PCL-5 PTSD Screening Checklist

Patient Name *

Date of Screening

____ / ____ / ________

Repeated disturbing memories

Repeated disturbing dreams

Suddenly feeling as if the event were happening again

Feeling upset when reminded of the event

Physical reactions when reminded

Avoiding memories or thoughts

Avoiding external reminders

Trouble remembering important parts of the event

Strong negative beliefs about self or world

Blaming self or others for the event

Strong negative feelings

Loss of interest in activities

Feeling distant or cut off from others

Difficulty experiencing positive feelings

Irritable or angry behavior

Taking too many risks or self-destructive behavior

Being super alert or on guard

Feeling jumpy or easily startled

Difficulty concentrating

Trouble falling or staying asleep