SURVEY

Human-Being

DESCRIBE YOUR PHYSICAL CONDITION

1. When I wake up, I feel... *

Drained
Tired or uncomfortable
Well and energized

2. At noon, I feel... *

Drained
Tired or uncomfortable
Well and energized

3. At the end of the day, I feel... *

Drained
Tired or uncomfortable
Well and energized

4. When I go to bed, I feel... *

Drained
Tired or uncomfortable
Well and energized

DESCRIBE YOUR EMOTIONAL STATE

5. In general, do you feel light-hearted or heavy-hearted? *

Heavy
Usually heavy
Usually light
Light

6. What emotions do you most commonly feel at work,
at home, and in your personal relations? *

7. When you are alone with yourself, how do you feel? *

Empty
Worried
Content

8. When you encounter unexpected experiences or situations (good or bad),
how do you react? *

Withdraw
Stay silent
Express yourself