LCSD Wellness Survey 09/10 for Students ( High School )



A red asterisk (*) indicates required questions.


  1. Grade
    9
    10
    11
    12


  1. Gender
    Male
    Female


  1. I am aware that there is a wellness policy in our schools.
    Yes
    No


  1. I know at least two goals of the wellness policy.
    Yes
    No


  1. I know how to read and understand food labels.
    Yes
    Sometimes
    Rarely
    No


  1. I try to read food labels before buying or eating food.
    Yes
    Sometimes
    Rarely
    No


  1. I know how to make good food choices at meals.
    Yes
    Sometimes
    Rarely
    No


  1. I eat breakfast every day.
    Yes
    Sometimes
    Rarely
    No


  1. I know what makes up a balanced meal.
    Yes
    Sometimes
    Rarely
    No


  1. I bring in healthy snacks each day.
    Yes
    Sometimes
    Rarely
    No


  1. I choose whole grain products when offered at meals.
    Yes
    Sometimes
    Rarely
    No


  1. I exercise everyday.
    Yes
    Sometimes
    Rarely
    No


  1. I only exercise during physical education classes at school.
    Yes
    Sometimes
    Rarely
    No


  1. I play a sport on a school team.
    Yes
    Sometimes
    Rarely
    No


  1. I play a sport on a team/activity other than school (town/church/recreation/gymnastics/martial arts/dance)
    Yes
    Sometimes
    Rarely
    No


  1. I play active sports/games with my friends.
    Yes
    Sometimes
    Rarely
    No


  1. I am physically active after school. (bike riding, walking, jogging etc...)
    Yes
    Sometimes
    Rarely
    No


  1. I get at least 8 hours of sleep each night.
    Yes
    Sometimes
    Rarely
    No


  1. I am often up late doing school work at night.
    Yes
    Sometimes
    Rarely
    No


  1. I am often up late playing games or watching television.
    Yes
    Sometimes
    Rarely
    No


  1. I watch 2 hours or less of television each night.
    Yes
    Sometimes
    Rarely
    No


  1. I watch more than 2 hours of television each night.
    Yes
    Sometimes
    Rarely
    No


  1. I know what my Body Mass Index (BMI) is.
    Yes
    Sometimes
    Rarely
    No


  1. I know I am at a healthy weight for my age/height.
    Yes
    Sometimes
    Rarely
    No


  1. I would like to weigh less.
    Yes
    Sometimes
    Rarely
    No


  1. I would like to weigh more.
    Yes
    Sometimes
    Rarely
    No


  1. I usually feel good about myself and the way I look.
    Yes
    Sometimes
    Rarely
    No


  1. I feel that I want to change my activity/fitness level.
    Yes
    Sometimes
    Rarely
    No


  1. I can handle problems as they come along.
    Yes
    Sometimes
    Rarely
    No


  1. I know how to plan ahead and try to keep my time organized.
    Yes
    Sometimes
    Rarely
    No


  1. I feel I have a healthy support system in my family.
    Yes
    Sometimes
    Rarely
    No


  1. I feel I have a healthy support sytem in my friends.
    Yes
    Sometimes
    Rarely
    No


  1. I feel I have a healthy support system at school.
    Yes
    Sometimes
    Rarely
    No


  1. I feel I have a healthy social life.
    Yes
    Sometimes
    Rarely
    No


  1. I speak or act negatively towards others.
    Yes
    Sometimes
    Rarely
    No


  1. In the last year, how often has someone called you a name, "dissed" or teased you about your race, color, religion or ethnicity?
    Never
    1-2 times a month
    1-2 times a week
    3 or more times a week


  1. In the last year, how often has someone called you a name, "dissed" or teased you about sexual orientation?
    Never
    1-2 times a month
    1-2 times a week
    3 or more times a week


  1. In the last year, how often has someone called you a name, "dissed" or teased you about your intellectual or academic ability?
    Never
    1-2 times a month
    1-2 times a week
    3 or more times a week


  1. In the last year, how often has someone called you a name, "dissed" or teased you about your physical ability or body shape/size?
    Never
    1-2 times a month
    1-2 times a week
    3 or more times a week


  1. In the last year, how often have you seen or heard other students get teased or "dissed" about their race,color,ethnicity, sexual orientation,gender, age, mental health, physical ability, academic ability, or body shape and size?
    Never
    1-2 times a month
    1-2 times a week
    3 or more times a week


  1. In which of the above categories do you think most of the teasing or "dissing" occurs?


  1. In the last month how often have you teased or "dissed" another person based on any of the categories mentioned above?
    Never
    1-2 times a month
    1-2 times a week
    3 or more times a week


