1 - How many hours is your television on daily? 1 or less || A couple || 3-4 || 5 or more 2 - Do you happen to leave your television on even if you are not following any particular program? Never || Sometimes || Frequently || Always 3 - Do you leave your television on during meals with other people? (for example your family) Never || Sometimes || Frequently || Always 4 - Do you turn the television off when you start a conversation with another person? Never || Sometimes || Frequently || Always 5 - Do you prefer to watch the television alone or in company? Alone || In company || It's indifferent 6 - Do you ever feel a sensation of wellbeing (relaxation) while watching tv? Never || Sometimes || Frequently || Always 7 - Do you ever feel a strong impulse to turn the television on? Always || Frequently || Sometimes || Never 8 - Do you find that television keeps you company? Always || Frequently || Sometimes || Never 9 - Do you prefer to stay home and watch a nice program or movie or to go out with your friends? To stay home and watch tv || To go out with friends 10 - Do you ever get asleep with your tv turned on in the background? Never || Sometimes || Frequently || Always
11 - Do you ever happen to forget the tv turned on while you are doing something else and remember about it hours later? Never || Sometimes || Frequently || Always 12 - Do you watch or listen television even when you are performing some mentally demanding activities? (calculations, reading, writing) Never || Sometimes || Frequently || Always 13 - When you are watching a program that you like, are you bothered by other people's comments and opinions? Never || Sometimes || Frequently || Always 14 - During tv commercials, do you stand up and do something else? Never || Sometimes || Frequently || Always 15 - Is the television your primary information source? Never || Sometimes || Frequently || Always 16 - When you're are visiting new places (foreign nations, for example) is it important for you to have a television in your room? Never || Sometimes || Frequently || Always 17 - Do you believe that life without tv would be incomplete? Never || Sometimes || Frequently || Always 18 - Do you believe that newscasts offer an exhaustive and reliable panorama of world's facts and happenings? Never || Sometimes || Frequently || Always 19 - Do you believe that everything we see on tv is real? Never || Sometimes || Frequently || Always 20 - Do you think that tv may be dangerous? (for example by influencing mind, by creating complexes or discomforts)? Never || Sometimes || Frequently || Always