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How many hours of sleep on average do you receive every night? Or during the day if you are on a night shift?
   
What is the quality of your sleep on average (Excellent, Good, Fair, Poor)?
   
 
 
 
On your off days, what time do you go to sleep?
   
How many hours do you get?
   
What is the quality of your sleep (Excellent, Good, Fair, Poor)?
   
 
 
 
How many days per week do you experience periods of nodding off while driving home?
 
0
 
1
 
2
 
3
 
4
 
5
 
>5
 
 
 
What schedule are you currently working?
   
How long have you been working this shift?
   
 
 
 
What method(s) do you use to keep yourself awake when you're tired at work?
   
 
 
 
When you go to sleep, how long does it take on average to fall asleep?
 
<5 minutes
 
5-10 minutes
 
10-20 minutes
 
>20 minutes
 
 
 
On average, how tired are you?
 
Very
 
Moderately
 
A Little
 
Not At All
 
 
 
How do you feel about your organization's shift schedule?
   
Can it be improved? How?
   
 
 
 
Based on your mission's demands, what is your ideal schedule? Why?
   
 
 
 
Would you like information on sleep and improving sleep qualities?
 
Yes
 
No