Epworth Sleepiness Scale (ESS) Complete our online form below or download a form to complete. Name * First Name Last Name Today's date MM DD YYYY Your age Gender Male Female Other How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven't done some of these things recently, try to wrok out how they would have affected you. It is important that you answer each question as best you can. Sitting and reading * 0 - would never doze 1 - slight chance of dozing 2 - moderate chance of dozing 3 - high chance of dozing Watching TV * 0 - would never doze 1 - slight chance of dozing 2 - moderate chance of dozing 3 - high chance of dozing Sitting, inactive in a public place (e.g. a theatre or a meeting) * 0 - would never doze 1 - slight chance of dozing 2 - moderate chance of dozing 3 - high chance of dozing As a passenger in a car for an hour without a break * 0 - would never doze 1 - slight chance of dozing 2 - moderate chance of dozing 3 - high chance of dozing Lying down to rest in the afternoon when circumstances permit * 0 - would never doze 1 - slight chance of dozing 2 - moderate chance of dozing 3 - high chance of dozing Sitting and talking to someone * 0 - would never doze 1 - slight chance of dozing 2 - moderate chance of dozing 3 - high chance of dozing Sitting quietly after a lunch without alcohol * 0 - would never doze 1 - slight chance of dozing 2 - moderate chance of dozing 3 - high chance of dozing In a car, while stopped for a few minutes in the traffic * 0 - would never doze 1 - slight chance of dozing 2 - moderate chance of dozing 3 - high chance of dozing Total Score * Thank you!
