Start
nshd_62_cmc
The National Survey of Health and Development
(Population Investigation Committee)
Medical Research Council Unit London School of Economics
Under the joint auspices of
The Medical Research Council
The National Foundation for Educational Research in England and Wales
The Scottish Council for Research in Education
STRICTLY CONFIDENTIAL
intro i

Ref.No.

Generic text
intro ii

Name

Generic text
intro iii

Address

Generic text
intro iv

College

Generic text
For those whose home address has changed
intro v

New Address

Generic text
STUDENTS QUESTIONNAIRE 1962
EXPLANATORY NOTE
You will no doubt remember completing previous forms for this study: much valuable information has been gained as a result of these. We are asking you now to complete this questionnaire, so that we may get a full picture of what you are doing at the present time.
Please answer every question: some questions have numbered answers: with those questions all that is necessary for you is to put a ring round the number of the answer that is right for you. Other questions require you to write two or three words.
Thank you very much for your co-operation both now and in the past.
COLLEGE AND FURTHER EDUCATION
1

How old do you expect to be when you leave college?

6
16
7
17
8
18
9
Older
If you are working for any particular exams at present,
2 a
If you are working for any particular exams at present, state subjects and levels you hope to attain.
Subjects Levels
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
1
2
3
4
5
6
If you are not suitable specializing in any particular subjects,
2 b

If you are not specializing in any particular subjects, what course are you on?

Generic text
3
How much do you like the following subjects or if you have dropped any, how much did you like them?
-

1 - Liked v.much

2 - Liked

3 - Dis-liked

4 - Dis-liked v.much
English
Modern Languages
Mathematics
Science and/or Biology
THE UNIVERSITY
4

There are grants for University students. If the students need it, how much do you think this money covers?

1
the whole cost plus some pocket money
2
the whole cost but allows no pocket money
3
the fees and books only
4
living expenses only
*
other namely
Other
5

Which is your nearest University?

Generic text
6

Name any other British Universities that you know of?

Generic text
7

What entrance qualifications do you think are required for a University?

Generic text
8 a

Have you ever discussed with anyone the possibility of going to a University?

1
Yes
0
No
[If 'yes']
qc_8_a == 1
8 b

With whom?

Generic text
9 a

Do you think you will have this opportunity?

1
Yes
0
No
[If 'no']
qc_9_a == 0
9 b

Why is this?

Generic text
10 a

Would you go to University if offered a place?

1
Yes
0
No
[If 'no']
qc_10_a == 0
10 b

Why is this?

Generic text
[If 'yes']
qc_10_a == 1
10 c

Which would be you first choice of University?

Generic text
11 a
What are your brothers and sisters doing now?
Name Occupation
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
1
2
3
4
5
6
11 b

Have any of your elder brothers or sisters been to a University? Are they there now, or are they planning to go?

1
no older brothers or sisters
2
yes, have been to a University
3
yes, are there now
4
yes, are planning to go
5
none of these
12

Are any of your particular friends in your year going to a University?

1
Yes
0
No
YOUR CHOICE OF JOB
13 a

Have you discussed your future career with anybody?

1
Yes
0
No
[If 'yes']
qc_13_a == 1
13 b

With whom?

Generic text
13 c(i)

Your choice of job in January 1961 was

Generic text
13 c(ii)

Is your choice now still the same?

1
Yes
0
No
[If 'no']
qc_13_c_ii == 0
13 d

What is your present choice?

Generic text
13 e

What made you change your mind?

Generic text
14

Where are your particular friends mostly now?

please circle only one number

1
at school
2
on training courses or at college
3
in apprenticeships
4
in full-time jobs(excluding apprenticeships)
WORK
15

How hard do you think you work compared with your classmates?

1
much harder than most of them
2
a bit harder than most of them
3
about as hard as most of them
4
less hard than most of them
5
much less hard than most of them
16

How quickly do you think you manage to pick things up and see the answers compared with your classmates?

