SEKOLAH MENENGAH KEBANGSAAN TUNKU KURSHIAH

KM 2, JALAN TAMPIN, KAMPUNG TEBAT KENING, 72000 KUALA PILAH,

NEGERI SEMBILAN DARUL KHUSUS

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QUESTIONNAIRE:
TITLE:
CAFFEINE CONSUMPTION AMONG TEACHERS AND STAFFS AT SMK TUNKU KURSHIAH

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I am writing to express my interest in the Caffeine Addiction Questionnaire project at SMK Tunku Kurshiah
As a passionate advocate and a dedicated researcher, I am excited about the opportunity to contribute to
a project that addresses such a relevant and pressing issue in today's society.

I am particularly drawn to Science Technology Engineering and Mathematics for innovative research and
commitment to improving the well-being of individuals. My attention to detail, methodical approach, and
ability to extract meaningful insights from complex data sets make me well-suited to contribute
meaningfully to the Caffeine Addiction project. Furthermore, my passion for promoting public health and
raising awareness about substance addiction aligns perfectly with the objectives of this initiative.

Nevertheless, I look forward to the possibility of your contribution towards this important research
efforts. I hope that Mr/Mrs can complete this survey with full sincerity and honesty. Thank you for
cooperation.
Tick ✓ in the chosen box.
1. I consume more than 2 cups of caffeine daily.
 Yes
 No

2. I feel restless if I don’t have my daily coffee intake.

 Yes
 No

3. I feel anxious, worried or alarmed before or after caffeine intake.

 Yes
 No

4. I feel excited or refreshed only after having caffeine.

 Yes
 No

5. I find it difficult to fall asleep if I have any caffeinated drinks.

 Yes
 No

6. I noticed reddening of the face during or after consumption of caffeine.

 Yes
 No

7. I have the constant urge to pee.

 Yes
 No

8. I constantly experience any of these: stomach pain, diarrhea, constipation, heart burn or
nausea.
 Yes
 No

9. I experience muscle twitching.

 Yes
 No

10. I experience hurried or confused speech or thought.

 Yes
 No