NEXT AGM: THURS 27 JAN 2022: 6PM AEST
For all questions, please tick
the appropriate square
Initials:
Date:
QUESTION: In the past 4 weeks...
01 About How often do you feel tired out for no good reason?12345
02 About how often did you feel nervous?12345
03 About how often did you feel so nervous that nothing could calm you down?12345
04 About how often did you feel hopeless?12345
05 About how often did you feel restless or fidgety?12345
06 About how often did you feel so restless you could not sit still?12345
07 About how often did you feel depressed?12345
08 About how often did you feel that everything is an effort?12345
09 About how often did you feel so sad that nothing could cheer you up?12345
10 About how often did you feel worthless?12345
10-15 = Low Distress – No Help Required
16-19 = Mild Distress – Self Help
20-24 = Moderate Distress – Self Help
25-29 = Severe Distress – Some Support Required
30-50 = Extremely Severe Distress - Professional Help Required
0/50
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No Satisfaction At allCompletely Satisfied
0
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10
1. How satisfied are you with your life as a whole? 12345678910
2. How satisfied are you with your standard of living? 12345678910
3. How satisfied are you with your health? 12345678910
4. How satisfied are you with what you are currently achieving in life? 12345678910
5. How satisfied are with your personal relationships? 12345678910
6. How satisfied are you with how safe you feel? 12345678910
7. How satisfied are you with feeling part of your community? 12345678910
8. How satisfied are you with your future security? 12345678910
TOTAL SCORE: 0
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