SWIFT

Name:

Email:

If this is the first time you are filling this out for this study, answer keeping in mind the last one month. Mark symptoms only if they have been present for at least one month. If you have filled out this questionnaire before for this study, answer based on the period of time since you last filled this out. Be sure to answer every question to the best of your ability. This questionnaire refers to your usual way of life in recent times. Even if you have not 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:

A. How much of a problem is it to stay awake during the day ( or your usual wake period if you sleep during the day)?

1. Struggling to stay awake during the day

2. Difficulty staying awake while driving

3. Difficulty staying stopped at a traffic signal

4. Difficulty staying awake at work or while doing tasks

5. Difficulty staying awake while reading or studying

6. Difficulty staying awake in social situations

B.How much of a problem has fatigue, tiredness or lack of energy been for you?

1.Feeling tired when at work or while doing tasks

2. Lack of energy during social situations

3. Struggling with fatigue during social situations

4. Feeling tired while reading or studying

5. No energy to do tasks that do not absolutely have to be done

6. Difficulty driving because of fatigue

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