1
much more quickly than most of them
2
more quickly than most of them
3
about as quickly as most of them
4
less quickly than most of them
5
much less quickly than most of them
HOMEWORK, PREPARATION AND PART-TIME JOBS
17

At what time do you start your homework on an average weekday evening?

Generic time
18

At what time do you finish your homework on an average weekday evening?

Generic time
19

How long do you spend on your homework on an average Saturday and Sunday taken together?

Generic text
20 a

Do you nowadays receive any regular help or coaching (excluding evening classes) with your homework from your parents or any other person?

1
Yes
0
No
[If 'yes']
qc_20_a == 1
20 b

Who gives it?

Generic text
20 c

In what subjects is this help given?

Generic text
21

Do you have your own desk or table at home (i.e. yours only) at which to work?

1
Yes
0
No
22

Where do you do your homework?

1
in your own room by yourself
2
in a room by yourself, away from the family
3
in a room at home with others who are studying
4
in a room at home with others who are not studying
*
elsewhere, namely
Other
23 a

Do you attend any evening classes?

1
Yes
0
No
[If 'yes']
qc_23_a == 1
23 b

What subjects are these classes in?

Generic text
23 c

Are you hoping to pass any examination or examinations with the help of these classes?

1
Yes
0
No
[If 'yes']
qc_23_c == 1
23 d

What examination or examinations?

Generic text
24

Have you ever had a part-time job (e.g. paper rounds, Saturday shop serving, etc.,) for longer than three months?

1
Yes
0
No
25 a

Do you have a part-time job at present?

1
Yes
0
No
[If 'yes']
qc_25_a == 1
25 b

What is it?

Generic text
25 c

How many hours a week does it occupy? ... hrs

How many
25 d

Why do you do it?

Generic text
HOLIDAYS
26 a

Did you do any studying last holidays?

1
Yes
0
No
[If 'yes']
qc_26_a == 1
26 b

How many hours per week on an average was it? ... hrs

How many
27 a

Did you take any full-time holiday job last summer for two weeks or longer?

1
Yes
0
No
[If 'yes']
qc_27_a == 1
27 b

What was it?

Generic text
27 c

Why did you do it?

Generic text
LEISURE INTERESTS
28

What are your main hobbies?

Generic text
29 a

Do you belong to any voluntary college clubs or organisations?

1
Yes
0
No
[If 'yes']
qc_29_a == 1
29 b
Please name club or clubs, give the number of times you have attended each in the last month and the number of times you could have attended.
Clubs Attendances in last month Number that could have been made
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many
1
2
3
30 a

Do you belong to any Church clubs?

1
Yes
0
No
[If 'yes']
qc_30_a == 1
30 b
Please name club or clubs, give the number of times you have attended each in the last month and the number of times you could have attended.
Clubs Attendances in last month Number that could have been made
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many
1
2
3
31

Do you belong to any other clubs?

1
Yes
0
No
[If 'yes']
qc_31 == 1
31 b
Please name club or clubs, give the number of times you have attended each in the last month and the number of times you could have attended.
Clubs Attendances in last month Number that could have been made
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many
1
2
3
32 a

Do you play games apart from compulsory ones at college?

1
Yes
0
No
[If 'yes']
qc_32_a == 1
32 b

How are these organised?

1
by a club
2
by the college
3
informally
33

What books, if any, have you read in the last four weeks apart from college set books?

Generic text
34

Where did these books come from? (if necesseary circle more than one number)

1
college library
2
other library
3
home
4
borrowed from friends
5
bought yourself
*
other, namely
Other
35

What magazines, if any, do you read fairly regularly?

Generic text
36

What daily papers, if any, do you read fairly regularly?

Generic text
37

What Sunday newspapers, if any, do you read fairly regularly?

Generic text
GENERAL HEALTH
38 a(i)

The last Hospital admission for you was

Generic text
38 a(ii)

Have you been a hospital in-patient since then?

