completing this assessment, please be aware that any information or personal
details will be kept private and confidential, according to our Privacy
questions are designed to ascertain whether there may be a problem with
alcohol, though do not confirm or refute. The questionnaire is not a
replacement for medical or psychological advice and is for informational
& educational purposes only.
you have concerns regarding your health & well being in relation to
alcohol consumption please contact your GP or other health professional. You
may also make contact with the ‘Kick Off’ team.
Do you sometimes wake in the morning after a big night out &
periods of the night before?
have a habit of arguing or getting into fights when you are
spouse or partner complain about your drinking?
Do your family or team mates express concern
often the first person to arrive for a night out drinking,
the last one to go home?
a few drinks, do you find it difficult to stop or slow down,
to keep going?
find yourself apologizing for behaviour during those
you have been drinking?
ever drink before noon?
job or career been affected by your drinking? Have you
sacked, fined or reprimanded as a result?
ever been late for training due to drinking the night
have you ever arrived at training intoxicated? YesNo
name performance ‘on field’ ever been affected as a result
ever been in trouble with the law (eg. Drink driving)? YesNo
lost wives, partners, girlfriends etc. as a result of your
drink every day?
ever had any side effects from drinking such as: tremor,
– the day after you have been drinking?
If you answered yes to 4
or more of the questions, further assessment by the appropriate skilled clinician should be sought. Please
contact your GP or other related medical professional. Alternatively, you may contact the ‘Kick Off’ team if you
-*only if you would like a