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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 
 
 
 
 
 
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
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
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
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

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Self-awareness and lifestyle survey

  • 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