1 – Almost never
2 – Very infrequently
3 – Infrequently
4 – Sometimes
5 – Frequently
6 – Very frequently
7 – Almost always
¹
1
2
3
4
5
6
7
1
I feel tired.
2
I have no energy for going to work in the morning.
3
I feel physically drained.
4
I feel fed up.
5
I feel like my “batteries” are “dead.”
6
I feel burned out.
7
My thinking process is slow.
8
I have difficulty concentrating.
9
I feel I am not thinking clearly.
10
I feel I am not focused on my thinking.
11
I have difficulty thinking about complex things.
12
I feel I am unable to be sensitive to the needs of coworkers and customers.
13
I feel I am not capable of investing emotionally in coworkers and customers.
14
I feel I am not capable of being sympathetic to coworkers and customers.
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.