Firefighter Wellness Fatigue Assessment Form
Complete the Firefighter Wellness Fatigue Assessment Form to help evaluate your current fatigue and wellness status.
How would you rate your overall fatigue level today?
*
No fatigue
1
2
3
4
5
6
7
8
9
Extreme fatigue
10
1 is No fatigue, 10 is Extreme fatigue
How many hours did you sleep in the past 24 hours?
*
How restful was your sleep?
*
Very restful
Somewhat restful
Neutral
Somewhat restless
Very restless
How would you describe your current mood?
*
Very positive
Positive
Neutral
Negative
Very negative
How physically exhausted do you feel right now?
*
Not exhausted
1
2
3
4
5
6
7
8
9
Completely exhausted
10
1 is Not exhausted, 10 is Completely exhausted
How mentally fatigued do you feel right now?
*
Not fatigued
1
2
3
4
5
6
7
8
9
Extremely fatigued
10
1 is Not fatigued, 10 is Extremely fatigued
How would you rate your stress level today?
*
No stress
1
2
3
4
5
6
7
8
9
Extreme stress
10
1 is No stress, 10 is Extreme stress
Did you stay hydrated during your last shift?
*
Yes
Somewhat
No
How would you rate your nutrition over the last 24 hours?
*
Excellent
Good
Fair
Poor
Is there anything else you'd like to share about your wellness or fatigue today?
Submit Assessment
Should be Empty: