Beat the Blues and De-stress Program

Pre-participation and Post-ParticipationSurvey

1) To what degree are you now feeling fatigue?

2) Do you have fatigue that is interfering with work or activities you enjoy?

3) To what degree are you now feeling ...

4) To what degree are you now feeling ...

5) To what degree are you now feeling ...

6) To what degree are you now feeling ...

7) To what degree are you now feeling ...

8) To what degree are you now feeling ...

9) To what degree are you now feeling ...

1 (None)
2
3
4
5
6
7
8
9
10 (Great Deal)

1 (None)
2
3
4
5
6
7
8
9
10 (Great Deal)

1 (Awake)
2
3
4
5
6
7
8
9
10 (Sleepy)

1 (Great Deal Refreshed)
2
3
4
5
6
7
8
9
10 (Tired)

1 (Energetic)
2
3
4
5
6
7
8
9
10 (Unenergetic)

1 (Patient)
2
3
4
5
6
7
8
9
10 (Impatient)

1 (Relaxed)
2
3
4
5
6
7
8
9
10 (Tense)

1 (Able to Concentrate)
2
3
4
5
6
7
8
9
10 (Unable to Concentrate)

1 (Able to Remember)
2
3
4
5
6
7
8
9
10 (Unable to Remember)

PRE-PARTICIPATION SURVEY
POST-PARTICIPATION SURVEY