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Dehydration Questionnaire
Do you have experienced two or more of the following signs and/or symptoms of dehydration? If you answer Yes, then check Yes to all those signs and symptoms you have been experiencing in the past 24 hours, if not, then check No.
| Signs and Symptoms of Dehydration | Yes | No |
| Have You Worked Hard Indoors or out Doors and Feel More Thirsty Then Usual Today | ||
| Have You Been Exposed to Significant Heat and or Hard Working Conditions Today | ||
| You Have Dry Lips, Mouth and/or Tongue | ||
| You Have Dry Eyes | ||
| You Have a Headache | ||
| You Have Low Blood Pressure | ||
| You Are Feeling Dizzy or Weak When Standing, Siting or Changing Positions (Orthostatic Hypotension) | ||
| You Are Dizziness | ||
| You Have the Feeling Your Going to Faint or You Have Fainted | ||
| You Are Having Muscle Cramping (In Any Part Of Your Body) | ||
| You Are Feeling Irritable, Having Mood Swings, Feeling Grumpy and/or More Emotional Than Usual | ||
| You Are More Fatigued Than Usual | ||
| You Are Feeling Confused or A Sense of Confusion | ||
| You Have Reduced Urine Output | ||
| Your Urine Is Dark and Has a Stronger Than Usual Smell | ||
| You Have Urinated Less Than 4 Times in the Past 24 Hours | ||
| You Have Dry, Wrinkled Skin | ||
| You Have A Rapid Heartbeat | ||
| You Are Breathing More Rapid Than Usual | ||
| You Have Been Sweating A Lot and Your Skin Now Feels: Sticky and Has Lost Its Elasticity. Your Skin Feels Cool or Cold or Is Blotchy or Looks Dry |
If you experience 2 or more of the above signs or symptoms than you are dehydrated.
