RESEARCH INSTRUMENT A4

RESEARCH INSTRUMENT
Self-Care: Its Relationship To Students Emotional Quotient
Name (optional): ___________________________________________________________

School (optional):
____________________________________________________________
General Direction: This questionnaire requires you to access your Self-Care and Emotional
Quotient level. Please answer honestly in terms of the following situations in each indicator
by checking the appropriate box that matches your natural reaction to the statement. There
are no right or wrong answers and please do not leave any questions unanswered.
PART I. SELF- CARE
For each given statement, indicate the level of self- care in terms of physical self-
care, emotional self- care, and phsycological self- care. Please put a checkmark on the
box that corresponds to your answer based on the 5- point Likert Scale below.
5 STRONGLY AGREE The statement is always true.

4 AGREE The statement is often true.
3 MODERATELY AGREE The statement is sometimes true.
2 DISAGREE The statement is seldom true.
1 STRONGLY DISAGREE The statement is rarely true.
Items
A. Physical Self-Care 5 4 3 2 1
I…
1. eat regularly (breakfast, lunch, and dinner)
2. eat healthy foods.
3. get regular medical care.
4. get medical care when needed.
5. take time off when sick.
6. do fun physical activities.
7. get enough sleep

8. wear clothes I like.
9. take vacations.
10. make time away from cell phones and social

media.
B. Emotional Self Care 5 4 3 2 1
I…
1. spend time with others whose company you

enjoy.
2. stay in contact with important people in your

life.
3. praise myself.
4. love myself.
5. reread books.
6. identify comforting activities.
7. allow myself to cry.
8. find things that make me laugh.
9. express my outrage in social actions.
10. play with children.
C.Psychological Self- Care 5 4 3 2 1
I…
1. make time for self-reflection.
2. have my own personal psychotherapy.
3. do something at which are not export or in

charge.
4. can always calm down quickly when i am
very angry.
5. always encourage myself to try my best.
6. prioritize between a set of important tasks.
7. always know my friend's emotions from their

behavior.
8. am a good observer of others' emotions.
9. like getting to know new people and making

new friends.
10. say yes to extra responsibilities.
Reference:Norton(1996). Transforming the Pain: A Workbook on Vicarious Traumatization,

Saakvitne, Pearlan, & Staff of TSI/ CAAP
https://wellness.sfsu.edu/sites/default/files/documents/Self-Care%20Questionnaire%20and
%20Contract%20%281%29%28Accessible%29.pdf
PART II. EMOTIONAL QUOTIENT
For each given statement, indicate the level of self- care in terms of handling emotions,
empathy, and self awareness Please put a checkmark on the box that corresponds to your
answer based on the 5- point Likert Scale below.
5 STRONGLY AGREE The statement is always true.

4 AGREE The statement is often true.
3 MODERATELY AGREE The statement is sometimes true.
2 DISAGREE The statement is seldom true.
1 STRONGLY DISAGREE The statement is rarely true.
Items
A. Handling Emotions 5 4 3 2 1
I...
1. immediately know when i

become angry.
2. can recognize emotions.
3. lose my temper when

dealing with difficult people.
4. can change my mood when

i want to.
5. don’t let stressful situations

affect my work.
6. can quickly control and

manage my anger.
7. always like to be aware of

my emotions.
8. have control of my
emotions.
9. can suppress my emotions

when i need to.
10. keep my emotions to

myself.
B. Empathy 5 4 3 2 1
I...
1. see the problem someone

faces from his point of view.
2. can easily empathize with

others when i listen to their
issues.
3. like knowing new people

and make friends.
4. can understand things

people are trying to tell me.
5. have good listening skills.
6. build strong relationships

with those i work with.
7. see or hear someone who is

happy it makes me happy
too.
8. can easily tell if someone
else is interested or bored
with what i’m saying.
9. friends usually talk to me

about their problems as they
say i’m very understanding.
10. can find it easy to put myself

in somebody else’s shoes.
C. Self Awareness 5 4 3 2 1
I...
1. am communicating with
adults is comfortable for me.
2. feel passionate about my

interest/hobbies.
3. am at my best first thing in

the morning.
4. prefer animals to humans.
5. don’t like to take risks.
6. really enjoy caring for other

people.
7. am self-motivating.
8. am ready to listen and

consider the opinions of
others.
9. would never break a rule no

matter how minor.
10. tend to have very strong

opinions.
Reference:TutorialsPoint(2023).Empathy-quotient-assessment.pdf.https://
www.tutorialspoint.com/social_intelligence/emotional_quotient_questionnaire.htm
Thank you for your participation and honest response.
Samirah Tan
Annysah Paidumama
Neylan Kusin
Researchers

RESEARCH INSTRUMENT A4

Uploaded by

Copyright:

Available Formats

RESEARCH INSTRUMENT A4

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

RESEARCH INSTRUMENT A4

Uploaded by

Copyright:

Available Formats

RESEARCH INSTRUMENT

Self-Care: Its Relationship To Students Emotional Quotient

Name (optional): ___________________________________________________________

PART I. SELF- CARE

5 STRONGLY AGREE The statement is always true.

1. eat regularly (breakfast, lunch, and dinner)

2. eat healthy foods.

3. get regular medical care.

4. get medical care when needed.

5. take time off when sick.

6. do fun physical activities.

7. get enough sleep

10. make time away from cell phones and social

B. Emotional Self Care 5 4 3 2 1

1. spend time with others whose company you

2. stay in contact with important people in your

6. identify comforting activities.

7. allow myself to cry.

8. find things that make me laugh.

9. express my outrage in social actions.

10. play with children.

C.Psychological Self- Care 5 4 3 2 1

1. make time for self-reflection.

2. have my own personal psychotherapy.

3. do something at which are not export or in

5. always encourage myself to try my best.

6. prioritize between a set of important tasks.

7. always know my friend's emotions from their

8. am a good observer of others' emotions.

9. like getting to know new people and making

10. say yes to extra responsibilities.

Reference:Norton(1996). Transforming the Pain: A Workbook on Vicarious Traumatization,

5 STRONGLY AGREE The statement is always true.

1. immediately know when i

3. lose my temper when

4. can change my mood when

5. don’t let stressful situations

6. can quickly control and

7. always like to be aware of

9. can suppress my emotions

10. keep my emotions to

1. see the problem someone

2. can easily empathize with

3. like knowing new people

4. can understand things

5. have good listening skills.

6. build strong relationships

7. see or hear someone who is

9. friends usually talk to me

10. can find it easy to put myself

2. feel passionate about my

3. am at my best first thing in

4. prefer animals to humans.

5. don’t like to take risks.

6. really enjoy caring for other

8. am ready to listen and

9. would never break a rule no

10. tend to have very strong