NEARS Wellness Survey- Pre Training

Question Title

* 1. Please enter your ID Code and Zip/Postal Code.

ID Code

ZIP/Postal Code

Question Title

* 2. Please enter today's date.

Date / Time

Date

This survey has just 15 questions, many similar to ones that you have seen, or will see on other surveys in this study. Please read each question and carefully rank your responses according to your health experience in the last 30 days.

	Always	Most of the time	Sometimes	Rarely	Never
I cough	I cough Always	I cough Most of the time	I cough Sometimes	I cough Rarely	I cough Never
I feel optimistic about my life.	I feel optimistic about my life. Always	I feel optimistic about my life. Most of the time	I feel optimistic about my life. Sometimes	I feel optimistic about my life. Rarely	I feel optimistic about my life. Never
I sleep soundly and get a good night's sleep.	I sleep soundly and get a good night's sleep. Always	I sleep soundly and get a good night's sleep. Most of the time	I sleep soundly and get a good night's sleep. Sometimes	I sleep soundly and get a good night's sleep. Rarely	I sleep soundly and get a good night's sleep. Never
I worry about the future.	I worry about the future. Always	I worry about the future. Most of the time	I worry about the future. Sometimes	I worry about the future. Rarely	I worry about the future. Never
I can notice an unpleasant body sensation without worrying about it.	I can notice an unpleasant body sensation without worrying about it. Always	I can notice an unpleasant body sensation without worrying about it. Most of the time	I can notice an unpleasant body sensation without worrying about it. Sometimes	I can notice an unpleasant body sensation without worrying about it. Rarely	I can notice an unpleasant body sensation without worrying about it. Never
I have phlegm.	I have phlegm. Always	I have phlegm. Most of the time	I have phlegm. Sometimes	I have phlegm. Rarely	I have phlegm. Never
When I am tense, I notice where the tension is located in my body.	When I am tense, I notice where the tension is located in my body. Always	When I am tense, I notice where the tension is located in my body. Most of the time	When I am tense, I notice where the tension is located in my body. Sometimes	When I am tense, I notice where the tension is located in my body. Rarely	When I am tense, I notice where the tension is located in my body. Never
I am aware of my body posture and alignment.	I am aware of my body posture and alignment. Always	I am aware of my body posture and alignment. Most of the time	I am aware of my body posture and alignment. Sometimes	I am aware of my body posture and alignment. Rarely	I am aware of my body posture and alignment. Never
I use body awareness as a resource.	I use body awareness as a resource. Always	I use body awareness as a resource. Most of the time	I use body awareness as a resource. Sometimes	I use body awareness as a resource. Rarely	I use body awareness as a resource. Never
I have tightness in my chest.	I have tightness in my chest. Always	I have tightness in my chest. Most of the time	I have tightness in my chest. Sometimes	I have tightness in my chest. Rarely	I have tightness in my chest. Never
When walking uphill (upstairs) I can converse with another person.	When walking uphill (upstairs) I can converse with another person. Always	When walking uphill (upstairs) I can converse with another person. Most of the time	When walking uphill (upstairs) I can converse with another person. Sometimes	When walking uphill (upstairs) I can converse with another person. Rarely	When walking uphill (upstairs) I can converse with another person. Never
My joints and muscles are free of pain and stillness.	My joints and muscles are free of pain and stillness. Always	My joints and muscles are free of pain and stillness. Most of the time	My joints and muscles are free of pain and stillness. Sometimes	My joints and muscles are free of pain and stillness. Rarely	My joints and muscles are free of pain and stillness. Never
My body aches and I feel fatigued.	My body aches and I feel fatigued. Always	My body aches and I feel fatigued. Most of the time	My body aches and I feel fatigued. Sometimes	My body aches and I feel fatigued. Rarely	My body aches and I feel fatigued. Never
I can use my breath to reduce tension.	I can use my breath to reduce tension. Always	I can use my breath to reduce tension. Most of the time	I can use my breath to reduce tension. Sometimes	I can use my breath to reduce tension. Rarely	I can use my breath to reduce tension. Never
I feel safe and comfortable going away from my home by myself.	I feel safe and comfortable going away from my home by myself. Always	I feel safe and comfortable going away from my home by myself. Most of the time	I feel safe and comfortable going away from my home by myself. Sometimes	I feel safe and comfortable going away from my home by myself. Rarely	I feel safe and comfortable going away from my home by myself. Never

Always

Most of the time

Sometimes

Rarely

Never

I cough

I cough Always

I cough Most of the time

I cough Sometimes

I cough Rarely

I cough Never

I feel optimistic about my life.

