Fatigue Survey
Student – Social Emotional
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Step
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S1S) During an average school day, how often do you feel emotionally exhausted?
0
% of the time.
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S2S) Which of these statements apply to you when you are emotionally exhausted? Choose all that apply.
I feel worn out or want to give up
I act out (Example: behave badly, get into arguments, yell or shout)
I don’t want to participate in class or do my schoolwork
I am too tired to hang out with friends or family
I want to be alone
I avoid noisy areas
I avoid conversations
Other
If you selected other, type your response here.
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S3S) How do you know when you are emotionally exhausted? Choose all that apply.
I feel frustrated or irritable
I feel impatient or angry
I feel nervous or anxious
I feel sad or depressed
I feel sleepy or tired
I feel embarrassed or insecure about myself
Other
If you selected other, type your response here.
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S4S) What situations make you feel emotionally exhausted? Choose all that apply.
When there are too many people talking around me (Example: big crowds)
When people don’t include me in conversations
When people are having side conversations
When I am in settings or situations I don’t know
When I have lots of things to do (Example: busy schedule)
When I have to repeat myself or ask others to repeat information
Other
If you selected other, type your response here.
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S5S) What do you do when you are emotionally exhausted? Choose all that apply.
I stay away from the things that make me feel emotionally exhausted (Example: staying home from school, going to my room)
I take a break (Example: closing eyes, turning off hearing aids or implants, eating or drinking something)
I distract myself with things I enjoy (Example: listening to music, pulling out my phone)
I distract others
I talk about my feelings (Example: journaling, talking to family or friends, talking to counsellor)
I don’t do anything
I try to push through
Other
If you selected other, type your response here.
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S6S) When do you feel emotionally 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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S7S) At the end of the school day, how often do you feel too emotionally exhausted to do after-school activities (playing sports, participating in clubs)?
0
% of the time
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S8S) At the end of the school day, how often do you feel too emotionally exhausted to spend time with family?
0
% of the time
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S9S) How often does feeling emotionally exhausted affect your relationships with others?
0
% of the time
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S10S) When you are emotionally exhausted, what situations are the most difficult to be in? Choose all that apply.
School activities or classes
Out of school activities
Social events
Family dinners or gatherings
Hanging out with friends
Other
If you selected other, type your response here.
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S11S) While spending time with others, what do you do when you feel emotionally exhausted? Choose all that apply.
I hang out with just a few people
I bring a friend to support me
I pull out my phone
I make sure that I am in a spot where I can hear and see best
I leave the situation
I pretend I understand what people are saying
Other
If you selected other, type your response here.
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