Health, Physical Education, and Recreation
Health Fitness Evaluation Stress Form

   

 

The following scale was designed to rate your vulnerability to stress. Please rate each statement accordingly:

 

1 -almost, always
2 -most of the time
3 -about half the time
4 -seldom
5 -never

Make sure to mark each statement. If a particular statement does not apply to you, check 1 (for example, if you are a non-smoker, check 1 for question number 6).



  1. I eat at least one hot, balanced meal a day.
    1 2 3 4 5
  2. I get seven to eight hours of sleep at least four nights a week.
    1 2 3 4 5
  3. I give and receive affection regularly.
    1 2 3 4 5
  4. I have at least one relative within fifty miles on whom I can rely.
    1 2 3 4 5
  5. I exercise to the point of perspiration at least twice a week.
    1 2 3 4 5
  6. I limit myself to less than half a pack of cigarettes a day.
    1 2 3 4 5
  7. I take fewer than five alcoholic drinks a week.
    1 2 3 4 5
  8. I am comfortable/satisfied with my current weight.
    1 2 3 4 5
  9. I have an income adequate to meet basic expenses.
    1 2 3 4 5
  10. I draw strength from my religious beliefs.
    1 2 3 4 5

  11. I regularly attend club or social activities.
    1 2 3 4 5
  12. I have a network of friends and acquaintances.
    Yes No
  13. I have one or more friends to confide in about personal matters.
    Yes No
  14. I believe I am in good health.
    Yes No
  15. I am able to speak openly about my feelings when angry or worried.

    1 2 3 4 5

     

  16. I have regular conversations with the people I live with about domestic problems (i.e., chores, money, etc.).
    1 2 3 4 5
  17. I do something for fun at least once a week.
    1 2 3 4 5
  18. I am able to organize my time effectively.
    1 2 3 4 5
  19. I drink fewer than three cups of coffee (or caffeine-rich drinks) a day.
    1 2 3 4 5
  20. I take some quiet time for myself during the day.    1 2 3 4 5

     

    Please type your email address so that we can contact you:

    First Name:    

    Last Name:



         

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    For more information contact:  

    Jacksonville State University
    Department of HPER
    700 Pelham Road North
    Jacksonville, AL 36265
    (256) 782-5515 or
    1-800-231-5291
    hper@jsu.edu