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Inputs

• Have you wished you were dead or wished you could go to sleep and not wake up?
• Have you actually had any thoughts of killing yourself?
• Have you been thinking about how you might do this?
• Have you had these thoughts and had some intention of acting on them?
• Have you started to work out or worked out the details of how to kill yourself, and did you intend to carry out this plan?
• Have you ever done anything, started to do anything, or prepared to do anything to end your life?

Inputs

• Little interest or pleasure in doing things
• Feeling down, depressed, or hopeless
• Trouble falling/staying asleep, or sleeping too much
• Feeling tired or having little energy
• Poor appetite or overeating
• Feeling bad about yourself — or that you are a failure
• Trouble concentrating on things
• Moving or speaking slowly, or being fidgety/restless
• Thoughts that you would be better off dead or of hurting yourself