1
Yes
0
No
[If 'yes' please give]
qc_38_a_ii == 1
38 b

Name of hospital

Generic text
38 c

Date of admission

Generic date
38 d

The nature of the illness or operation

Generic text
38 e

The length of your stay in hospital

Generic text
38 f

The name of the Doctor in charge of you in hospital

Generic text
39 a

Since January 1961 have you attended hospital as an out-patient?

1
Yes
0
No
[If 'yes' please give]
qc_39_a == 1
39 b

Name of hospital

Generic text
39 c

Date of first attendance

Generic date
39 d

Reason for attendance

Generic text
40 a

Since January 1961 have you attended a clinic?

1
Yes
0
No
[If 'yes' please give]
qc_40_a == 1
40 b

Name of clinic

Generic text
40 c

Date of first attendance

Generic text
40 d

Reason for attendance

Generic text
41

The last accident we have recorded for you was ... when you were ... years old,

Generic text
Age
41 a

Since this accident or since January 1961 have you had an accident when you were BURNT or SCALDED, BROKE A BONE, were BADLY CUT, or BRUISED or INJURED by a CHEMICAL.

1
Yes
0
No
[If 'yes']
qc_41_a == 1
41 b(i)
Please give the following details about each accident starting with the earliest:-
Type of injury (enter as BURN SCALD, BROKEN BONE, CUT etc.) Part or parts in-jured Age when in-jured (in years and months) Treatment, Hosp.I,P, Hosp.O.P, Nursing Home, Own home If treated in own home, who gave treatment (Doctor, Nurse, other)? Details of remaining scarring, disability or deformity
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
First Accident 1
Second 2
41 b(ii)
Please give the following details about each accident starting with the earliest:-
DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or oil stove) Where it occurred (own home, school street, etc.,)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident 1
Second 2
42 a

Do you have trouble with your sleep?

1
Yes
0
No
[If 'yes']
qc_42_a == 1
42 b

What sort of trouble do you have?

if necessary circle more than one of the numbers

1
difficulty in getting off to sleep
2
waking up during the night and not being able to get off to sleep again quickly
3
unpleasant dreams or nightmares
4
waking too early in the morning and staying awake
5
sleeping all right but still feeling tired in the morning
*
other, namely
Other
Don't leave any questions out. There are no right or wrong answers - this isn't a test of intelligence, it is simply to give us an idea of how you feel and behave.
43
Now here are some questions about the way you behave, and feel, and act, after each question there is 'yes' a '?' and a 'no'. Try and decide whether 'yes' or 'no' is how you usually feel and then circle the 'yes' and the 'no' like this:. If you find it quite impossible to decide, then circle the '?', like this:. However don't use the question-mark unless you feel you have to. Work quickly and don't spend too much time on any question, we want your first reaction.
-

1 - Yes

2 - ?

3 - No
Are you happiest when you get involved in some project that calls for rapid action?
Do you sometimes feel happy, sometimes depressed, without any apparent reason?
Does your mind often wander while you are trying to concentrate?
Do you usually take the initiative in making new friends?
Are you inclined to be quick and sure in your actions?
Are you frequently 'lost in thought' even when supposed to be taking part in a conversation?
Are you sometimes bubbling over with energy and sometimes very sluggish?
Would you rate yourself as a lively individual?
Would you be very unhappy if you were prevented from making numerous social contacts?
Are you inclined to be moody?
Do you have frequent ups and downs in mood, either with or without apparent cause?
Do you prefer action to planning for action?
PLEASE CHECK THAT YOU HAVE ANSWERED EVERY QUESTIONS THAT APPLIES TO YOU.
outro i

How long did this questionnaire take you to fill in?

