Cognitive Failure Questionnaire (CFQ)
Broadbent DE, et al. Br J Psychol 1982;21: 1-16

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The following questions are about minor mistakes which everyone makes from time to time, but some of which happen more often than others. We want to know how often these things have happened to you in the last four weeks. Per statement you can choose one out of five answer categories, varying from very often; quite often; occasionally; very rarely; and never. Please chose the appropriate answer.
 
1. Do you read something and find you haven't been thinking about it and must read it again?

 

 Very often          Quite often          Occasionally          Very rarely          Never
2. Do you find you forget why you went from one part of the house to the other?

 

 Very often          Quite often          Occasionally          Very rarely          Never
3. Do you fail to notice signposts on the road?

 

 Very often          Quite often          Occasionally          Very rarely          Never
4. Do you find you confuse right and left when giving directions?
  Very often          Quite often          Occasionally          Very rarely          Never
5. Do you bump into people?
  Very often          Quite often          Occasionally          Very rarely          Never
6. Do you find you forget whether you've turned off a light or a fire or locked the door?
  Very often          Quite often          Occasionally          Very rarely          Never
7. Do you fail to listen to people's names when you are meeting them?
  Very often          Quite often          Occasionally          Very rarely          Never
8. Do you say something and realize afterwards that it might be taken as insulting?
  Very often          Quite often          Occasionally          Very rarely          Never
9. Do you fail to hear people speaking to you when you are doing something else?
  Very often          Quite often          Occasionally          Very rarely          Never
10. Do you lose your temper and regret it?
  Very often          Quite often          Occasionally          Very rarely          Never
11. Do you leave important letters unanswered for days?
  Very often          Quite often          Occasionally          Very rarely          Never
12. Do you find you forget which way to turn on a road you know well but rarely use?
  Very often          Quite often          Occasionally          Very rarely          Never
13. Do you fail to see what you want in a supermarket (although it's there)?
  Very often          Quite often          Occasionally          Very rarely          Never
14. Do you find yourself suddenly wondering whether you've used a word correctly?
  Very often          Quite often          Occasionally          Very rarely          Never
15. Do you have trouble making up your mind?
  Very often          Quite often          Occasionally          Very rarely          Never
16. Do you find you forget appointments?
  Very often          Quite often          Occasionally          Very rarely          Never
17. Do you forget where you put something like a news-paper or a book?
  Very often          Quite often          Occasionally          Very rarely          Never
18. Do you find you accidentally throw away the thing you want and keep what you meant to throw away - as in the example of throwing away the matchbox and putting the used match in your pocket?
  Very often          Quite often          Occasionally          Very rarely          Never
19. Do you daydream when you ought to be listening to something?
  Very often          Quite often          Occasionally          Very rarely          Never
20. Do you find you forget people's names?
  Very often          Quite often          Occasionally          Very rarely          Never
21. Do you start doing one thing at home and get distracted into doing something else (unintentionally)?
  Very often          Quite often          Occasionally          Very rarely          Never
22. Do you find you can't quite remember something although it's 'on the tip of your tongue'?
  Very often          Quite often          Occasionally          Very rarely          Never
23. Do you find you forget what you came to the shops to buy?
  Very often          Quite often          Occasionally          Very rarely          Never
24. Do you drop things?
  Very often          Quite often          Occasionally          Very rarely          Never
25. Do you find you can't think of anything to say?
  Very often          Quite often          Occasionally          Very rarely          Never
When all questions are answered, please push the button  >> 

 

 

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