Burnout Questionnaire

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This questionnaire is to gauge where you are at in the stages of burnout.By checking three or more this indicates your level of burnout.

Your responses will be emailed to you.

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Early Burnout Signs
Check all that apply.

Occasional exhaustion or feelings of being overwhelmed.

Struggling to keep up with responsibilities or deadlines.

Temporary irritability or dissatisfaction with work or life.

Symptoms may improve with rest or self-care.

Moderate Burnout
Check all that apply.

Stress and exhaustion are persistent, even with attempts to rest.

Increased cynicism and frustration, especially toward work or responsibilities.

Loss of motivation or feeling disengaged from activities you used to enjoy.

Sleep and energy levels are noticeably impacted.

You may begin to withdraw socially or neglect self-care.

Severe Burnout

Check all that apply

Emotional and physical exhaustion feel constant and unrelenting.

Productivity and performance drop significantly.

Chronic feelings of negativity, hopelessness, or being "stuck."

Physical symptoms like headaches, gastrointestinal issues, or chronic pain worsen.

Potential use of unhealthy coping mechanisms (e.g., overuse of alcohol, emotional eating).

Critical Burnout
Check all that apply/

Chronic hopelessness

Inability to function in daily life or meet basic responsibilities.

Physical health may decline severely (e.g., high blood pressure, immune system issues).

Frequent panic attacks or debilitating depression episodes

Insomnia or over sleeping

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