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Fatigue Assessment
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Section 1: Self-Reported Fatigue Levels
How would you rate your overall level of fatigue in the last week
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
To what extent have you experienced mental tiredness or difficulty concentrating?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
How physically tired or exhausted have you felt in the last 24 hours
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
How physically tired or exhausted have you felt in the last 24 hours
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
Section 1: Self-Reported Fatigue Levels
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Section 2: Daily Activities Impact
Question 2.1: How has fatigue affected your ability to preform at work or be productive?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
Questions 2.2: To what extent has fatigue affected your participation in social and personal activities?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
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Section 2: Daily Activities Impact
Question 3.1: Rate the quality of your average sleep?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
Questions 3.2: Have you woken up this morning / today tired?
Yes
No
Questions 3.3: How much do you feel your sleep quality influences your fatigue levels?
Yes
No
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Section 2: Daily Activities Impact
Question 4.1: Rate your overall stress levels within the past week?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
Questions 4.2: To what extent do you believe that stress contributes to your fatigue
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
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Section 2: Daily Activities Impact
Question 5.1: Rate your engagement in physical activities / exercise in the past week?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
Questions 5.2: How do you perceive the relationships between physical activities and your fatigue?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
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Section 2: Daily Activities Impact
When did you last yawn?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
Questions 5.2: How do you perceive the relationships between physical activities and your fatigue?
No Fatigue
Mild Fatigue
Moderate Fatigue
Severe Fatigue
Extreme Fatigue
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