| 1. General discomfort | None □ | Slight □ | Moderate □ | Severe □ |
| 2. Fatigue | None □ | Slight □ | Moderate □ | Severe □ |
| 3. Headache | None □ | Slight □ | Moderate □ | Severe □ |
| 4. Eyestrain | None □ | Slight □ | Moderate □ | Severe □ |
| 5. Difficulty focusing | None □ | Slight □ | Moderate □ | Severe □ |
| 6. Increased salivation | None □ | Slight □ | Moderate □ | Severe □ |
| 7. Sweating | None □ | Slight □ | Moderate □ | Severe □ |
| 8. Nausea | None □ | Slight □ | Moderate □ | Severe □ |
| 9. Difficulty concentrating | None □ | Slight □ | Moderate □ | Severe □ |
| 10. Fullness of Head | None □ | Slight □ | Moderate □ | Severe □ |
| 11. Blurred vision | None □ | Slight □ | Moderate □ | Severe □ |
| 12. Dizziness with eye open | None □ | Slight □ | Moderate □ | Severe □ |
| 13. Dizziness with eye closed | None □ | Slight □ | Moderate □ | Severe □ |
| 14. Vertigo | None □ | Slight □ | Moderate □ | Severe □ |
| 15. Stomach awareness | None □ | Slight □ | Moderate □ | Severe □ |
| 16. Burping | None □ | Slight □ | Moderate □ | Severe □ |
| Original version: Kennedy, R.S.; Lane, N.E.; Berbaum, K.S.; Lilienthal, M.G. Simulator sickness questionnaire: An enhanced method for quantifying simulator sickness. Int. J. Aviat. Psychol. 1993, 3, 203–220. | ||||