PBC SURVEY PART 2
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1
. Do you turn your cell phone off at night?
Do you turn your cell phone off at night?
a. Yes
b. No
2
. Do you share a bedroom with others?
Do you share a bedroom with others?
a. Yes, with one other person
b. Yes, with more than one other person
c. No, I have my own room
d. I don’t sleep in a bedroom
3
. What time do you go to bed? Between:
What time do you go to bed? Between:
a. 9:00 – 10:00 pm
b. 10:00 – 11:00 pm
c. 11:00 – 12:00 am
d. 12:00 – 1:00 am
e. 1:00 – 2:00 am
f. Other_________
4
. Do you drink coffee, tea, or other caffeinated beverages (i.e. Coke, Pepsi, energy drinks) after 3:00pm?
Do you drink coffee, tea, or other caffeinated beverages (i.e. Coke, Pepsi, energy drinks) after 3:00pm?
a. Yes
b. No
c. Sometimes
5
. How many hours of sleep do you get on an average school night?
How many hours of sleep do you get on an average school night?
a. 10 hrs.
b. 9 hrs.
c. 8 hrs.
d. 7 hrs.
e. 6 hrs.
f. 5 hrs.
g. Less than 5 hrs.
h. More than 10 hrs.
6
. What is your wake-up time? Between:
What is your wake-up time? Between:
a. 5:00 – 6:00 am
b. 6:00 – 7:00 am
c. 7:00 – 8:00 am
d. Other __________
7
. About what time do you usually arrive at school?
About what time do you usually arrive at school?
a. 7:15 am
b. 7:20 am
c. 7:25 am
d. 7:30 am
e. 7:35am
f. 7:40 am
g. 7:45 am
h. 7:50 am
i. 8:00 am
j. After 8:00 am
k. Other ___________
8
. Do you eat breakfast?
Do you eat breakfast?
a. Yes, I eat breakfast at home
b. Yes, I eat breakfast at school
c. Yes, I stop and pick something up on the way
d. No, I don’t like to eat breakfast
e. No, I don’t have time to eat breakfast
9
. Do you use your school planner?
Do you use your school planner?
a. Yes
b. No
10
. Do you make a “to do” list every day?
Do you make a “to do” list every day?
a. Yes
b. No
c. Sometimes
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