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.

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

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

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

At home? Y N

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

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

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

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

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

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)

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

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

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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