Healthy Kids Learn Better 2010
Exit this survey >> 

1. Healthy Kids Learn Better

 
Coordinated School Health Elementary Survey
Here are questions about who you are.
*

1. Are you a girl or boy?

*

2. What grade are you in?

Here are questions about what you ate and drank yesterday.
*

3. Yesterday, did you drink any kind of milk? Milk includes chocolate or other flavored milk, milk on cereal, or drinks made with milk.

*

4. Yesterday, did you eat French fries or chips?
Chips are potato chips, tortilla chips, Cheetos®, corn chips, or other snack chips.

*

5. Yesterday, how many fruits (including fruit juice) and vegetables did you eat?
Include all fruits and 100% fruit juice such as orange juice, apple juice, grap juice. Do not count punch, Kool-aid, Capri Sun, Gatorade, etc.
Vegetables are all cooked and uncooked vegetables; salads; and boiled, baked and mashed potatoes.
Do not count French fries or chips.

*

6. Yesterday, did you drink any punch, Kool-Aid®, Capri Sun®, sports drinks like Gatorade®, or other fruit-flavored drinks?
Do not count 100% fruit juice.

*

7. Yesterday, did you drink any sodas or soft drinks?

*

8. Yesterday, did you eat breakfast?

*

9. Yesterday, did you eat any meals with your family?

More questions about foods and drinks
*

10. If healthy snacks (for example - apples, oranges, peanuts, etc.) were available at the school store, would you buy them?

11. What kinds of snacks do you eat at home?

12. What ideas do you have for less sugary foods during classroom parties and birthdays?

*

13. How much water do you drink everyday?

*

14. Does the adult (parent) at your house encourage you to drink water?

*

15. Are you allowed to have a water bottle at your desk?

These questions are about P.E class and how much physical activity you do.
*

16. Do you like P.E.?

*

17. Do you feel like you are getting better at P.E.?

*

18. Do you set a goal for yourself in P.E. class?

*

19. Do you feel encouraged during P.E. class to try your best?

20. Are you embarrassed during P.E.?

21. Do you think you have learned some activities in P.E. that you can do as you get older to stay in shape?

*

22. During P.E., I am active (breathing harder)

*

23. Yesterday, did you do any exercise that made your heart beat fast and made you breathe hard for at least 20 minutes? (For example: basketball, running or jogging, dancing, swimming, skating, bicycling, jumping rope, soccer, or other similar aerobic activities.)

*

24. Yesterday, did you do any exercise that did not make your heart beat fast and did not make you breathe hard for at least 30 minutes? (For example: walking, kickball, baseball, working in the yard, or chores around the house like mopping floors.)

*

25. Do you currently take part in any organized sports or take lessons?
• Sports teams can include soccer, basketball, baseball, softball, swimming, cheerleading, wrestling, track, football, and volleyball teams
• Classes can include martial arts, dance, gymnastics, and tennis
Do not include PE classes.

*

26. Yesterday, how many hours did you watch TV or video movies?

*

27. Yesterday, how many hours did you spend on the computer or play video games like Nintendo®, Sega®, Xbox®, Playstation®, or arcade games?

*

28. Yesterday, how many total hours of screen time did you have (this includes TV, movies, computer, and video games)?

*

29. Do your parents or guardian limit the amount of TV, computer, videos or video games that you can watch or play?

30. Does your family do any "active" activities together (that make you breathe harder)? Swimming, going for a walk, bike riding, hiking, other?

*

31. Do you ever run laps at school for the Laps Program?

32. What is your favorite lap's prize? Choose only one and you can choose it if you haven't earned it yet.

*

33. Do your walk or bike to school?

34. Do you have any ideas on how to make walking/biking to school something that more kids would want to do?

35. Do you have any ideas on how to make walking/biking to school safer?

These questions are about the lunches at your school.
*

36. Do you eat school lunches?

*

37. If you eat hot lunch, how often do you take “seconds”?

Here are questions about safety
*

38. When you ride in a car do you wear a seat belt?

*

39. When you ride a bicycle or a skateboard do you wear a helmet?

*

40. Are you home alone after school?

*

41. During the past month, have you hit or pushed other kids at school when you were not playing around?

*

42. During the past month, did other kids hit or push you at school when they are not just playing around?

*

43. During the past month, have you spread mean rumors or lies about other kids at school?

*

44. During the past month, did other kids at school spread mean rumors or lies about you?

*

45. Do you feel safe on school property?

*

46. Do you feel safe away from school?

47. Can you write down why you do not feel safe at home or school?

*

48. Have you had fire prevention lessons at school in the last year?

*

49. Do you feel like you know what to do if there is a fire at school?

*

50. Do you feel like you know what to do if there is a fire at home?

*

51. Do you have a family emergency plan in case of tsunami, earthquake, fire?

These questions below are about your health and things you might do.
*

52. Do you know what the food pyramid is?

*

53. Have you ever tried to lose weight?

*

54. Have other kids at school ever teased you about what your body looks like?

*

55. Compared to other students in your grade who are as tall as you, do you think you weigh:

*

56. Has a parent or some other adult ever told you that you have asthma?

*

57. When you're playing or working outside, do you wear sunscreen?

These questions are about taking care of our teeth
*

58. Have you ever been to a dentist?

*

59. How often do you brush you teeth?

*

60. Do you floss your teeth?

*

61. How many of the questions on this survey did you understand?

Thank you for taking this survey!