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Sleep Deprivation Survey + Sample Questionnaire Template

The sleep deprivation survey is a questionnaire designed to collect feedback from a student respondent about their sleep habits and the situations in which they feel sleepy. This sample survey template also collects data on other parameters like GPA to understand from each student, the causes of sleepiness and collect feedback on the aspects that can be introduced to reduce the negative effects of sleep deprivation. This in-depth survey consists of various survey questions that profiles a student that is part of a clinical site and the reasons that cause sleeplessness as well as the circumstances under which they feel sleepy.


How likely are you to doze off or fall asleep while
Would never doze
Slight chance of dozing
Moderate chance of dozing
High chance of dozing
While sitting and reading
While watching TV
When sitting, inactive in a public place (e.g., a theater or meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
While sitting and talking to someone
While sitting quietly after a lunch without alcohol
When in a car, while stopped for a few minutes in traffic
How many hours of sleep per night do you average?
What are the numbers of hours you spend per week at your clinical site or workplace?
What are the numbers of hours per week you spend studying, at lectures/meetings, etc.?
How many days of vacation does your program allow?
What is your current GPA?
How does sleepiness affect your clinical and didactic performance as a nurse anesthesia student?
If you are experiencing sleepiness, what do you feel are the causes?
What can be introduced into your nurse anesthesia program to improve the negative effects of sleep deprivation in your clinical and didactic experiences?

ヘルスケア調査

医療検査サービス調査テンプレート

21 質問

診察の機能、および現在のサービスの顧客の態度の望ましさのための医療サービス評価調査。

ヘルスケア調査

ヘルスケア意識調査テンプレート

44 質問

品質、手頃な価格、可用性、および顧客の嗜好に関する病院やヘルスケア世論調査。

ヘルスケア調査

医師・プラクティス調査テンプレート

47 質問

医師は、提供病院やサービスの評価を提供し、調査を実践します。