Please answer the following questions to determine your “sleepiness”.

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Name
How likely are you to doze off or fall asleep in the following situations?
0=Would never fall asleep1=Slight chance of falling asleep2=Moderate chance of falling asleep3=High chance of falling asleep
Sitting and reading
0=Would never fall asleep
1=Slight chance of falling asleep
2=Moderate chance of falling asleep
3=High chance of falling asleep
Watching TV
0=Would never fall asleep
1=Slight chance of falling asleep
2=Moderate chance of falling asleep
3=High chance of falling asleep
Sitting inactive, in a public place (eg, a theater or meeting)
0=Would never fall asleep
1=Slight chance of falling asleep
2=Moderate chance of falling asleep
3=High chance of falling asleep
As a passenger in a car, for an hour or more without a break
0=Would never fall asleep
1=Slight chance of falling asleep
2=Moderate chance of falling asleep
3=High chance of falling asleep
Lying down to rest in the afternoon, when circumstances permit
0=Would never fall asleep
1=Slight chance of falling asleep
2=Moderate chance of falling asleep
3=High chance of falling asleep
Sitting and talking to someone
0=Would never fall asleep
1=Slight chance of falling asleep
2=Moderate chance of falling asleep
3=High chance of falling asleep
Sitting quietly after lunch without alcohol
0=Would never fall asleep
1=Slight chance of falling asleep
2=Moderate chance of falling asleep
3=High chance of falling asleep
In a car, while stopped for a few minutes in traffic
0=Would never fall asleep
1=Slight chance of falling asleep
2=Moderate chance of falling asleep
3=High chance of falling asleep