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EJS Empower U Survey
First name
Last name
1. I thought about something else; tried to forget it; and/or went and did something like watch TV or play a game to get it off my mind.
Yes
No
How much did it help?
Not at all
A little
A lot
2. I stayed away from people; kept my feelings to myself; and just handled the situation on my own.
Yes
No
How much did it help?
Not at all
A little
A lot
3. I tried to see the good side of things and/or concentrated on something good that could come out of the situation.
Yes
No
How much did it help?
Not at all
A little
A lot
4. I realized I brought the problem on myself and blamed myself for causing it.
Yes
No
How much did it help?
Not at all
A little
A lot
5. I realized that someone else caused the problem and blamed them for making me go through this.
Yes
No
How much did it help?
Not at all
A little
A lot
6. I thought of ways to solve the problem; talked to others to get more facts and information about the problem and/or tried to actually solve the problem.
Yes
No
How much did it help?
Not at all
A little
A lot
7. I talked about how I was feeling; yelled; screamed; or hit something.
Yes
NO
How much did it help?
Not at all
A little
A lot
8. Tried to calm myself by talking to myself, praying, taking a walk, or just trying to relax.
Yes
No
How much did it help?
Not at all
A little
A lot
9. I kept thinking and wishing this never happened; and/or that I could change what had happened.choice
Yes
No
How much did it help?
Not at all
A little
A lot
10. I turned to my family, friends, or other adults to help me feel better.
Yes
No
How much did it help?
Not at all
A little
A lot
11. I just accepted the problem because I knew I couldn’t do anything about it.
Yes
No
How much did it help?
Not at all
A little
A lot
Submit
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