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Burnout Self-Assessment Checklist

Rate the signs of exhaustion, cynicism and reduced efficacy

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A reflection checklist built around the three parts of burnout: exhaustion, cynicism and reduced efficacy. Rate how often each sign has been true over the last month (0 = never, 4 = almost always). This is not a diagnostic test — it's a starting point for a conversation with your therapist or doctor.

Exhaustion

I wake up tired even after a full night's sleep
none
1
2
3
4
most
I dread the start of the work week
none
1
2
3
4
most
Small tasks feel like they take everything I have
none
1
2
3
4
most
I get sick more often or my body feels run down
none
1
2
3
4
most
My exhaustion total (out of 16)

Cynicism / detachment

I feel numb or irritated about people I used to care about
none
1
2
3
4
most
I go through the motions without feeling connected
none
1
2
3
4
most
I catch myself being sarcastic or cold about my work
none
1
2
3
4
most
I've pulled back from colleagues, friends or family
none
1
2
3
4
most
My cynicism / detachment total (out of 16)

Reduced efficacy

I doubt that what I do makes any difference
none
1
2
3
4
most
I make more mistakes or forget things more than usual
none
1
2
3
4
most
Tasks I used to do easily now feel hard
none
1
2
3
4
most
I no longer feel good at what I do
none
1
2
3
4
most
My reduced efficacy total (out of 16)
Which area scored highest — and when did it start rising?
Physical signs I've noticed (sleep, appetite, headaches, getting sick)
What is still giving me energy, even a little
One thing I want to bring to my next session

References & further reading

Conceptual background and further reading, not validation of this handout. Named instruments and methods belong to their original authors; custom prompts and trackers are not validated versions of those instruments.

  • Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience. World Psychiatry, 15(2), 103–111.
  • World Health Organization. (2019). Burn-out an "occupational phenomenon": International Classification of Diseases (ICD-11, QD85).
© 2026 TherapistAssist · For clinical use · Not a substitute for assessment
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About this worksheet

Burnout is not just being tired. The World Health Organization describes it as an occupational phenomenon with three dimensions: exhaustion, growing mental distance or cynicism about work, and reduced professional efficacy. This checklist turns those three dimensions into twelve plain-language signs. Clients rate each one from 0 (never) to 4 (almost always) over the last month, total each area, and notice which one is loudest. It is a reflection tool, not a validated diagnostic test like the Maslach Burnout Inventory, and it doesn't replace a medical check — fatigue, low mood and poor concentration can also come from depression, thyroid problems, anemia or sleep disorders.

When to use it

  • At intake when a client describes work stress or 'running on empty'.
  • Before building a burnout recovery plan, so you know which area to target first.
  • Clinician, nurse and caregiver burnout, including supervision.
  • Repeated monthly to track change during recovery.

How to use it

  1. 1
    Use the last month

    A short window keeps the ratings concrete instead of a vague sense of 'always'.

  2. 2
    Total each area separately

    Exhaustion, cynicism and efficacy respond to different changes, so the pattern matters more than one score.

  3. 3
    Rule out other causes

    High exhaustion with low mood or physical symptoms is worth a depression screen and a medical check.

  4. 4
    Pick the next step

    Move to the Burnout Recovery Plan or Energy Audit with the loudest area in mind.

Frequently asked questions

Is this a burnout test?+

It's a self-reflection checklist based on the three dimensions of burnout. It can show which signs are strongest, but it doesn't diagnose burnout or anything else.

What are the signs of burnout?+

The three core signs are exhaustion that rest doesn't fix, cynicism or detachment from work and the people in it, and feeling ineffective. Physical signs such as poor sleep, headaches and getting sick more often are common too.

Is burnout the same as depression?+

No, though they overlap. Burnout is tied to work or caregiving and often eases when those demands change; depression tends to affect every area of life. If low mood is present outside work, screen for depression too.

Is this worksheet free?+

Yes. Free printable PDF. Sign in to TherapistAssist to send as a secure client link.

Worksheet — Burnout Self-Assessment Checklist — provided by TherapistAssist for clinical use. Not a substitute for assessment or treatment.