Global Check Set


I drink alcoholic beverages daily.


I feel sad, empty, or become tearful.


I feel hopeless and worthless.


I have been exposed directly or indirectly(i.e. family, friend, colleagues) to a traumatic event..


I worry and feel anxious.


My body is usually pain free.


I cannot recall details of a trauma I experienced.


I use illegal drugs daily.


My sleep is disrupted or I feel tired when I wake up.


I have a positive and cheerful attitude toward life.


Thoughts of a traumatic event keep coming to my mind (i.e. thoughts, dreams, flashbacks).


I seem to be unable to control my worries or fears.


I worry about my health.


I do not know how I came to be at some place.


Drugs or alcohol interferes with what I need to get done.


I am no longer interested in activities I used to enjoy.



I think about ending my life.


I have not been well due to a diagnosed physical illness(es).


I easily recall important information about myself.


Drugs/alcohol have negatively impacted my personal life.


I have a lot of energy.



I have a specific plan to end my life.


I lose my temper easily.


I always feel on edge.


I have frequent headaches.


I act out of character and feel I don’t know myself.


Drugs or alcohol are not a problem in my life.


I have lost or gained over 10 pounds recently.


I fear that my life may never improve.


I avoid people, places, or things that are trauma reminders.


My concentration is good.


I am afraid that I will become seriously ill in the future.


I feel outside myself – detached like an observer.


I am fairly relaxed and do not startle easily.


I feel irritable most of the time.


Your depression is: __

Your substance use is: __

Your suicidality is: __

Your PTSD is: __

Your Generalized Anxiety Disorder is: __

Your somatization is: __

Your dissociation is: __

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