Name Date 0 would neverdoze or sleep1 slight chance of dozing or sleeping2 moderatechance of dozing or sleeping3 highchance of dozing or sleeping Fill in your answers and see where yo ID: 875407
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1 Name: ________________________
Name: ________________________ Date: ________________ Sleepiness Scale 0 = would never doze or sleep. 1 = slight chance of dozing or sleeping 2 = moderate chance of dozing or sleeping 3 = high chance of dozing or sleeping F ill in your answers and see where you stand. Situation Chance of Dozing or Sleeping Sitting and reading ____ Watching TV ____ Sitting inactive in a public place ____ Being a passenger in a motor vehicle for an hour or more ____ Lying down in the afternoon ____ Sitting and talking to someone ____ Sitting quietly after lunch (no alcohol) ____ Stopped for a few minutes in traffic while driving ____ Total score (add the scores up) (This is your Epworth score) ____