Name (Optional):______________________________ Grade & Section__________

Sex: Male Female Age: ________

Directions: For each statement in the survey, put a check in the box on the right side of each
statement. Your answers will be kept strictly confidential and you will not be identified.

Scale 4 - Always
3 - Sometimes
2 - Often
1 - Usually

Questionnaire Always Sometimes Often Usually

1.You feel too many demands are being made on you.

2.You feel under pressure from deadlines.

3.You feel loaded down with responsibility.

4.You feel you’re in a hurry.

5.You feel frustrated.

6.You feel tired.

7.You feel mentally exhausted.

8.You have trouble relaxing.

9.You fear you may not manage to attain your goals.

10.You have many worries.

11.You have many decisions to make.

12.You find yourself in a situation of conflict.

13.You are under pressure from other people.

14.Your problems seem to be piling up.

15.You are afraid for the future.

16.You are full of energy.

17.You have enough time for yourself.

18.You enjoy yourself.

19.You feel rested.

20.You feel calm.