Name____________
Gender___________
Age______________
Weight(in kilograms) ___________
Height( in feet and inches) ____________
Class_____________
School name______________
School fee________________
Area of residence ______________
House type( flat, single storey, double storey)
Number of rooms____________
Number of people living in the house________
House appliances (Air conditioner, television, microwave/oven, computer/laptops)
How do you typically commute to school on a daily basis?
Please select from: Car/vehicle, Public transportation, Walk, Bike, Other_______
What factors influence your choice of transportation for daily commutes?
Please select from: convenience, cost, environmental impact, health benefits.
DIETARY INTAKE
1. How often do you consume fruit in a typical week?
Never, Rarely, Occasionally, Frequently, Daily
2. How many servings of vegetables do you consume in a day?
Never, Rarely, Occasionally, Frequently, Daily
3. On average, how many glasses of milk do you drink each week?
Never, Rarely, Occasionally, Frequently, Daily
4. How often do you include meat(chicken,lamb,beef, mutton )in your meals?
Never, Rarely, Occasionally, Frequently, Daily
5. How frequently do you consume processed foods in your daily diet?
Never, Rarely, Occasionally, Frequently, Daily
6. What are some examples of processed foods that you tend to consume regularly? (e.g.,
packaged snacks, frozen meals, fast food, etc. others _________
7. Do you find it challenging to resist sugary foods or beverages?
Yes/No
8. How often do you consume sugary treats like candy, soda, or desserts?
Never, Rarely, Occasionally, Frequently, Daily
9. How often do you drink cold sugary drinks such as soda, sweetened juices, or energy
drinks?
Never, Rarely, Occasionally, Frequently, Daily
10. How often do you consume sugary treats like candy or desserts?
Never, Rarely, Occasionally, Frequently, Daily
11. How frequently do you eat breakfast during the weekdays? Please select from: Every
day, Most days, Sometimes, Rarely, Never.
12. How often do you eat lunch during the school week?
Please select from: Every day, Most days, Sometimes, Rarely, Never.
13. What are common lunch options for you during the school week? (e.g., sandwich, salad,
pasta, specify ________________
14. How often do you have dinner with your family during the week? Please select from:
Every day, Most days, Sometimes, Rarely, Never
15. What does a typical dinner consist of in your household? (e.g., protein, vegetables,
grains, etc.) specify______________
16. How often do you consume snacks between meals?
Please select from: Every day, Most days, Sometimes, Rarely, Never.
17. What are your go-to snacks? (e.g., fruits, chips, cookies, nuts, yogurt, etc.)
specify______________
18. Do you usually drink water, sugary beverages, or other drinks throughout the day? If so,
please specify what and how much you typically consume___________
PHYSICAL AND OUTDOOR ACTIVITIES
1. Which outdoor activities do you participate in regularly?
(select all that apply: sports, cycling, jogging, swimming, playing at the park, etc.)
others_________
2. How many hours per week do you spend on outdoor activities or physical exercise?
_____________
3. How many hours a day do you spend sitting on the couch watching TV, playing video
games, or doing nothing?
_____________
4. What do you usually do during your free time?
(Select all that apply: read, play sports, watch TV, play video games, socialize with
friends, etc.)
5. How often do you engage in outdoor activities each week?
Please select from: Every day, Most days, Sometimes, Rarely, Never.
6. What are some of your favorite outdoor activities to participate in? (e.g., hiking, biking,
swimming, playing sports, if others specify please ___________
7. Do you have access to a park or outdoor space near your home where you can exercise
or play? If so, how often do you utilize this space?
__________________
8. How frequently do you engage in physical activities or exercise each week?
Please select from: Every day, Most days, 3-4 times a week, 1-2 times a week, Rarely,
Never.
9. What types of physical activities do you enjoy doing for exercise? (e.g., running, yoga,
dancing, weightlifting, etc. specify __________
10. Are there any barriers or challenges that hinder your ability to engage in regular physical
activity? ____________________
11. On a scale of 1 to 10, how would you rate your current level of physical fitness?
(1 being very low, 10 being very high)
______________
12. What do you usually do during your free time?
(Select all that apply: read, play sports, watch TV, play video games, socialize with
friends, etc.)
13. How important is staying active and fit to you in your daily life?
Please select from:
Very important, Somewhat important, Not very important, Not at all important