General Practice Physical Activity Questionnaire Date……………………… Name…………………….. 1. Please tell us the type and amount of physical activity involved in your work. Please tick one box that is closest to your present work from the following five possibilities: Please mark one box only I am not in employment (e.g. retired, retired for health a reasons, unemployed, full-time carer etc.) I most of my time at work sitting (such as in an office) b I most of my time at work standing or walking. However, c my work does not require much intense physical effort (e.g. shop assistant, hairdresser, security guard, childminder, etc.) My work involves definite physical effort including handling of heavy objects and use of tools (e.g. plumber, electrician, d carpenter, cleaner, hospital nurse, gardener, postal delivery workers etc.) My work involves vigorous physical activity including handling e of very heavy objects (e.g. scaffolder, construction worker, refuse collector, etc.) 2. During the last week, how many hours did you spend on each of the following activities? Please answer whether you are in employment or not Please mark one box only on each row None Some 1 hour 3 but but or less less more
General Practice Physical Activity Questionnaire Date……………………… Name…………………….. 1. Please tell us the type and amount of physical activity involved in your work. Please tick one box that is closest to your present work from the following five possibilities: Please mark one box only a I am not in employment (e.g. retired, retired for health reasons, unemployed, full-time carer etc.) b I most of my time at work sitting (such as in an office) c I most of my time at work standing or walking. However, my work does not require much intense physical effort (e.g. shop assistant, hairdresser, security guard, childminder, etc.) d My work involves definite physical effort including handling of heavy objects and use of tools (e.g. plumber, electrician, carpenter, cleaner, hospital nurse, gardener, postal delivery workers etc.) e My work involves vigorous physical activity including handling of very heavy objects (e.g. scaffolder, construction worker, refuse collector, etc.) 2. During the last week, how many hours did you spend on each of the following activities? Please answer whether you are in employment or not Please mark one box only on each row None Some but less 1 hour but less 3 or more
Schedule-2-Service-Specification-Lot-1b-Standard-Operating-Procedures-FINAL-V2.docx