PTSD Checklist for DSM-5 (PCL-5)

Step 1 of 2Event Assessment

This questionnaire asks about problems you may have had after a very stressful experience involving actual or threatened death, serious injury, or sexual violence. It could be something that happened to you directly, something you witnessed, or something you learned happened to a close family member or close friend.

Briefly identify the worst event (if you feel comfortable doing so):

How long ago did it happen?

Did it involve actual or threatened death, serious injury, or sexual violence?

Yes

No

How did you experience it?

It happened to me directly

I witnessed it

I learned about it happening to a close family member or close friend

I was repeatedly exposed to details about it as part of my job (for example, paramedic, police, military, or other first responder)

Other

If the event involved the death of a close family member or close friend, was it due to some kind of accident or violence, or was it due to natural causes?

Accident or violence

Natural causes

Not applicable (the event did not involve the death of a close family member or close friend)