Fatigue Severity Scale
MedaFile - 21 point modification, 2 added items

       ID:         DATE:           TIME (24hr): 


Instructions: Circle the number that best represents your response to each question.
Scoring range: 0=strongly disagree with the statement to 10=strongly agree with the statement.
During the past weekk, I have found that:

Does not apply A mild problem A moderate problem Strongly agree
0 1 2 3 4 5 6 7 8 9 10
1.   My motivation is lower when I am fatigued.
2.   Exercise brings on my fatigue
3.   I am easily fatigued.
4.   Fatigue interferes with my physical functioning.
5.   Fatigue causes frequent problems for me.
6.   My fatigue prevents sustained physical functioning.
7.    Fatigue interferes with carrying out certain duties and responsibilities.
8.   Fatigue is among my three most disabling symptoms.
9.   Fatigue interferes with my work, family, or social life.
10. Fatigue makes it difficult to concentrate.
No memory problem No worse than usual Worse than usual Much worse than usual
11. Fatigue impairs my memory?

TEXT FOR YOUR RECORDS

Need reference - Jennifer Loftis

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Last update: 11/14/2021