1 – Almost never
2 – Rarely
3 – Sometimes
4 – Frequently
5 – Almost always
¹
1
2
3
4
5
1
I go to bed later than I had intended.
2
I go to bed early if I have to get up early in the morning.
3
If it is time to turn off the lights at night I do it immediately.
4
Often I am still doing other things when it is time to go to bed.
5
I easily get distracted by things when I actually would like to go to bed.
6
I do not go to bed on time.
7
I have a regular bedtime which I keep to.
8
I want to go to bed on time but I just don't.
9
I can easily stop with my activities when it is time to go to bed.
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.