It's the same one you're supposed to fill out on your PR profile. I just broke it down into three tiers for the poll.
Activity level Scale:
Good
10—Fully recovered, or in full remission. 9—Normal life activity level, mild symptoms. 8—Near-normal life activity level, but still symptomatic. 7—Able to work full-time but with difficulty. 6—Six to seven hours activity a day, able to work part-time. 5—Four to five hours of work/activity a day.
Moderate
4—Three to four hours of work/activity a day. 3—Leave house several times a week, two hours work/activity at home a day.
Severe
2—Leave house once a week, concentrate one hour a day. 1—Bedridden most of day, very rarely leave house.
0—Bedridden constantly, except to go to bathroom.