The FATAL 10 Self-Assessment

Over the past 5 years I have experienced (Check ALL that apply):*

Cardiovascular DiseaseDiabetesDizzinessShortness of breathFatigueChest painsRapid heart rateHeadache/MigraineHeart attackHigh blood pressureStrokeBack painAcid reflux/GERD (Gastroesophageal reflux disease)IBS/IBS-C (irritable bowel syndrome with and without constipation)ArthritisAbdominal pain/bloatingNeck/joint painChronic painOther Chronic medical issuesNone of these applyOther

017. Cardiovascular Disease

018. Diabetes

019. Dizziness

20. Shortness of breath

21. Fatigue

22. Chest pains

23. Rapid heart rate

24. Heart attack

25. High blood pressure

26. Stroke

27. Acid reflux/GERD (Gastroesophageal reflux disease)

28. Chronic pain

Total 04 - Over the past 5 years I have experienced (Check ALL that apply):

I experience pain*

YesNo

I am on a pain management program*

YesNo

I smoke cigarettes/vape/use marijuana or marijuana products or edibles*

YesNo

I have experienced an injury (on or off duty) which affects my health*

YesNo

My immunizations are up to date*

YesNo

I had a physical in the past year*

YesNo

I have visited the dentist in the past year for a check up*

YesNo

I use a chiropractor*

YesNo

Overall, I feel healthy*

YesNo

When is the soonest you will be “eligible” to retire years months days

When do you plan on retiring*

Are you financially prepared to retire*

YesNo

Are you emotionally prepared to retire*

YesNo

Will retirement include continued employment*

YesNo

My average household income is/will be dramatically reduced in retirement*

YesNo

If retired, I find retirement to be more stressful than anticipated*

YesNoNA (Not Applicable)

Total of Page 4:

Total Form Score:

Final Risk Category:

HIGH RISK:

HIGH RISK:

Based on your current assessment responses, you are deemed HIGH RISK. This means your responses indicate actions and/or behavior(s) that place you at greater risk for physical, emotional, and/or psychological issues now or in the future. Your results indicate limited protective factors, which also contribute to this finding. Though you are currently in the HIGH-RISK category, there are lifestyle changes that can help reduce your overall risk.

MODERATE RISK:

MODERATE RISK:

Based on your current responses you are deemed MODERATE RISK for negative outcomes. This means your responses indicate actions or behavior(s) that place you at MODERATE RISK for physical, emotional, and/or psychological issues now or in the future. Your results indicate several protective factors, which also contribute to this finding. Though you are currently not deemed high risk, your chances of becoming high risk are increased without a plan to reduce your risks.

LOW RISK:

LOW RISK:

Based on your current responses you are deemed LOW RISK for negative outcomes. This means your responses indicate actions or behavior(s) place you at LOW RISK for physical, emotional, and/or psychological issues now or in the future. Your results indicate adequate protective factors, which also contribute to this finding. However, it is essential to work on maintaining this level of wellness so to reduce the chances of going into the moderate or high- risk category.

The FATAL 10 Self-Assessment

DEMOGRAPHICS

SUBSTANCE USE

CUMULATIVE STRESS & TRAUMA

SLEEP ISSUES

MENTAL HEALTH ISSUES

MEDICAL/PHYSICAL ISSUES

PENDING OR NEARING RETIREMENT