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Daily Activity and Anxiety Assessment

This document contains a 10 question survey about daily activities, timeliness, energy levels, stress responses, and temperament. Respondents are asked to select from answer options like 'Always', 'Sometimes', 'Never' to questions about their typical behaviors and experiences.

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Shilpa
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4 views3 pages

Daily Activity and Anxiety Assessment

This document contains a 10 question survey about daily activities, timeliness, energy levels, stress responses, and temperament. Respondents are asked to select from answer options like 'Always', 'Sometimes', 'Never' to questions about their typical behaviors and experiences.

Uploaded by

Shilpa
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

1. what do you think is the speed of your day to day activities?

- Slow

- Moderate

- Fast

- Very fast

2. do you complete your given task within stipulated time?

- Always

- Most of the time

- Sometimes

- Rarely/never

3. as a child, were you late most of the time for school?

- Yes, I was late frequently

- No, I was usually on time

- Occasionally, I was late

- I don't remember

4. before any event / attending meetings are you extremely nervous / anxious?

- Extremely nervous/anxious

- Somewhat nervous/anxious

- Neutral

- Confident
5. before any kind of performance on stage or before an exam do you have sleepless nights / increased
frequency of urination or increased bowel movements?

- I experience sleepless nights

- I have increased frequency of urination

- I have increased bowel movements

- I don't experience any of the above symptoms.

6. do you feel active and energetic all throughout the day?

- Extremely active and energetic

- Somewhat active and energetic

- Neutral

- Tired and sluggish.

7. do you like to involve yourself in outdoor sport activities or do you prefer indoor activities or games?

- Outdoor sports activities

- Indoor activities or games

- I enjoy both outdoor and indoor activities

- I'm not really interested in either outdoor or indoor activities.

8. do you experience palpitations / increased sweating frequently?

- Yes, I experience palpitations and increased sweating frequently

- I experience palpitations or increased sweating occasionally

- No, I don't experience palpitations or increased sweating


9. are you prone to gastric troubles easily? do you experience gastric troubles when you eat outside
food or rich fatty food?

- Yes, I'm prone to gastric troubles easily

- I experience gastric troubles occasionally

- No, I don't experience gastric troubles

10. do you lose your temper easily on least provocation?

- Very easily, even on least provocation

- Somewhat easily, but only on significant provocation

- Rarely or never

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