This document contains a survey with questions about personal habits, feelings, sports participation, diet, sleep, and screen time. The survey asks the respondent about how often they experience certain feelings, participate in physical activities, eat healthy foods, go to bed, and use screens before bed. Response options include always, sometimes, never, yes, no, and selections between multiple choice answers. The questions cover topics like empathy, conflict resolution, confidence, friendships, kindness, pride, school performance, caring about others' opinions, liking various activities, eating habits, bedtime routines, and screen use before sleep.
1. Age_________ Male Female
1. I understand how other people feel.
Always Sometimes Never
2. I am a happy person.
Always Sometimes Never
3. I am able to recognise/talk about my feelings.
Always Sometimes Never
4. I am good at resolving conflict.
Always Sometimes Never
5. I make friends easily.
Always Sometimes Never
2.
Class _______
6. I am kind to others.
Always Sometimes Never
7. I feel proud of myself.
Always Sometimes Never
8. I am confident.
Always Sometimes Never
9. I try my best at school.
Always Sometimes Never
10. I care what other people think about me.
Always Sometimes Never
11. I like sport.
Always Sometimes Never
3. 12. I play sport.
Always Sometimes Never
13. I walk/cycle/board to and from school.
Always Sometimes Never
14. My family do outdoor activities together.
Always Sometimes Never
15. I like playing outside at break time.
Always Sometimes Never
16. I prefer playing sport to watching sport.
Always Sometimes Never
17. Do you get tired easily when doing sport?
Always Sometimes Never
18. Do you like PE lessons at school?
Always Sometimes Never
4. 19. I like team sports.
Always Sometimes Never
20. I like doing sports by myself.
Always Sometimes Never
21. Do you eat fruit every day?
Yes No
22. Do you eat vegetables every day?
Yes No
23. Do you eat breakfast every day?
Yes No
24. Where do you eat your meals at home?
(Breakfast and Evening meal?)
a. With my family at the table
b. On my own at the table
c. In front of the TV / Screen
25. How do you feel first thing in the morning?
a. Very tired
b. A bit tired
c. Not tired at all
5. 26. Do you drink water every day?
Yes No
27. I eat food that would be considered ‘junk food‛ like…
Sweets, crisps, chocolate, French Fries, Fast Food, candy
a. daily
b. a few times a week
c. once a week
d. never
28. What time do you go to bed on school nights?
a. 7pm – 8pm (19:00 – 20:00)
b. 8pm – 9pm (20:00 – 21:00)
c. 9pm – 10pm (21:00 – 22:00)
d. 10pm – 11pm (22:00 – 23:00)
e. 11pm – 12:pm (23:00 – 24:00)
f. After midnight
29. Do you have a screen in your bedroom?
Yes No
(A screen is one of the following: a TV, DVD Player, iPad, tablet, laptop, mobile phone, games console (PSP/Wii)
30. Do you use a screen right up until the time you go to sleep at night?
Yes No