Time taken
outro ii

Signed

Generic text
outro iii

Date

Generic date
End

nshd_62_cmc

s_intro_i
The National Survey of Health and Development
s_intro_ii
(Population Investigation Committee)
s_intro_iii
Medical Research Council Unit London School of Economics
s_intro_iv
Under the joint auspices of
s_intro_v
The Medical Research Council
s_intro_vi
The National Foundation for Educational Research in England and Wales
s_intro_vii
The Scottish Council for Research in Education
s_intro_viii
STRICTLY CONFIDENTIAL
intro i
Ref.No.
Generic text
intro ii
Name
Generic text
intro iii
Address
Generic text
intro iv
College
Generic text

For those whose home address has changed

intro v
New Address
Generic text
s_intro_ix
STUDENTS QUESTIONNAIRE 1962
s_intro_x
EXPLANATORY NOTE
s_intro_xi
You will no doubt remember completing previous forms for this study: much valuable information has been gained as a result of these. We are asking you now to complete this questionnaire, so that we may get a full picture of what you are doing at the present time.
s_intro_xii
Please answer every question: some questions have numbered answers: with those questions all that is necessary for you is to put a ring round the number of the answer that is right for you. Other questions require you to write two or three words.
s_intro_xiii
Thank you very much for your co-operation both now and in the past.

COLLEGE AND FURTHER EDUCATION

1
How old do you expect to be when you leave college?
6
16
7
17
8
18
9
Older
2 a

If you are working for any particular exams at present, state subjects and levels you hope to attain.

Subjects Levels
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
1
2
3
4
5
6
If you are working for any particular exams at present,
2 b
If you are not specializing in any particular subjects, what course are you on?
Generic text
If you are not suitable specializing in any particular subjects,
3

How much do you like the following subjects or if you have dropped any, how much did you like them?

-

1 - Liked v.much

2 - Liked

3 - Dis-liked

4 - Dis-liked v.much
English
Modern Languages
Mathematics
Science and/or Biology

THE UNIVERSITY

4
There are grants for University students. If the students need it, how much do you think this money covers?
1
the whole cost plus some pocket money
2
the whole cost but allows no pocket money
3
the fees and books only
4
living expenses only
*
other namely
Other
5
Which is your nearest University?
Generic text
6
Name any other British Universities that you know of?
Generic text
7
What entrance qualifications do you think are required for a University?
Generic text
8 a
Have you ever discussed with anyone the possibility of going to a University?
1
Yes
0
No
8 b
With whom?
Generic text
[If 'yes']
9 a
Do you think you will have this opportunity?
1
Yes
0
No
9 b
Why is this?
Generic text
[If 'no']
10 a
Would you go to University if offered a place?
1
Yes
0
No
10 b
Why is this?
Generic text
[If 'no']
10 c
Which would be you first choice of University?
Generic text
[If 'yes']
11 a

What are your brothers and sisters doing now?

Name Occupation
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
1
2
3
4
5
6
11 b
Have any of your elder brothers or sisters been to a University? Are they there now, or are they planning to go?
1
no older brothers or sisters
2
yes, have been to a University
3
yes, are there now
4
yes, are planning to go
5
none of these
12
Are any of your particular friends in your year going to a University?
1
Yes
0
No

YOUR CHOICE OF JOB

13 a
Have you discussed your future career with anybody?
1
Yes
0
No
13 b
With whom?
Generic text
[If 'yes']
13 c(i)
Your choice of job in January 1961 was
Generic text
13 c(ii)
Is your choice now still the same?
1
Yes
0
No
13 d
What is your present choice?
Generic text
[If 'no']
13 e
What made you change your mind?
Generic text
[If 'no']
14
Where are your particular friends mostly now?
1
at school
2
on training courses or at college
3
in apprenticeships
4
in full-time jobs(excluding apprenticeships)

