Please answer the questions and submit the form
Instructions: Listed below are a number of difficult or stressful things that sometimes happen to people. For each event check one or more of the boxes to indicate that: (a) it happened to you personally; (b) you witnessed it happen to someone else; (c) you learned about it happening to a close family member or close friend; (d) you were exposed to it as part of your job (for example, paramedic, police, military, or other first responder); (e) you’re not sure if it fits; or (f) it doesn’t apply to you.
Be sure to consider your entire life (growing up as well as adulthood) as you go through the list of events.
B. If you have experienced more than one of the events in PART 1, think about the event you consider the worst event, which for this questionnaire means the event that currently bothers you the most. If you have experienced only one of the events in PART 1, use that one as the worst event. Please answer the following questions about the worst event (check all options that apply):
Below is a list of problems that people sometimes have in response to a very stressful experience. Keeping your worst event in mind, please read each problem carefully and then select one of the options to indicate how much you have been bothered by that problem in the past month.
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