Fatigue Survey
Student – Physical
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1
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S1P) During an average school day, how often do you feel physically exhausted?
0
% of the time.
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S2P) How do you know when you are physically exhausted? Choose all that apply.
My head hurts
I feel dizzy or weak
I feel sleepy or tired
I feel tension, aches or pains in my body
My eyes bother me (Example: burn, itch, blurry vision)
I do things more slowly
I feel hungry or thirsty
Other
If you selected other, type your response here.
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S3P) When you're physically exhausted, where in your body do you feel it? Choose all that apply.
Eyes
Ears
Head
Neck
Shoulders
Hands
Other
If you selected other, type your response here.
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S4P) What situations make you 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 I need it
Being in a noisy or visually busy environment
Other
If you selected other, type your response here.
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S5P) What do you do when you are physically exhausted? Choose all that apply.
I take a brain break (Example: breathing exercises, meditation, listen to music, pull out my phone)
I rest (Example: lie down, go to bed early)
I take a movement break (Example: stretch, walk around, leave the classroom, go to the washroom)
I ask for what I need (Example: ask for breaks, let someone know if I need help)
I try to reduce background noise (Example: turn down volume or take off hearing aids or cochlear implants)
I do nothing
I eat or drink something
Other
If you selected other, type your response here.
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S6P) At school, do breaks and free time between classes help you to get more energy?
Yes
No
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S7P) When do you feel physically 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)
In the evening before bed
Other
I don’t ever feel emotionally exhausted
If you selected other, type your response here.
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S7P) At the end of the school day, how often do you feel too physically exhausted to do after-school activities (playing sports, completing homework, chores)?
0
% of the time
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