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Questionnaire template

Daily Stress Check

Measures how stressful adults find their typical day, which activities and situations cause stress, and how they cope.

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Healthcare · Patient. All Healthcare templates

Questions in this template

Your Daily Routine

  1. Thank you for taking part. Your answers help us understand everyday stress and plan better support for managing it.

  2. How would you describe a typical day for you?

    Choose one:

    • Very relaxed
    • Relaxed
    • Neutral
    • Stressful
    • Very stressful

  3. How much stress do these everyday activities usually cause you?

    • Getting ready in the morning
    • Travelling to work or study
    • Work or study tasks
    • Housework
    • Caring for family

    For each row: choose one:

    • No stress
    • A little stress
    • Moderate stress
    • High stress
    • Extreme stress
    • Does not apply

Sources of Stress

  1. Which of these situations cause you stress? Select all that apply.

    Choose any that apply:

    • Deadlines
    • Money worries
    • Family problems
    • Health worries
    • Too little time for myself
    • Other
    • None of these

  2. How do the situations you selected affect your stress?

    Condition: Shown when at least one situation is selected

    Open answer

Coping with Stress

  1. What do you mainly do to manage stress?

    Choose one:

    • Exercise
    • Meditation or prayer
    • Hobbies
    • Medication
    • Therapy or counselling
    • Other
    • No particular method

  2. What other method do you mainly use?

    Condition: Shown when Other is selected

    Open answer

  3. How well does this method work for you, from 1 (not at all) to 10 (extremely well)?

    Condition: Shown to people who use a method

    Choose one:

    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10

About You

  1. What is your gender?

    Choose one:

    • Female
    • Male
    • Non-binary
    • Prefer not to say

  2. How old are you?

    A number from 16 to 120

  3. What is the highest level of education you have completed?

    Choose one from a list:

    • Less than secondary school
    • Secondary school or equivalent
    • Some college
    • Bachelor's degree
    • Master's degree
    • Doctorate