|
Rate how much these indicators described you today |
|
Very |
|
Moderately |
|
Hardly |
None |
1. |
How oriented, clear headed,
did you feel today? |
|
|
|
|
|
|
|
2. |
How rested did you feel
when you woke up this morning? |
|
|
|
|
|
|
|
3. |
How energetic, ready to
go did you feel today? |
|
|
|
|
|
|
. |
4. |
How strong did you feel
today? |
|
|
|
|
|
|
|
5. |
Were you able to get around
well enough today? |
|
|
|
|
|
|
|
6 |
Were you able to meet challenges
in your life today? |
|
|
|
|
|
|
|
7. |
How much were you able to
meet your financial obligations today? |
|
|
|
|
|
|
|
8. |
How happy did you feel today? |
|
|
|
|
|
|
|
9. |
How much were you able to
put things in perspective? |
|
|
|
|
|
|
|
1O. |
How much were you able to
maintain your sense of humor today? |
|
|
|
|
|
|
|
11. |
How often did you lose it
today, rage attacks, explosive outbursts? |
|
|
|
|
|
|
|
12. |
How much of an interesting
person to be with were you today? |
|
|
|
|
|
|
|
13. |
How stressful was your day? |
|
|
|
|
|
|
|
14. |
How much were you able to
manage stresses in your life today? |
|
|
|
|
|
|
|
15. |
How stressful was your work
day? |
|
|
|
|
|
|
|
16. |
How much were you able to
fulfill your work responsibilities today? |
|
|
|
|
|
|
|
17. |
How well did you get along
with your co-workers or clients today? |
|
|
|
|
|
|
|
18. |
How much did you enjoy your
family life today? |
|
|
|
|
|
|
|
19. |
How rewarding today was
your family life? |
|
|
|
|
|
|
|
20. |
How much were you able to
fulfill your family responsibilities today? |
|
|
|
|
|
|
|
21. |
How well did you get along
with your friend(s) today? |
|
|
|
|
|
|
|
22. |
How much were you able to
meet your social obligations today? |
|
|
|
|
|
|
|
23. |
How much did you enjoy your
social or cultural activities today? |
|
|
|
|
|
|
|
24. |
How much time did you take
for yourself today? |
|
|
|
|
|
|
|
25. |
How confident did you feel
today? |
|
|
|
|
|
|
|
26. |
Did you feel good about
your body today? |
|
|
|
|
|
|
|
27. |
Did your body do what you
wanted today? |
|
|
|
|
|
|
|
28. |
How much were you able to
stay on task today? |
|
|
|
|
|
|
|
29. |
How much did you feel that
you could trust your instincts today? |
|
|
|
|
|
|
|
30. |
How much did you feel that
you could trust your senses today? |
|
|
|
|
|
|
|
31. |
Did you have any bothersome
health symptoms today? |
|
|
|
|
|
|
|
32. |
Did you feel susceptible
to illness? |
|
|
|
|
|
|
|