Your Quarantine Fatigue Assessment

1

How much of the time during the past 4 weeks have you felt irritable?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

2

Type a question

3

How much of the time during the past 4 weeks have you felt stressed?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

4

Type a question

5

How much of the time during the past 4 weeks have you felt anxious?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

6

Type a question

7

How much of the time during the past 4 weeks have you experienced racing thoughts?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

8

Type a question

9

How much of the time during the past 4 weeks have you felt generally on edge?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

10

Type a question

11

How much of the time during the past 4 weeks have you had difficulty in getting to sleep?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

12

Type a question

13

How many hours of sleep are you getting on a nightly basis?* This field is required.Please give the one answer that comes closest to the way you have been feeling

Less than 6 hours

6-7 hours

7-9 hours

9-10 hours

Over 10 hours

14

Type a question

15

How much of the time during the past 4 weeks have you slept well and woken up feeling well-rested?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

16

Type a question

17

How much of the time during the past 4 weeks have you been LESS productive than you normally are?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

18

Type a question

19

How much of the time during the past 4 weeks have you been LESS motivated than you normally are?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

20

Type a question

21

How much of the time during the past 4 weeks have you been eating MORE than you normally do?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

22

Type a question

23

How much of the time during the past 4 weeks have you been eating LESS than you normally do?* This field is required.Please give the one answer that comes closest to the way you have been feeling

All of the time

Most of the time

A good bit of the time

Some of the time

A little of the time

None of the time

24

Type a question

25

How much are you moving on a daily basis?* This field is required.Estimate if you are unsure. Moderate intensity exercise includes brisk walking, cycling or sports.

Up to 2k steps OR 15 mins moderate exercise

2k-5k steps OR 15-30 mins of moderate exercise

5k-8k steps OR 30-45 mins of moderate exercise

8k-10k steps OR 45-60 mins of moderate exercise

Over 10k steps OR 60 mins of moderate exercise

26

Type a question

27

Roughly what percentage of the food that you eat contains refined sugar or carbohydrates?* This field is required.Refined carbohydrates are usually found in processed foods including fizzy drinks, baked goods, white bread, sweets, sauces, etc. Non-refined carbohydrates are found in fresh fruit, grains and other whole foods.

Less than 20%

20-50%

50-80%

80-100%

28

Type a question

29

Roughly how many glasses or cups of caffeinated beverages do you consume per day?* This field is required.Caffeinated beverages include coffee, black tea and energy drinks. Decaffeinated varieties and herbal teas can be excluded.

Up to 1 per day

1-2 per day

2-4 per day

4+ per day

30

Type a question

31

Do you ever consume caffeinated beverages after 2pm?* This field is required.

No, never

Yes, sometimes

Yes, regularly

32

Type a question

33

Roughly how many units of alcohol do you consume per week?* This field is required.A pint of lager contains 2 to 3 units of alcohol. A 125ml glass of wine contains 1.5 to 2 units of alcohol.

None

Up to 14 units per week

14-21 units per week

21+ units per week

34

Type a question

35

What is your name?* This field is required.

First Name

Last Name

36

What is the best email to send you the results?* This field is required.Make sure it's real!

example@example.com

37

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