WORK

15
How hard do you think you work compared with your classmates?
1
much harder than most of them
2
a bit harder than most of them
3
about as hard as most of them
4
less hard than most of them
5
much less hard than most of them
16
How quickly do you think you manage to pick things up and see the answers compared with your classmates?
1
much more quickly than most of them
2
more quickly than most of them
3
about as quickly as most of them
4
less quickly than most of them
5
much less quickly than most of them

HOMEWORK, PREPARATION AND PART-TIME JOBS

17
At what time do you start your homework on an average weekday evening?
Generic time
18
At what time do you finish your homework on an average weekday evening?
Generic time
19
How long do you spend on your homework on an average Saturday and Sunday taken together?
Generic text
20 a
Do you nowadays receive any regular help or coaching (excluding evening classes) with your homework from your parents or any other person?
1
Yes
0
No
20 b
Who gives it?
Generic text
[If 'yes']
20 c
In what subjects is this help given?
Generic text
[If 'yes']
21
Do you have your own desk or table at home (i.e. yours only) at which to work?
1
Yes
0
No
22
Where do you do your homework?
1
in your own room by yourself
2
in a room by yourself, away from the family
3
in a room at home with others who are studying
4
in a room at home with others who are not studying
*
elsewhere, namely
Other
23 a
Do you attend any evening classes?
1
Yes
0
No
23 b
What subjects are these classes in?
Generic text
[If 'yes']
23 c
Are you hoping to pass any examination or examinations with the help of these classes?
1
Yes
0
No
[If 'yes']
23 d
What examination or examinations?
Generic text
[If 'yes']
[If 'yes']
24
Have you ever had a part-time job (e.g. paper rounds, Saturday shop serving, etc.,) for longer than three months?
1
Yes
0
No
25 a
Do you have a part-time job at present?
1
Yes
0
No
25 b
What is it?
Generic text
[If 'yes']
25 c
How many hours a week does it occupy? ... hrs
How many
[If 'yes']
25 d
Why do you do it?
Generic text
[If 'yes']

HOLIDAYS

26 a
Did you do any studying last holidays?
1
Yes
0
No
26 b
How many hours per week on an average was it? ... hrs
How many
[If 'yes']
27 a
Did you take any full-time holiday job last summer for two weeks or longer?
1
Yes
0
No
27 b
What was it?
Generic text
[If 'yes']
27 c
Why did you do it?
Generic text
[If 'yes']

LEISURE INTERESTS

28
What are your main hobbies?
Generic text
29 a
Do you belong to any voluntary college clubs or organisations?
1
Yes
0
No
29 b

Please name club or clubs, give the number of times you have attended each in the last month and the number of times you could have attended.

Clubs Attendances in last month Number that could have been made
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many
1
2
3
[If 'yes']
30 a
Do you belong to any Church clubs?
1
Yes
0
No
30 b

Please name club or clubs, give the number of times you have attended each in the last month and the number of times you could have attended.

Clubs Attendances in last month Number that could have been made
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many
1
2
3
[If 'yes']
31
Do you belong to any other clubs?
1
Yes
0
No
31 b

Please name club or clubs, give the number of times you have attended each in the last month and the number of times you could have attended.

Clubs Attendances in last month Number that could have been made
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many
1
2
3
[If 'yes']
32 a
Do you play games apart from compulsory ones at college?
1
Yes
0
No
32 b
How are these organised?
1
by a club
2
by the college
3
informally
[If 'yes']
33
What books, if any, have you read in the last four weeks apart from college set books?
Generic text
34
Where did these books come from? (if necesseary circle more than one number)
1
college library
2
other library
3
home
4
borrowed from friends
5
bought yourself
*
other, namely
Other
35
What magazines, if any, do you read fairly regularly?
Generic text
36
What daily papers, if any, do you read fairly regularly?
Generic text
37
What Sunday newspapers, if any, do you read fairly regularly?
Generic text

