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Republic of the Philippines

Eastern Visayas State University


Tanauan Campus
Tanauan, Leyte

Checklist Survey Questionnaire

Questions
What is your O O O
gender? Male Female Transgender
What is your age? O O O O
15-17 18-20 21 above Others( please
specify)
Answer as applicable Yes No
Do you have a smart phone?

Do you have internet accessibility


on your phone?
Do you think you can survive
without phone?
O O O
What is your source of internet? Data Wi-fi Other (
Card please
specify)
On daily basis, about how much O O O O O
you spend on your mobile Never 1-2 hrs 2-5 hrs. 5hrs. Everytime
application?
How much time you
approximately spend on these
mobile application daily?
O O O O O
Facebook Never 1-2hrs 2-5hrs 5hrs. Every time

O O O O O
What’s App Never 1-2hrs 2-5hrs 5hrs. Every time
Twitter O O O O O
Never 1-2hrs 2-5hrs 5hrs. Every time
Google O O O O O
Never 1-2hrs 2-5hrs 5hrs. Every time
Instagram O O O O O
Never 1-2hrs 2-5hrs 5hrs. Every time
Messenger O O O O O
Never 1-2hrs 2-5hrs 5hrs. Every time
Others
( please specify)
Answers as applicable
You are obsessed with your O O O O O
phone? Never 1-2hrs 2-5hrs 5hrs. Everytime
You feel stressed on not being O O O O O
able to use your phone? Never 1-2hrs 2-5hrs 5hrs. Everytime
You have ever tried hard and O O O O O
failed to control your addiction to Never 1-2hrs 2-5hrs 5hrs. Everytime
your phone?

You have used your phone O O O O O


Longer than intended Never 1-2hrs 2-5hrs 5hrs. Everytime
You feel comfortable in virtual O O O O O
world than the real world. Never 1-2hrs 2-5hrs 5hrs. Everytime
You get impatient when you don’t O O O O O
find your mobile showing Never 1-2hrs 2-5hrs 5hrs. Everytime
notification.
Running out of battery in your O O O O O
mobile scares you. Never 1-2hrs 2-5hrs 5hrs. Everytime
O
How do you often use the O O O O Others(
internet for: Gaming Social Entertain- Academic please
Networking ment Purposes. specify)

Thank You for your cooperation!