"Saving Those Who Save Others"            
Firefighter Behavioral Health Alliance
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Suicide Questionnaire

Firefighter’s Suicide Screening

Below is a self-screening for suicide ideations for firefighters.  Please circle either Y= Yes, or N=No.  When you have completed screening please review your score at the end of the screening.

 

 

  1. Are you feeling like a burden to your family, friends, or fire company?          Y           N

 

  1. Do you feel the world would be a better place without you in it?                     Y           N

 

  1. Have you started to isolate yourself from others in the firehouse?                Y          N

             At home?                                                                                                                    Y          N

 

  1. Have you found yourself turning to alcohol or other addictive behaviors to make yourself feel better?                                                                                                                        Y          N

 

  1. Have you or someone close to you notice that your sleeping patterns have changed?            Y         N

 

  1. Are you thinking, “what is the use” when going to the fire house or responding on calls?     Y       N

 

  1. Do you find yourself thinking about or performing unnecessary risks while at a fire scene or on an emergency incident?                                                                                               Y         N

 

  1. Have you found an increased or new interest in risky activities outside the firehouse such as:      

            sky-diving, reckless motorcycle riding or purchasing guns?                             Y         N

 

  1. Are you displaying unexplained angry emotions or been disciplined recently for anger towards other  firefighters?      Officers?       Or the Public within the last two months?      

                                                      Y         N                 (any option will receive a circle of Yes)

 

  1. Have you been told that “you have changed” by:  Friends?     Family?

 

              Fellow firefighters?       Y          N             (any option will receive a circle of Yes)

 

  1. Does your family have a history of a suicide?                                                     Y         N

 

    12.   Do you have a history of feeling depressed?                                                         Y         N

 

    13.   Do you have feelings of hopelessness?                                                                Y         N

 

    14.   Do you feel like killing yourself?                                                                               Y         N

 

    15.  Have you created plans to kill yourself?                                                                  Y        N

 

    16.  Have you recently attempted to kill yourself?                                                        Y         N

Scoring: Total the amount of (Yes) circled.


Score:__________   

If you circled question 15 or 16, then please seek help immediately from a trusted friend, chaplain, counselor, dial 911 or call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or 1-800-SUICIDE (1-800-784-2433) .

 Firefighter Behavioral Health Alliance (FBHA) recommends that if a person answers YES to at least three of these questions, it would be recommended that you contact a local Mental Health Care Professional that deals with firefighters who suffer from suicidal ideations and depression.  If you need assistance, please contact FBHA for further information at 847-485-8953.

 
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