by Archibald D. Hart  (NOTE: This focuses only on burnout; it is not a stress questionnaire.)

Review the past 12 months of your TOTAL life: work, social situations, family and recreation. Reflect on each of the following questions and rate the amount of CHANGE that has occurred during this period. Place more emphasis on change that occurred during the past six months.

Use the following scale and assign a number in the rating column that reflects the degree of change you have experienced. BE HONEST. The value of this self-assessment is negligible if you don’t.

  • 1 = No or little change
  • 2 = Just noticeable change
  • 3 = Noticeable change
  • 4 = Fair degree of change
  • 5 = Great deal of change

Measurement Dimension

 Rating

1.   Do you become more fatigued, tired or "worn out" by the end of the day?

 ______

2.   Have you lost interest in your present work?

 ______

3.   Have you lost ambition in your overall career?

 ______

4.   Do you find yourself becoming easily bored (spending long hours with nothing significant to do)?

 ______

5.   Do you find you have become more pessimistic, critical or cynical of yourself or others?

 ______

6.   Do you forget appointments, deadlines, or activities and don't feel very concerned about it?

 ______

7.   Do you spend more time alone, withdrawn from friends, family and work acquaintances?

 ______

8.   Has any increase occurred in your general level of irritability, hostility or aggressiveness?

 ______

9.   Has your sense of humor become less obvious to yourself or others?

 ______

10. Do you become sick more easily (flu, colds,pain problems)?

 ______

11. Do you experience headaches more than usual?

 ______

12. Do you suffer from gastrointestinal problems(stomach pains, chronic diarrhea or colitis)?            

 ______

13. Do you wake up feeling extremely tired and exhausted most mornings?

 ______

14. Do you find you deliberately try to avoid people you previously did not mind being around?

 ______

15. Has there been a lessening of your sexual drive?

 ______

16. Do you find you now tend to treat people as "impersonal objects" or with a fair degree of callousness?

 ______

17. Do you feel you are not accomplishing anything worthwhile in your work, and that you are ineffective in making any changes?

 ______

18. Do you feel you are not accomplishing anything worthwhile in your personal life or that you have lost spontaneity in your activities?

 ______

19. Do you find you spend much time each day thinking or worrying about your job, people, future or past?

 ______

 20. Do you feel you are at the “end of your tether” or at the point of "breaking down" or "cracking up"?

 ______

 Total Score  

 ______

INTERPRETATION

Remember, no inventory is absolutely accurate or foolproof. Your score on this “Burnout Checklist” is merely a guide to your experience of burnout. Take it as an indication that your life may be out of control. If your score is very high, take steps toward finding help by consulting your family, physician, psycho­therapist, spiritual counselor or personal advisor. The first step toward relief from burnout is to acknowledge, without being self-rejecting, that you have a problem.

20 – 30   There is no burnout. You may be taking your life or work too casually.

31 – 45   This is a normal score for anyone who works hard and seriously. Make sure you do relax periodically.

46 – 60   You are experiencing some mild burnout and could benefit from careful review of your lifestyle.

61 – 75   You are beginning to experience burnout. Take steps to better control your life.

76 – 90   You are burning out. You should seek help, reevaluate your present life and make changes.

Over 90 You are dangerously burned out and need immediate relief. Your burnout is threatening your physical and mental well-being.