Omak School District Student Survey

Instructions: The purpose of this survey is to get information on your fitness, nutrition, and health behaviors. Your teacher will not see your answers. Please answer all of the questions honestly and ask for help if you have any questions.
Please scroll down to see all of the questions When you are finished click on the "Submit Survey" button at the bottom of the page. This will take you to a new page. When you see this page please close your browser window.
Thank you for taking this survey!

Age:

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

What grade are you in?

K
1
2
3
4
5
6
7
8
9
10
11
12
Is this a Pre survey or a Post survey?
Pre
Post

  Please indicate your gender
Female
Male
Do you like your PE Class?
Yes
No
I don't have PE this year.
Do you participate in organized physical activities (such as football, dance, karate, volleyball, etc.)?
Yes
No
If 'Yes', when? (you can select more then one)
Fall
Winter
Spring
Summer
Average number of hours you sleep each night?
5-6
7-8
9 or more
How many hours do you spend watching TV or playing video/computer games in a day?
0
1-2
3-4
5-6
7 or more
How many servings of dairy products (milk, cheese, yogurt, etc.) do you normally eat in a day?
0
1-3
4-6
7 or more
How many servings of fruits and vegetables do you normally eat in a day?
0
1-3
4-6
7 or more
In an average WEEK how many minutes of exercise do you get where your breathing and heart rate increase? Try to add up all of the minutes you exercised for an average 7 day week NOT including your PE class.
None
30 minutes
60 minutes (1 hour)
90 minutes (1 and 1/2 hours)
120 minutes (2 hours)
150 minutes (2 and 1/2 hours)
180 minutes (3 hours)
210 minutes (3 and 1/2 hours)
240 minutes (4 hours)
How many times during a week do you eat fast food or food out of a hot case?
0
1-3
4-6
7 or more
How often do you choose a healthy choice food when you eat out?
Always
Sometimes
Never
Idon't think about healthy choices
What types of drinks do you consume in a day? (you can select more then one)
Water
Pop
Diet Pop
Juices
Sports Drinks
Milk
Coffee/Tea/Lattes
What do you eat for lunch? (you can select more then one)
Nothing
Fruit
Vegetables
Meat
Fast Food
School Lunch
Lunch from home