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Free Trauma Response Check Template

Free trauma-response self-check — intrusion, avoidance and arousal rated since a stressful event, with an AI report keeping help pathways visible.

~7 min
3 symptom groups
AI PDF Report
AI Consultant
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Quick answer

Free trauma-response self-check — intrusion, avoidance and arousal rated since a stressful event, with an AI report keeping help pathways visible.

Disclaimer: this page and its AI report are for self-reflection and process reference only. They do not constitute medical, psychological, financial, legal or safety advice. Consult a qualified professional when needed.

Methodology: items are an original adaptation inspired by widely used three-cluster framing, not an official version; scoring is indicative, not diagnostic, and strong responses direct to professional support.

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About this template

After a scary event, the classic pattern runs through three clusters — intrusions, avoidance and arousal. This self-check asks clients to rate each cluster since the event, and the AI report keeps help pathways front and center: what the pattern suggests, when to contact a professional, and immediate support lines if responses flag risk. Indicative, never a diagnosis.

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Live Preview

Sample form and AI report preview (fillable once the app is published).

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Fill it in to see how responses flow.
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Sample AI report with scoring visuals and recommendations, printable as a PDF.
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Scan the QR on the report to start an AI consultant chat.
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What's Included

The arousal, avoidance and re-experiencing items it screens.

1

Three-cluster structure

Intrusion, avoidance and arousal kept separate in scoring.

2

Event-anchored wording

Items refer to a period since a specific stressful event.

3

AI report with help paths

Explains patterns and points toward trauma-informed support.

4

Safety framing

Strong responses direct to crisis and professional contact first.

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How It Works

From copy to a trauma-response readout in four steps.

1

Copy the template

Import the check with scoring and report — free.

2

Set the anchor

Define the recall window and event phrasing with the client.

3

Complete privately

Seven minutes; never require it before rapport exists.

4

Read with care

Use the report to discuss trauma-informed options, not labels.

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Who Is This For

Who it suits — trauma clinicians or survivors checking in.

1

Trauma-informed therapists

A gentle, structured opener for trauma work.

2

Individuals after a hard event

Name what has changed since the event.

3

First responders & EAP teams

Peer-support screening with clear escalation notes.

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Key Features

What makes this trauma check safe and non-triggering.

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Sample Questions Inside

The intrusion, avoidance and arousal items — the live check adds banded scoring with trauma-informed help pathways.

  1. Since the event, unwanted memories or images arrive uninvited. (1-5)
  2. Since the event, I avoid reminders — places, people, conversations. (1-5)
  3. Since the event, I am on guard for danger even when relaxed. (1-5)
  4. Since the event, sleep has been disturbed by thoughts of it. (1-5)
  5. Since the event, I feel detached from people close to me. (1-5)
  6. Since the event, small surprises make me jump. (1-5)
  7. What has been hardest since the event? (open)
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Frequently Asked Questions

Is this a PTSD diagnostic tool?
No — it is a self-reflection check with adapted wording inspired by the classic three-cluster framing; diagnosis of trauma-related disorders belongs to qualified clinicians, and strong scores should prompt professional contact, not a label.
Should someone take this during acute crisis?
No — during immediate distress, contact emergency services or a crisis line; this check is for reflective periods after stabilizing.
What do the three clusters capture?
Intrusion (memories arriving uninvited), avoidance (dodging reminders) and arousal (on-guard reactivity) — the report keeps them separate because treatment differs by cluster.
Is it free to use?
Yes — copy the check, scoring and AI report into your FormLM workspace at no cost.
Why does the report include help guidance?
Trauma self-checks without a support pathway can scare people; every report ends with concrete next-step resources.
Can clinicians adapt the items?
Yes — anchor wording to the event type and culture of the client; the template is fully editable.

After the event — understand the after

A trauma-response check with an AI report that keeps help pathways visible. Free.