Caregiver Self-Assessment*
If you checked “Frequently” or “Always” for any of the above, then its time to seek help from a healthcare provider,
or your local health and social service network—because you have to take care of yourself, too!
* Not intended as a substitute for medical advice. Please consult your doctor if you are experiencing a health problem.
Signs of burnout/fatigue Never Sometimes Frequently Always
I can’t fall asleep or I frequently
wake up.
I have a lack of energy during
the day.
I eat too much or too little.
I am sick more often (flus, colds,
I feel impatient or I am easily agitated.
I feel guilty that I am not doing enough.
I have trouble concentrating
on everyday simple tasks.
I am becoming more forgetful.
I stopped doing activities I used
to find enjoyable.
I am more socially isolated from
my friends and family.
I feel sad or depressed.
I feel anxious or worried.
I have lost interest in doing things.
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