Template library · Assessments & screeners
Compassion Fatigue Screen template
Rate how often you have experienced the following in the past 30 days.
Screen for compassion fatigue in helping professionals
- 17 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Compassion Fatigue Symptoms
- 1. I feel emotionally exhausted from caring for others' problemsChoice
- 2. I feel detached from clients I work withChoice
- 3. I have intrusive thoughts about clients' traumatic experiencesChoice
- 4. I have reduced sense of accomplishment in my workChoice
- 5. I avoid certain clients or situationsChoice
Risk Flags
- Significant sleep disruptionTick box
- Withdrawal from colleagues or personal relationshipsTick box
- Increased substance useTick box
- Considering leaving the professionTick box
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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