GENERAL HEALTH

38 a(i)
The last Hospital admission for you was
Generic text
38 a(ii)
Have you been a hospital in-patient since then?
1
Yes
0
No
38 b
Name of hospital
Generic text
[If 'yes' please give]
38 c
Date of admission
Generic date
[If 'yes' please give]
38 d
The nature of the illness or operation
Generic text
[If 'yes' please give]
38 e
The length of your stay in hospital
Generic text
[If 'yes' please give]
38 f
The name of the Doctor in charge of you in hospital
Generic text
[If 'yes' please give]
39 a
Since January 1961 have you attended hospital as an out-patient?
1
Yes
0
No
39 b
Name of hospital
Generic text
[If 'yes' please give]
39 c
Date of first attendance
Generic date
[If 'yes' please give]
39 d
Reason for attendance
Generic text
[If 'yes' please give]
40 a
Since January 1961 have you attended a clinic?
1
Yes
0
No
40 b
Name of clinic
Generic text
[If 'yes' please give]
40 c
Date of first attendance
Generic text
[If 'yes' please give]
40 d
Reason for attendance
Generic text
[If 'yes' please give]
41
The last accident we have recorded for you was ... when you were ... years old,
Generic text
Age
41 a
Since this accident or since January 1961 have you had an accident when you were BURNT or SCALDED, BROKE A BONE, were BADLY CUT, or BRUISED or INJURED by a CHEMICAL.
1
Yes
0
No
41 b(i)

Please give the following details about each accident starting with the earliest:-

Type of injury (enter as BURN SCALD, BROKEN BONE, CUT etc.) Part or parts in-jured Age when in-jured (in years and months) Treatment, Hosp.I,P, Hosp.O.P, Nursing Home, Own home If treated in own home, who gave treatment (Doctor, Nurse, other)? Details of remaining scarring, disability or deformity
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First Accident 1
Second 2
[If 'yes']
41 b(ii)

Please give the following details about each accident starting with the earliest:-

DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or oil stove) Where it occurred (own home, school street, etc.,)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident 1
Second 2
[If 'yes']
42 a
Do you have trouble with your sleep?
1
Yes
0
No
42 b
What sort of trouble do you have?
1
difficulty in getting off to sleep
2
waking up during the night and not being able to get off to sleep again quickly
3
unpleasant dreams or nightmares
4
waking too early in the morning and staying awake
5
sleeping all right but still feeling tired in the morning
*
other, namely
Other
[If 'yes']
s_q43_i
Don't leave any questions out. There are no right or wrong answers - this isn't a test of intelligence, it is simply to give us an idea of how you feel and behave.
43

Now here are some questions about the way you behave, and feel, and act, after each question there is 'yes' a '?' and a 'no'. Try and decide whether 'yes' or 'no' is how you usually feel and then circle the 'yes' and the 'no' like this:. If you find it quite impossible to decide, then circle the '?', like this:. However don't use the question-mark unless you feel you have to. Work quickly and don't spend too much time on any question, we want your first reaction.

-

1 - Yes

2 - ?

3 - No
Are you happiest when you get involved in some project that calls for rapid action?
Do you sometimes feel happy, sometimes depressed, without any apparent reason?
Does your mind often wander while you are trying to concentrate?
Do you usually take the initiative in making new friends?
Are you inclined to be quick and sure in your actions?
Are you frequently 'lost in thought' even when supposed to be taking part in a conversation?
Are you sometimes bubbling over with energy and sometimes very sluggish?
Would you rate yourself as a lively individual?
Would you be very unhappy if you were prevented from making numerous social contacts?
Are you inclined to be moody?
Do you have frequent ups and downs in mood, either with or without apparent cause?
Do you prefer action to planning for action?
s_outro_i
PLEASE CHECK THAT YOU HAVE ANSWERED EVERY QUESTIONS THAT APPLIES TO YOU.
outro i
How long did this questionnaire take you to fill in?
Time taken
outro ii
Signed
Generic text
outro iii
Date
Generic date
Name

1962 Student's Questionnaire