survey on self habits questions

1. Questions on Self Habits
This is a feedback request form to be filled out by you so that I can see my habits' reflection
through my friends and family.
Instructions: In the table below, for each statement, mark how much you agree with on the
table.
Health and Exercise
Please evaluate my habits through the
following statements.
Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
1 I'm as physically fit as most people of
my age.
2 I've good physical endurance.
3 I participate in vigorous exercise like
running, swimming, speed walking,etc.
for 30 minutes a day.
4 I try to keep my body healthy and fit.
Psychological Health
Please evaluate my psychological health
through the following statements.
Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
1 I'm able to manage the stress in my life.
2 I'm able to relax and unwind.
3 I've clear direction in life.

2. Study Habits
Please evaluate my study habits through the
following statements.
Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
1 I set my goals for myself.
2 I study where it's quiet with little distractions.
3 I like creative thinking.
4 I put my notes in my own words to understand
the material better.
5 I study with a friend or a group.
Eating Habits
Please evaluate my eating habits through the
following statements.
Regular Sometime Never
1 I eat dinner before sleep time.
2 Drink water instead of juice syrup and
carbonate drinks.
3 I eat junk food.
4 I eat fresh fruits and vegetables.
Environmental Concern
Please evaluate my environmental concern
through the following statements.
Yes No Often Not Sure
1 I make an effort to conserve water.
2 I make sure any refuse (garbage) I produced is
properly disposed off.
3 I use public transport to avoid pollution.

3. Social Concern
Please evaluate my social concern through the
following statements.
Never Sometime Usually Always
1 I'm respectful of the feelings of others.
2 I'm the kind of person who is there for the
people in the hour of need.
3 I try to help people in need without expecting
anything in return.
Hygiene Habits
Please evaluate my hygiene habit through the
following statements.
Yes No Usually
1 I wash my and before and after eating.
2 I change my clothes daily.
3 I change my toothbrush every 3 months.
Sleep Habits
Please evaluate my sleep habits through the
following statements.
Regular Sometime Never
1 I watch TV before sleeping.
2 I use to clean my teeth before sleep.
3 I sleep 7-8 hours for almost.