How likely are you to doze off or fall asleep in the following situations in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently, try to work out how they would have affected you.

Use the following scale to choose the most appropriate number for each situation:

0 = would never doze ♦ 1 = slight chance of dozing ♦ 2 = moderate chance of dozing ♦ 3 = high chance of dozing

Situation
Chance of Dozing
Sitting and reading __________________
Watching television __________________
Sitting inactive in a public place (e.g. a theatre or a meeting) __________________
As a passenger in a car for an hour with a break __________________
Lying down to rest in the afternoon when circumstances permit __________________
Sitting quietly after a lunch without alcohol __________________
Sitting and talking to someone __________________
In a car, while stopped for a few minutes in traffic __________________
TOTAL
__________________