University of Perpetual Help System Laguna - JONELTA

Basic Education Department – Senior High School

SURVEY QUESTIONNAIRE

Dear Respondents,

We are currently conducting our research entitled, “Effects of Sleep Deprivation on Learners’
Performance Result” as a partial fulfilment of our course requirement for the subject Practical
Research 2 at the University of Perpetual Help System Laguna. In this light, we are humbly
requesting for your time and effort to go over this questionnaire as your responses will be very
much helpful in achieving the purpose of my research. Rest assured that the information you will
provide will be kept confidential and will be used for research purposes only. Thank you.

Shane Caroline G. Almazora

Researcher

Name of the respondent (optional):_______________________________________________

Date of filling the questionnaire:________________________________________________

Adviser:___________________________________________________________________
Instruction: Encircle your answers.

Part 1: Respondents' Sleep Deprivation

A. Sleeping schedule
1. What time do you usually get to bed?
a. 10 pm – 11pm
b. 12 am – 1am
c. 2 am – 3 am
d. Others: Please specify:__________
2. How many hours of sleep do you get every night?
a. 4-5 hours
b. 2-3 hours
c. 1 hour
 University of Perpetual Help System Laguna - JONELTA
Basic Education Department – Senior High School

d. Others: Please specify:___________

3. What time do you usually wake up?
4 am
5-6 am
7-8 am
Others: Please specify:___________
B. Sleeping hygiene

1 – Never
2 – Occasionally
3 – Fairly many times
4 – Very often
5 – Always
1 2 3 4 5
4. I take naps.

5. I do not worry about my problems before

sleeping.
6. I do something relaxing before sleeping

7. I do not go to bed with a full or empty stomach.

8. I avoid drinks that contain caffeine.

9. I sleep in a restful environment.

Part II. Respondents' Performance Result

Directions: Below is a scale to get the academic performance result of the respondents during
the middle term. Put a check mark (/) in the appropriate box presenting the grade.
______96 – above ______85 – 89 ______79 – 75

______90 – 95 ______80 – 84 ______74–below

University of Perpetual Help System Laguna - JONELTA
Basic Education Department – Senior High School