Global Check Set | Forward-Facing Institute

(Gentry and Baranowsky, 2012 edition)

Instructions: Read through each statement responding to items in a manner that best describes your experience over the most recent 2 weeks. Some questions relate to the present and some to the past, respond accordingly.

I drink alcoholic beverages daily.

Never
Rarely.
Sometimes
Frequently
Always

I feel sad, empty, or become tearful.

Never
Rarely.
Sometimes
Frequently
Always

I feel hopeless and worthless.

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

I worry and feel anxious.

Never
Rarely.
Sometimes
Frequently
Always

My body is usually pain free.

Never
Rarely.
Sometimes
Frequently
Always

I cannot recall details of a trauma I experienced.

Never
Rarely.
Sometimes
Frequently
Always

I use illegal drugs daily.

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

I have a positive and cheerful attitude toward life.

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

I worry about my health.

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

I think about ending my life.

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

I easily recall important information about myself.

Never
Rarely.
Sometimes
Frequently
Always

Drugs/alcohol have negatively impacted my personal life.

Never
Rarely.
Sometimes
Frequently
Always

I have a lot of energy.

Never
Rarely.
Sometimes
Frequently
Always

I have a specific plan to end my life.

Never
Rarely.
Sometimes
Frequently
Always

I lose my temper easily.

Never
Rarely.
Sometimes
Frequently
Always

I always feel on edge.

Never
Rarely.
Sometimes
Frequently
Always

I have frequent headaches.

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

Drugs or alcohol are not a problem in my life.

Never
Rarely.
Sometimes
Frequently
Always

I have lost or gained over 10 pounds recently.

Never
Rarely.
Sometimes
Frequently
Always

I fear that my life may never improve.

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

My concentration is good.

Never
Rarely.
Sometimes
Frequently
Always

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

Never
Rarely.
Sometimes
Frequently
Always

I feel outside myself – detached like an observer.

Never
Rarely.
Sometimes
Frequently
Always

I am fairly relaxed and do not startle easily.

Never
Rarely.
Sometimes
Frequently
Always

I feel irritable most of the time.

Never
Rarely.
Sometimes
Frequently
Always

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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