Template library · Assessments & screeners
Trauma Symptom Checklist template
Rate how often you have experienced the following in the past month.
Current trauma-related symptom review
- 17 fields across 3 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
Symptom Frequency
- 1. Unwanted memories or images of the event(s)Choice
- 2. Avoiding reminders of the event(s)Choice
- 3. Feeling on guard or easily startledChoice
- 4. Feeling emotionally numb or detachedChoice
- 5. Difficulty sleepingChoice
- 6. Irritability or anger outburstsChoice
- 7. Negative beliefs about self, others, or the worldChoice
- Below threshold — Subclinical: Monitor
- Above threshold — Clinically significant: Full trauma assessment recommended
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
- Client SignatureSignature
- Date signed (client)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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