Middle and High School Wellness Survey

Please complete this survey honestly and accurately to help us best understand the activity level and eating habits of our students.  The results of this survey will be confidential.  Your unique responses will not be traced to you.  

The survey is an important part of us understanding our students and in helping us identify needs that could bring much needed resources to the school to help improve our physical education and fitness programs.  

Thank you in advance for your help.

I am in:

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* 1. I am in:

I am a:

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* 2. I am a:

Which best describes you as a student?

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* 3. Which best describes you as a student?

Yesterday, did you eat any vegetables?  
Vegetables are salads; boiled, baked and mashed potatoes; and all cooked and uncooked vegetables.
Do not count French fries or chips. 

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* 4. Yesterday, did you eat any vegetables?  
Vegetables are salads; boiled, baked and mashed potatoes; and all cooked and uncooked vegetables.
Do not count French fries or chips. 

Yesterday, did you eat fruit?  
Do not count fruit juice

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* 5. Yesterday, did you eat fruit?  
Do not count fruit juice

On how many of the last seven days did you exercise or participate in activities that accelerated your heart rate and made you breathe hard for at least 60 minutes.  (For example:  basketball, jogging, skating, dancing, swimming laps, tennis, fast bicycling, or aerobics)?

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* 6. On how many of the last seven days did you exercise or participate in activities that accelerated your heart rate and made you breathe hard for at least 60 minutes.  (For example:  basketball, jogging, skating, dancing, swimming laps, tennis, fast bicycling, or aerobics)?

How many hours each day do you usually watch TV, play video games, or use a  computer, tablet, or phone?

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* 7. How many hours each day do you usually watch TV, play video games, or use a  computer, tablet, or phone?

In the past week, how many times did you eat out at restaurants?

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* 8. In the past week, how many times did you eat out at restaurants?

Did you eat breakfast this morning?

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* 9. Did you eat breakfast this morning?

Which best describes the breakfast you ate this morning?

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* 10. Which best describes the breakfast you ate this morning?

I usually eat breakfast...

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* 11. I usually eat breakfast...

In the last 7 days, on how many days did you do sports, dance, or play games in which you were very active after school?

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* 12. In the last 7 days, on how many days did you do sports, dance, or play games in which you were very active after school?

Which one of the following describes you best for the last 7 days? 
Read all five statements before deciding on the one answer that best describes you.

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* 13. Which one of the following describes you best for the last 7 days? 
Read all five statements before deciding on the one answer that best describes you.

I would be interested in the school having more opportunities to be active before school, after school, and on the weekend.

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* 14. I would be interested in the school having more opportunities to be active before school, after school, and on the weekend.

What suggestions would you have for new or expanded fitness activities?

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* 15. What suggestions would you have for new or expanded fitness activities?

I would be interested in learning more about how my food choices can help me stay healthy.

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* 16. I would be interested in learning more about how my food choices can help me stay healthy.

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