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  1. Surveys
  2. 2014
  3. February
  4. E
  5. Experimental Survey
0%
Questions marked with an * are required Exit Survey
 
 
* Please input your assigned ID.
   
 
For each item, tick the box that most accurately describes you.
Almost always Very frequently Somewhat frequently Somewhat infrequently Very infrequently Almost never
* I could be experiencing some emotion and not be conscious of it until some time later
* I break or spill things because of carelessness, not paying attention, or thinking of something else.
* I find it difficult to stay focused on what’s happening in the present.
* I tend to walk quickly to get where I’m going without paying attention to what I experience along the way.
* I tend not to notice feelings of physical tension or discomfort until they really grab my attention.
 
For each item, tick the box that most accurately describes you.
Almost always Very frequently Somewhat frequently Somewhat infrequently Very infrequently Almost never
* I forget a person’s name almost as soon as I’ve been told it for the first time.
* It seems I am “running on automatic” without much awareness of what I’m doing.
* I rush through activities without being really attentive to them.
* I get so focused on the goal I want to achieve without being aware of what I’m doing.
* I do jobs or tasks automatically, without being aware of what I’m doing.
 
For each item, tick the box that most accurately describes you.
Almost always Very frequently Somewhat frequently Somewhat infrequently Very infrequently Almost never
* I find myself listening to someone with one ear, doing something else at the same time.
* I drive places on “automatic pilot” and then wonder why I went there.
* I find myself preoccupied with the future or the past.
* I find myself doing things without paying attention.
* I snack without being aware that I’m eating.
 
 
Writing
   
Drawing
   
Waving hello or goodbye
   
Using a TV remote
   
Snapping your fingers
   
Scratching an itchy nose
   
Pointing at something in the distance
   
Throwing an object
   
Reaching to pick up an object
   
Using a hammer
   
 
 
* I believe myself to be:
 
Right-handed
 
Left-handed
 
Ambidextrous (use both hands equally)
 
 
 
* Are your answers influenced by impairment to your shoulder, arm, or hand (e.g. amputation, injury, arthritis, paralysis, palsy, etc.)?
 
Yes
 
No