Below is a list of the common fears that most people experience to some extent. Indicate your degree of fear for each of these things by drawing a circle around M if you would usually have considerable fear, around S if you would usually have some fear, around L if you would have a little fear, and around N if you would usually feel no fear.
| 1. | Being buried alive. | M | S | L | N |
| 2. | Being bitten by a snake while walking alone in the woods. | M | S | L | N |
| 3. | Being drowned at sea or while swimming. | M | S | L | N |
| 4. | Friends losing confidence in you because of untrue rumors. | M | S | L | N |
| 5. | Walking past graveyards alone late at night. | M | S | L | N |
| 6. | Having friends learn about your worst faults. | M | S | L | N |
| 7. | Touching mice, rats, worms, or lizards. | M | S | L | N |
| 8. | Losing your wife or sweetheart to somebody else. | M | S | L | N |
| 9. | Getting too deeply in debt or having financial misfortune. | M | S | L | N |
| 10. | Looking down from the edge of a precipice. | M | S | L | N |
| 11. | Being punished in the next world. | M | S | L | N |
| 12. | Elevator falling while descending from the top of a skyscraper. | M | S | L | N |
| 13. | Losing your mind or becoming insane. | M | S | L | N |
| 14. | Losing your eyesight. | M | S | L | N |
| 15. | Listening to radio horror story late at night while alone. | M | S | L | N |