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Facebook Addiction Survey

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ELECTRICAL TECHNOLOGY
MFI Technological Institute

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Good day! I am [surveyor’s name], 2nd year Electrical Technology student of MFI – Technological Institute. As part of our requirements in Technical English III, we are conducting a study on the Effects of Facebook Addiction to Relationship within the Immediate Family. In order for us to fully understand the topic, we would like to ask for your participation and cooperation in this study. This would only take you 5 minutes to finish answering this. All information that you will provide in this survey will be kept confidential. Thank you.
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Name: Yr. and Section:
Age: Gender:
Address:

1. Do you have Facebook account?
___Yes ___No (Please do not continue answering this)

Below are series of statements that were derived from the questions in Facebook Addiction Test (FAT). FAT is a 20-item questionnaire that measures mild, moderate, and severe levels of Facebook Addiction. To assess your level of addiction, please put a check mark to rate how often these statements happen to you.

Use the following guidelines:
1 = Rarely 2 = Occasionally 3 = Frequently 4 = Often 5 = Always (DNA) Does Not Apply

| 5 | 4 | 3 | 2 | 1 | DNA | 1. I find to stay on Facebook longer than I intended. | | | | | | | 2. I neglect household chores to spend more time on Facebook. | | | | | | | 3. I prefer the excitement of the Facebook to intimacy with my partner. | | | | | | | 4. I form new relationships with fellow Facebook users. | | | | | | | 5. People in my life complain about the amount of time I spend Facebook. | | | | | | | 6. My grades or school works suffer because of the amount of time I spend on Facebook. | | | | | | | 7. I check my e-mail before something else that I need to do. | | | | | | | 8. My job performance or productivity suffers because of Facebook. | | | | | | | 9. I become defensive or secretive when anyone asks me what I do on Facebook. | | | | | | | 10. I block out disturbing thoughts about my life with soothing thoughts of the Facebook. | | | | | | | 11. I find myself anticipating when I will go on Facebook again. | | | | | | | 12. I fear that life without Facebook would be boring, empty, and joyless. | | | | | | | 13. I snap, yell, or act annoyed if someone bothers me while I’m on Facebook. | | | | | | | 14. I lose sleep due to late-night log-ins. | | | | | | | 15. I feel preoccupied with the Facebook when off-line, or fantasize about being on Facebook. | | | | | | | 16. I find myself saying "just a few more minutes" when on Facebook. | | | | | | | 17. I try to cut down the amount of time I spend Facebook and fail. | | | | | | | 18. I try to hide how long I've been on Facebook. | | | | | | | 19. I choose to spend more time Facebook over going out with others. | | | | | | | 20. I feel depressed, moody or nervous when I’m off-line, which goes away once I’m are back on Facebook. | | | | | | |

Are you willing to have a one-on-one interview, if in case we found out that you are on the high level of Facebook addiction?
___Yes ___No

Thank you for your cooperation.

Date: ____________ ____________________
Signature

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