Fatigue Survey
Teacher – Cognitive
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Step
1
of 17
T1C) After an average school day, how often does the student seem mentally exhausted?
0
% of the time.
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T2C) How do you know when the student is mentally exhausted? Choose all that apply.
Loses focus or gets distracted
Has trouble following instructions
Asks for things to be repeated
Zones out, gives up, or lets someone else do things for them
Has difficulty making decisions
Makes more mistakes
Other:
If you selected other, type your response here.
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T3C) What situations make the student feel mentally exhausted? Choose all that apply.
Listening or watching for a long time
Classes where they need to learn new words/concepts or do a lot of reading
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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T4C) What does the student do when they are mentally exhausted? Choose all that apply.
Movement breaks (Example: stretch, walk around, leave the classroom, go to the washroom)
Brain breaks (Example: breathing exercises, meditation, listen to music, pull out their phone)
Asks for what they need (Example: ask for breaks, let someone know if they need help)
Tries to reduce background noise (Example: turn down volume or take off hearing aids or cochlear implants)
Stops paying attention (Example: close their eyes, lay head on desk)
Other
If you selected other, type your response here.
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T5C) When does the student seem mentally exhausted? 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)
Other
They don’t ever seem to feel mentally exhausted
If you selected other, type your response here.
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T7C) Do you think that others in the classroom think the student has to use more mental effort than their peers to watch, listen, and understand?
Yes
No
I don’t know
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T8C) Do you think that the student's parents/guardians think the student has to use more mental effort than their peers to watch, listen, and understand in the classroom?
Yes
No
I don’t know
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T9C) Does the student need breaks from listening and watching during class?
Yes
No
I don’t know
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T10C) How often does the student take breaks from listening and watching during class?
All the time
Often
Not Often
Never
I don’t know
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T11C) Which of the following strategies have you suggested to the student's individual support team to help with mental exhaustion? Choose all that apply.
Schedule breaks during the day
Provide designated quiet area
Allow optimal seating location (Example: close to the front of the class, close to speaker)
Allow resources for stress and anxiety (Example: fidget toys)
Reduce background noise
Use visuals (Example: visual schedule, closed captions on videos, images to support text)
Audio/video record lessons
Provide note takers or provide class notes in advance
Use assistive technology properly
Look for signs or symptoms of fatigue
Reduce speaker overlap
Other
I haven’t had the opportunity to suggest any strategies
If you selected other, type your response here.
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T12C) What kind of background noise makes it difficult for the student to listen, watch, or understand? Choose all that apply.
Heating or air conditioning system
Outdoor/hallway sounds
People fidgeting with papers
People moving around
Chairs moving
People talking
Equipment or appliances (Example: projectors, kettles, smartboards, TVs, gym equipment)
Other
I don’t know
If you selected other, type your response here.
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T13C) What kind of communication problems make it difficult for the student to listen, watch and understand? Choose all that apply.
Talking over each other (Example: group discussions)
Speaking fast, quietly, or mumbling
People with an accent that is difficult to understand
People covering their mouths or turning away while speaking
Other
I don’t know
If you selected other, type your response here.
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T14C) What kind of lighting problems in the classroom make it difficult for the student to listen, watch and understand? Choose all that apply.
Glare from window or computer screen
Computer screen brightness
Room is too dark or bright
Flickering light
Reflection on projector or smartboard
Other
I don’t know
If you selected other, type your response here.
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T15C) What kind of seating arrangement problems in the classroom make it difficult for the student to listen, watch and understand? Choose all that apply.
Can’t see/hear the teacher
Can’t see/hear the board
Can’t see/hear the interpreter
Can’t see/hear their classmates
Classroom design (Example: large classrooms, open ceilings, echo)
Other
I don’t know
If you selected other, type your response here.
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T16C) What kind of class material problems make it difficult for the student to listen, watch and understand? Choose all that apply.
Videos with the wrong auto-generated captions
Videos without captions
Not having the notes beforehand
FM/DM connection issues
Other
I don’t know
If you selected other, type your response here.
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T17C) What other problems in the classroom make it difficult for the student to listen, watch and understand? Choose all that apply.
Classes with new information or vocabulary they don’t know
Fast-paced class (Example: missing information and having to catch up)
Having to watch and focus without breaks
Having to do a lot of things at the same time (Example: watching interpreter, lip/speech-reading, note-taking)
Too much information given in class
No other problems apply to the student
Other
If you selected other, type your response here
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