Epworth Sleepiness Scale

Epworth Sleepiness Scale
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Please indicate the likelihood that you would fall asleep in the following situations (scale of 0-3). The refers to your usual way of life in recent times. Use the following scale to choose the most appropriate number for each situation:

0= Would never doze
1= Slight chance of dozing
2= Moderate chance of dozing
3= High chance of dozing

Please enter the most appropriate number*

	Chance of Dozing
Sitting and Reading?
Watching TV?
Sitting inactive in a public place? (i.e. theater)
As a passenger in a car for an hour without a break?
Lying down to rest in the afternoon when able?
Sitting and talking to someone?
Sitting quietly after lunch without alcohol?
In a car, while stopped for a few minutes in traffic?

Total((A total score of 9 or above indicates excessive sleepiness)
Should be Empty: