0920-1441 Virtual Reality Sickness Questionnaire

Form Approved

OMB No. 0920-1441

Exp. Date 09/30/2027

Attachment C

Virtual Reality Sickness Questionnaire

Instructions: Circle how much each symptom below is affecting you right now.

1. General discomfort	None	Slight	Moderate	Severe
2. Fatigue	None	Slight	Moderate	Severe
3. Headache	None	Slight	Moderate	Severe
4. Eye strain	None	Slight	Moderate	Severe
5. Difficulty focusing	None	Slight	Moderate	Severe
6. Fullness of the Head	None	Slight	Moderate	Severe
7. Blurred vision	None	Slight	Moderate	Severe
8. Dizziness with eyes closed	None	Slight	Moderate	Severe
9. Vertigo, or feeling off balance	None	Slight	Moderate	Severe

A = Sum of questions 1-4: __________ C = A/12 x 100: __________

B = Sum of questions 5-9: __________ D = B/15 x 100: __________

VRSQ Score = (C + D)/ 2: __________

Virtual Reality Sickness Questionnaire (VRSQ) is modified from the Simulator Sickness Questionnaire (SSQ).

Kim, H. K., Park, J., Choi, Y., & Choe, M. (2018). Virtual reality sickness questionnaire (VRSQ): Motion sickness measurement index in a virtual reality environment. Applied Ergonomics, 69, 66-73.

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to - CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333 ATTN: PRA (0920-1441).