PTSD Self-Assessment Form



Post-traumatic Stress Disorder (PTSD) is a mental health condition caused by witnessing or experiencing actual or threatened death, serious injury or violence, such as seeing a co-worker killed on the job. Being affected by these types of events is normal. But if the thoughts or memories of these events start to seriously affect you long after the event, you could be experiencing PTSD and so should seek help.


This form is based on one created by because first responders are at least twice as likely to suffer from PTSD as individuals in other occupations. But anyone in any job can develop PTSD. Make this form available to workers in conjunction with instruction on what PTSD is, its symptoms and how to get help. If a worker completes the assessment and believes he may have PTSD, direct him to the appropriate resources for help, such as your Employee Assistance Program.

OTHER RESOURCES:’s PTSD Resource Toolkit

Stress Prevention at Work Checklist

Infographic: Depression in the Workplace