot even when I am supposed to be relaxing. [ ]
6) Lack of self confidence and becoming anxious [ ]
7) Having greater dependency on alcohol,caffeine,nicotine or drugs [ ]
8) Being irritated with a shortening fuse. [ ]
9) Finding yourself exhausted in your routine. [ ]
10) Feeling great pressure of responsibilities. [ ]
11) Feeling unappreciated most of time [ ]
12) Losing enthusiasm or cheerfulness [ ]
13) Finding yourself occupied by thoughts [ ]
14) Finding yourself in trouble due to owns inability [ ]
15) Becoming obsessive over things and people [ ]
16) Lack of intimacy in life [ ]
17) Feeling insomniac [ ]
18) Becoming aggressive of short tempered frequently [ ]
19) Finding yourself lonely [ ]
20) Thinking yourself unaccomplished [ ]
21) Forgetting things and loss of memory [ ]
22) Being nervous facing problems or difficult situation [ ]
23) Becoming cynical or hyper-critical with friends or family [ ]
24) Lack of humour or unable to understand humour [ ]
25) Frequent somatic symptoms such as
Headache, chronic back ache, indigestion,skin rash, abdominal
Cramps or wind, mouth ulcer, chest pain, accidents etc.
(1 point for each symptom) [ ]

Total (50)