Rate yourself on the scale below. For each of the fifteen questions, choose a number from 0=5 that shows how you have felt during the last 3 months.
- Do you get tired easy? Do you feel worn out?
No Change 0 1 2 3 4 5 Much Change
- Do you get upset when people tell you “You don’t look so good lately?
No Change 0 1 2 3 4 5 Much Change
- Are you working harder and harder and feel like you’re getting nothing done?
No Change 0 1 2 3 4 5 Much Change
- Are you more sarcastic and disappointed in the world around you?
No Change 0 1 2 3 4 5 Much Change
- Are you sad a lot and don’t know why?
No Change 0 1 2 3 4 5 Much Change
- Are you more forgetful (missing doctor visits, losing things)?
No Change 0 1 2 3 4 5 Much Change
- Are you grumpy? More short-tempered? Do you expect more and more from the people around you?
No Change 0 1 2 3 4 5 Much Change
- Are you spending less time with your friends and family?
No Change 0 1 2 3 4 5 Much Change
- Are you too busy to do every day things (make phone calls, send out cards)?
No Change 0 1 2 3 4 5 Much Change
Do you always feel bad or are you sick all the time?
No Change 0 1 2 3 4 5 Much Change
- Do you feel confused at the end of the day?
No Change 0 1 2 3 4 5 Much Change
- Do you have trouble feeling happy?
No Change 0 1 2 3 4 5 Much Change
- Are you unable to laugh at a joke about yourself?
No Change 0 1 2 3 4 5 Much Change
- Does sex seem like more trouble than it’s worth?
No Change 0 1 2 3 4 5 Much Change
- Do you have very little to say to people?
No Change 0 1 2 3 4 5 Much Change
Calculate Score: _ _ _ _ _ _
If your score is:
Scores 0-25: Doing Fine
Scores 26-35: Watch out, you are at risk.
Scores 36-50: Candidate for Burnout.
Scores 51-65: You are Burning out.
Scores 65+: You are totally Burned out. Get help!