Fatigue Survey
Parent – Physical
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Step
1
of 7
P1P) After an average school day, how often does the student seem physically exhausted?
0
% of the time.
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P2P) How do you know when your child is mentally exhausted? Choose all that apply.
Complains about headaches
Complains about dizziness or weakness
Complains about sleepiness or tiredness
Complains about aches, pain or tension in their body
Rubs their eyes
Does things more slowly
Complains that they are hungry or thirsty
Shows changes in their body language/postures
Other
I don’t know
If you selected other, type your response here.
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P3P) What situations make your child feel physically exhausted? Choose all that apply.
Signing for a long time
Listening or watching for a long time
Not being able to take a break when they need it
Being in a noisy or visually busy environment
Other
I don’t know
If you selected other, type your response here.
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P4P) What does your child do when they are physically exhausted? Choose all that apply.
Brain breaks (Example: breathing exercises, meditation, listen to music, pull out their phone)
Movement breaks (Example: stretch, walk around, leave the classroom, go to the washroom)
Movement breaks (Example: stretch, walk around, leave the classroom, go to the washroom)
Movement breaks (Example: stretch, walk around, leave the classroom, go to the washroom)
Tries to reduce background noise (Example: turn down volume or take off hearing aids or cochlear implants)
Does nothing
Eats or drinks something
Other
If you selected other, type your response here.
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P5P) When does your child seem physically exahausted? Choose all that apply.
At the beginning of the school day
During classes throughout the school day
During breaks throughout the school day
At the end of the school day
During after-school activities (Example: sports)
In the evening before bed
Other
They don’t ever seem to feel physically exhausted
If you selected other, type your response here.
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P6P) At the end of the school day, how often does your child seem too physically exhausted to do after-school activities (playing sports, completing homework, chores)?
0
% of the time
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