I feel optimistic about my life. Always

I feel optimistic about my life. Most of the time

I feel optimistic about my life. Sometimes

I feel optimistic about my life. Rarely

I feel optimistic about my life. Never

I sleep soundly and get a good night's sleep.

I sleep soundly and get a good night's sleep. Always

I sleep soundly and get a good night's sleep. Most of the time

I sleep soundly and get a good night's sleep. Sometimes

I sleep soundly and get a good night's sleep. Rarely

I sleep soundly and get a good night's sleep. Never

I worry about the future.

I worry about the future. Always

I worry about the future. Most of the time

I worry about the future. Sometimes

I worry about the future. Rarely

I worry about the future. Never

I can notice an unpleasant body sensation without worrying about it.

I can notice an unpleasant body sensation without worrying about it. Always

I can notice an unpleasant body sensation without worrying about it. Most of the time

I can notice an unpleasant body sensation without worrying about it. Sometimes

I can notice an unpleasant body sensation without worrying about it. Rarely

I can notice an unpleasant body sensation without worrying about it. Never

I have phlegm.

I have phlegm. Always

I have phlegm. Most of the time

I have phlegm. Sometimes

I have phlegm. Rarely

I have phlegm. Never

When I am tense, I notice where the tension is located in my body.

When I am tense, I notice where the tension is located in my body. Always

When I am tense, I notice where the tension is located in my body. Most of the time

When I am tense, I notice where the tension is located in my body. Sometimes

When I am tense, I notice where the tension is located in my body. Rarely

When I am tense, I notice where the tension is located in my body. Never

I am aware of my body posture and alignment.

I am aware of my body posture and alignment. Always

I am aware of my body posture and alignment. Most of the time

I am aware of my body posture and alignment. Sometimes

I am aware of my body posture and alignment. Rarely

I am aware of my body posture and alignment. Never

I use body awareness as a resource.

I use body awareness as a resource. Always

I use body awareness as a resource. Most of the time

I use body awareness as a resource. Sometimes

I use body awareness as a resource. Rarely

I use body awareness as a resource. Never

I have tightness in my chest.

I have tightness in my chest. Always

I have tightness in my chest. Most of the time

I have tightness in my chest. Sometimes

I have tightness in my chest. Rarely

I have tightness in my chest. Never

When walking uphill (upstairs) I can converse with another person.

When walking uphill (upstairs) I can converse with another person. Always

When walking uphill (upstairs) I can converse with another person. Most of the time

When walking uphill (upstairs) I can converse with another person. Sometimes

When walking uphill (upstairs) I can converse with another person. Rarely

When walking uphill (upstairs) I can converse with another person. Never

My joints and muscles are free of pain and stillness.

My joints and muscles are free of pain and stillness. Always

My joints and muscles are free of pain and stillness. Most of the time

My joints and muscles are free of pain and stillness. Sometimes

My joints and muscles are free of pain and stillness. Rarely

My joints and muscles are free of pain and stillness. Never

My body aches and I feel fatigued.

My body aches and I feel fatigued. Always

My body aches and I feel fatigued. Most of the time

My body aches and I feel fatigued. Sometimes

My body aches and I feel fatigued. Rarely

My body aches and I feel fatigued. Never

I can use my breath to reduce tension.

I can use my breath to reduce tension. Always

I can use my breath to reduce tension. Most of the time

I can use my breath to reduce tension. Sometimes

I can use my breath to reduce tension. Rarely

I can use my breath to reduce tension. Never

I feel safe and comfortable going away from my home by myself.

I feel safe and comfortable going away from my home by myself. Always

I feel safe and comfortable going away from my home by myself. Most of the time

I feel safe and comfortable going away from my home by myself. Sometimes

I feel safe and comfortable going away from my home by myself. Rarely

I feel safe and comfortable going away from my home by myself. Never

Question Title

* 1. Please enter your ID Code and Zip/Postal Code.

Question Title

* 2. Please enter today's date.

Question Title

* 3. Mark how often each statement is true.