  1. If you have experienced physical bullying (hit, kicked, slapped, pushed, other unwanted physical contact on purpose) how did you respond? Check all that apply.
    Never happened to me
    I ignored it
    I spoke with an adult I trusted
    I stood up to/ spoke up to the bully
    I got support from a friend
    I told a friend, but didn't get support
    It's still going on and I don't know what to do about it
    I retaliated


  1. If you have experienced having property damaged or stolen how did you respond? Check all that apply.
    Never happened to me
    I ignored it
    I spoke with an adult I trusted
    I stood up to/ spoke up to the bully
    I got support from a friend
    I told a friend, but didn't get support
    It's still going on and I don't know what to do about it
    I retaliated


  1. Have you been called names or put-down referring to any of the following? If so, please check all that apply.
    Age
    Gender
    Mental/emotional health
    Family
    Financial/economic situation
    Other


  1. If you have experienced verbal bullying (name calling, "dissing" or put downs) how did you respond? Check all that apply.
    Never happened to me
    I ignored it
    I spoke with an adult I trusted
    I stood up to/ spoke up to the bully
    I got support from a friend
    I told a friend, but didn't get support
    It's still going on and I don't know what to do about it
    I retaliated


  1. If you have experienced threats in person or in writing how did you respond? Check all that apply.
    Never happened to me
    I ignored it
    I spoke with an adult I trusted
    I stood up to/ spoke up to the bully
    I got support from a friend
    I told a friend, but didn't get support
    It's still going on and I don't know what to do about it
    I retaliated


  1. If you have experienced cyber bullying (taunted or threatened by instant message,text,cell phone, or on social network sites/e-mail) how did you respond? Check all that apply.
    Never happened to me
    I ignored it
    I spoke with an adult I trusted
    I stood up to/ spoke up to the bully
    I got support from a friend
    I told a friend, but didn't get support
    It's still going on and I don't know what to do about it
    I retaliated


  1. If you have experienced exclusion from a group, lunch table or activity how did you respond? Check all that apply.
    Never happened to me
    I ignored it
    I spoke with an adult I trusted
    I stood up to/ spoke up to the bully
    I got support from a friend
    I told a friend, but didn't get support
    It's still going on and I don't know what to do about it
    I retaliated


  1. If you have experienced rumors being spread about you, but not through cyber bullying how did you respond? Check all that apply.
    Never happened to me
    I ignored it
    I spoke with an adult I trusted
    I stood up to/ spoke up to the bully
    I got support from a friend
    I told a friend, but didn't get support
    It's still going on and I don't know what to do about it
    I retaliated


  1. Please write if there are any other bullying experiences or responses that you would like to share that were not mentioned above.


  1. Which of the following statements are true for you? Choose all that apply.
    I generally feel comfortable and secure at school.
    I feel I have at least one adult at school that I can talk things over with.
    I have a good friend at school.
    I participate in a club, sport or activity I enjoy either in school or outside of school or both.
    I keep my problems to myself and don't share them with anyone.
    I have a job.
    I have participated in volunteering or community service this year.
    I feel stressed or worried most of the time.
    I am generally in a pretty good mood.
    I get worried or upset sometimes, but bounce back quickly.


  1. Which of the following statements do you think apply to you? Choose all that apply.
    I tend to pick on other people who I consider weaker than I am.
    When I think someone has disrespected me I try to get revenge.
    I don't have any prejudices.
    I am working on recognizing my own prejudices and learning to be more tolerant.
    I want to be more assertive but I have a hard time speaking up for myself or others.
    I make an effort to be tolerant and accepting of other people's differences.
    When I think someone has disrespected me I bring it to his/her attention respectfully.
    I consider myself a leader, someone who speaks up for tolerance and respect for everyone.


  1. Which of the following have you done in the past month? Check all that apply.
    I tried to help another student who seemed isolated, shy or lonely.
    I stood up for someone who was being picked on, put down or teased.
    I spoke up when hearing somone use language that could be hurtful (like that's so gay" etc...)
    I corrected my own language out loud after saying something accidentally that might be hurtful.
    I talked over a problem I was having with an adult I trust.
    I talked with a counselor, teacher or other school staff person about how to help a friend.
    I observed harassment or bullying and then reported it to an adult at school.
    I had a conversation with a peer about how to help someone who was being bullied or harassed.


  1. Please feel free to list any other comments/suggestions about student physical, emotional, or social well-being here at school.


  1. I have completed this survey.*
    Yes
    No





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