Date
BASELINE CHARACTERISTICS of STUDENTS FORM
Research Code
Age:
Height
Weight
Estimated monthly income range of your family?
a. < 12000 pesos
b. >12000-24 000 pesos
c. 24000- <145000 pesos
d. 145000-<250000 pesos
e. >250.000 pesos
GLOBAL SCHOOL-BASED STUDENT HEALTH SURVEY
Core Questionnaire Module
Copyright: WHO 2021
This survey is about your health and the things you do that may affect your health. Students like
you all over your country are doing this survey. Students in many other countries around the
world also are doing this survey. The information you give will be used to develop better health
programs for young people like yourself. DO NOT write your name on this survey or the answer
sheet. The answers you give will be kept private. No one will know how you answer. Answer the
questions based on what you really know or do. There are no right or wrong answers.
Completing the survey is voluntary. Your grade or mark in this class will not be affected whether
or not you answer the questions. If you do not want to answer a question, just leave it blank
The next questions ask about what you might eat and drink
1. During the past 30 days, how often did you go hungry because there was not enough food
in your home?
a. Never
b. Rarely
c. Sometimes
d. Most of the times
e. Always
2. During the past 30 days, how often did you eat breakfast?
a. Never
b. Rarely
c. Sometimes
d. Most of the times
e. Always
3. During the past 7 days, how often did you eat fruits such as orange, mango, and banana?
Hind
4. I did not eat fruits in a span of 7 days
5. 1-3x in a span of 7 days
6. 4-6x in a span of 7 days
7. 1-3x everyday
8. Almost everyday
The next questions asked about physical activity. Physical activity is any activity
that increases your heart rate and makes you breathe hard. Physical activity can be done in
sports, playing with friends, walking to school, or in physical education class. Some examples of
physical activity are running, fast walking, biking, dancing, football
1. During the past 7 days, on how many days, were you physically active for a total of at
least 60 minutes per day?
a. 0-1 day
b. 2-4 day
c. 5-6 day
d. Almost everyday
2. During the past 7 days, on how many days, did you do exercises, to strengthen up or
tone your muscles,such as push up, sit up, or weightlifting?
a. 0 – 1 day
b. 2-4 day
c. 5-6 day
d. Almost everyday
3. During the past 7 days, on how many days, were you walking or using bicycle to go
to school?
a. 0-1 day
b. 2-4 day
c. 5-6 day
d. Almost everyday
4. During this school year, on how many days did you go to PE class each week?
a. 0-1 day
b. 2-4 day
c. 5-6 day
d. Almost everyday
5. Most of the time, in one day, how many hours did you use to watch television, play
computer or mobile games, bonding with friends or classmates, or doing other
activities like sitting beside school activities?
a. 0-2 hours per day
b. 2-4 hours per day
c. 4-6 hours per day
d. 6-8 hours per day
The next question will be regarding your sleep duration in a day
1. Most of the time, in a day, how many hours of sleep did you take?
a. Less than 4 hours per day
b. 5 hours per day
c. 6-7 hours per day
d. 8 hours or more per day