During the past 7 days, how many days were you physically active for 0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days at least 1 hour? 1 2 3 4 5 During the past 7 days, how often were you so 4 or more 1 time last 2 times 3 times last active that your heart beat fast and you breathed Never times last week last week week hard most of the time? week 1 2 3 4 5 How many hours a day do you spend watching TV 1 hour or 5 or more or movies, playing electronic games or using a 2 hours 3 hours 4 hours less hours computer for something that is not school work? 1 2 3 4 5 How often do you wash your hands before Once in a Most of preparing something to eat? Think about Never Sometimes Always while the time preparing snacks or meals. How often do you wash vegetables and fruits Once in a Most of Never Sometimes Always before eating them? while the time When you take foods out of the refrigerator, how Once in a Most of Never Sometimes Always often do you put them back within 2 hours? while the time How often do you check the expiration date Once in a Most of Never Sometimes Always before eating or drinking foods? while the time 0 1 2 3 4 5 In the last month, if your family did not have Does not 4 or enough food, how often did you help by going to a apply Never 1 time 2 times 3 times more food pantry or finding other free or low-cost food times resources?
During the past 7 days, how many days were you physically active for at least 1 hour? 0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days 1 2 3 4 5 During the past 7 days, how often were you so active that your heart beat fast and you breathed hard most of the time? Never 1 time last week 2 times last week 3 times last week 4 or more times last week 1 2 3 4 5 How many hours a day do you spend watching TV or movies, playing electronic games or using a computer for something that is not school work? 1 hour or less 2 hours 3 hours 4 hours 5 or more hours 1 2 3 4 5 How often do you wash your hands before preparing something to eat? Think about preparing snacks or meals. Never Once in a while Sometimes Most of the time Always How often do you wash vegetables and fruits before eating them? Never Once in a while Sometimes Most of the time Always When you take foods out of the refrigerator, how often do you put them back within 2 hours? Never Once in a while Sometimes Most of the time Always How often do you check the expiration date before eating or drinking foods? Never Once in a while Sometimes Most of the time Always 0 1 2 3 4 5 In the last month, if your family did not have enough food, how often did you help by going to a food pantry or finding other free or low-cost food resources? Does not apply Never 1 time 2 times 3 times 4 or more times
9th-12th%20Scoring%20Rubric%20and%20Data%20Entry%20Instructions%20-%2009%2023%202014.docx