Skip to content

Physical Health (Physical Activity/Nutrition)

  1. Do you participate in any type of exercise after school is finished?
    1. Yes
    2. No
    3. I’m not sure
  2. In your opinion, how is your overall health?
    1. I am as healthy in mind and body as I could be
    2. I could be healthier, and plan to do what it takes to get healthier
    3. I could be healthier, but don’t know what to do about it
    4. I am not healthy
    5. I am not sure
  3. Would you like the cafeteria to offer lower fat meal options?
    1. Yes
    2. No
    3. I’m not sure
  4. Would you like the vending machines to offer healthier choices for snacks and drinks?
    1. Yes
    2. No
    3. I’m not sure
  5. Have you and your parents sought counseling due to fear that you may have an eating disorder?
    1. Yes
    2. No
    3. I’m not sure

Please note: the questions listed are those that have been used in various custom modules to-date. These questions are intended to be used as guides only, as WestEd does not make claims to their utility. Clients wishing to develop a custom module should do so in consultation with their Cal-SCHLS Regional Center.

© 2017 WestEd. All rights reserved.

730 Harrison Street, San Francisco, CA 94107 | Toll free 888.841.7536 | Fax 415.565.3012