Form Approved
OMB No: 0920-0445
Expiration Date: 10/31/2002









School Policy and Environment
School Questionnaire


School Policy and Environment
School Questionnaire





                                                            Questions 

General School Environment	1 - 15

Violence Prevention	16 - 38

Harassment Prevention	39 - 40

Tobacco Use Prevention	41 - 73

Alcohol Use Prevention	74 - 83

Illegal Drug Use Prevention	84 - 94

Accident and Injury Prevention	95 - 100

Other Influences on Healthy Lifestyles	101 - 126









Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, Mailstop D-24, Atlanta, GA  30333; Attention PRA (0920-0445).


Special Instructions



This questionnaire will be administered using Computer Assisted Personal Interviewing.  The interviewer will read the questions aloud and type responses to the questions into the laptop computer.  The interview program will 1) display the correct tense of verbs, 2) provide alternate answers to questions (e.g., not applicable, I dont know), 3) navigate complex skip patterns,   4) access information that was provided in previous contact with a school, and 5) perform other useful functions. The programming specifications for the interview are not included in this printed version of the questionnaire.

If you would like more information about this study or would like clarification of any questions in this questionnaire, please call Tim Smith at 1-800-647-9664, extension 6095.







General School Environment



What is your job title at the school? (In which role do you spend more time?)


1) Principal	11)	Guidance Counselor
2)	Asst. Principal/Other School	12)	Social Worker
Administrator	13)	Psychologist
3) School Secretary	14)	Other Mental Health/Social Services
4) Physical Ed Teacher		Provider
5) Athletic Director	15)	Nurse
6)	Health Ed Teacher	16)	Health Aide
7) Other Teacher	17)	Physician
8)	Food Service Manager	18)	Other Health Services Provider
9) Commercial Food Service Provider	19)	SBHC Health Services Staff
10) Other School Food Service Staff	20)	SBHC Mental Health/Social Services Staff
50)	Other Staff


During this interview, I will ask about policies and practices that affect the health, safety and security of the school environment at this school, such as measures taken to reduce violence, and to reduce alcohol and other drug use at school.  When I ask about policies, I mean any mandate issued by the state, the local school board, or any other agency that affects your school environment.  Please consider any policies officially adopted by your school or district, including policies developed by your school, by your (district/diocese), as well as policies built on model federal or state policies.  In addition, I will ask about practices that you might follow to promote the health and well-being of students.  Please keep in mind that I will be asking only about policies and practices, not about standard classroom instruction on these topics.  If I ask about things that do not apply to this school or that your school does not do, please bear with me.


1. How many students are currently enrolled in each grade?	


     Kindergarten	________ Students
     1ST Grade	________ Students
     2ND Grade	________ Students
     3RD Grade	________ Students
     4TH Grade	________ Students
     5TH Grade	________ Students
     6TH Grade	________ Students
     7TH Grade	________ Students
     8TH Grade	________ Students
     9TH Grade	________ Students
     10TH Grade	________ Students
     11TH Grade	________ Students
     12TH Grade	________ Students



SHOW CARD 1


     This card lists several topics related to school health.

    Tobacco use prevention
    Alcohol or other drug use prevention
    Food service or nutrition
    Physical education and physical activity
    Pregnancy prevention
    HIV or other STD prevention
    Violence prevention, such as bullying, fighting, or homicide
    Accident or injury prevention
    The psychological and social environment, or school climate
    Health education
    Health services
    Mental health or social services
    Faculty and staff health promotion
    Family and community involvement in school health programs

2.	Is there one or more groups at this school that develops policies or coordinates activities that address health topics like those listed on the card?  These groups are sometimes called school health councils.

    Yes	1
No	2	==>	Skip to Q 4



3. Does any group address...

     	Yes	No

a. Tobacco use prevention?	1	2
b. Alcohol or other drug use prevention?	1	2
c. Food service or nutrition?	1	2
d. Physical education and physical activity?	1	2

Answer 3e-f only if this school is a middle, junior high, or senior high school.
e. Pregnancy prevention?	1	2
f. HIV or other STD prevention?	1	2
g. Violence prevention, such as bullying, fighting, 
        or homicide?	1	2
h. Accident or injury prevention?	1	2
i. The psychological and social environment, or school 
        climate ?	1	2
j. Health education?	1	2
k. Health services?	1	2
l. Mental health or social services?	1	2
m. Faculty and staff health promotion?	1	2
n. Family and community involvement in school health 
        programs?	1	2


4. Does your school participate in a program in which family or community members serve as role models to students or mentor students, such as the Big Brothers/Big Sisters program?

    Yes	1
    No	2



    My next questions focus on safety and security measures.


5. Must visitors to this school report to the main office or reception area upon arrival?

    Yes	1
    No	2


6. Is this school  a closed campus, meaning that students are not allowed to leave school during the school day, including during lunchtime?

    Yes	1
    No	2


7. During the school day, are staff or adult volunteers assigned to monitor...

     	Yes	No

a. The school halls during and between classes?	1	2
b. The bathrooms?	1	2
c. School grounds?	1	2

Answer 7d only if this is an elementary school.
d. Playgrounds, while they are in use?	1	2


8. Does this school routinely conduct bag, desk, or locker checks?

    Yes	1
    No	2


9. Are students prohibited from carrying backpacks or book bags at school?

    Yes	1
    No	2	



10. Are students at this school required to wear school uniforms?

    Yes 	1	==>	Skip to Q 12
    No	2


11. Is there a dress code at your school?

    Yes	1
    No	2


12. Are students at your school required to wear identification badges?

    Yes	1
    No	2


13. During the school day, does your school use...

     	Yes	No

a. Surveillance cameras?	1	2
b. Metal detectors?	1	2
c. Communication devices such as cell-phones, 2-way 
        radios, walkie-talkies, or intercoms?	1	2


14. Im going to ask about different types of security staff that this school might use.  During the regular school day, does your school use...

Yes	No

a. Uniformed police?	1	2
b. Undercover police?	1	2
c. Security guards?	1	2



If this school uses security staff (any of 14a-c are Yes), continue with Q 15.  Otherwise, skip to Q 16.


15. Are any of the security staff at your school armed?

Yes		1
No		2



Violence Prevention



16. Has this school adopted a policy prohibiting physical fighting by students?

    Yes	1
No		2	==>	Skip to Q 18


17. Does that policy include guidelines on what actions the school should take when students are caught fighting?

    Yes	1
    No	2


18. During the 1998-99 school year, about how many times were students caught fighting?

_____	Times


SHOW CARD 2


19. Which of the things listed on this card help determine what actions the school takes when students are caught fighting?
    MARK ALL THAT APPLY.

    Zero-tolerance	1
    Effect or severity of the violation	2
    Grade level of student	3
    Victim versus perpetrator status	4
    Repeat offender status	5
None		6



SHOW CARD 3


20. When students are caught fighting, how often are they...
        				Almost
        			Some-	Always or
        	Never	Rarely	times	Always

a. Referred to a school counselor?	1	2	3	4
b. Referred to a school administrator?	1	2	3	4
c. Encouraged, but not required, to participate 
        in an assistance program?	1	2	3	4
d. Required to participate in an assistance
        program?	1	2	3	4
e. Referred to legal authorities?	1	2	3	4
f. Placed in detention?	1	2	3	4
g. Given in-school suspension?	1	2	3	4
h. Suspended from school?	1	2	3	4
i. Expelled from school?	1	2	3	4
j. Reassigned to an alternative school	1	2	3	4


21. When students are caught fighting, how often are parents or guardians notified?

    Never	1
    Rarely	2
    Sometimes	3
    Almost always or always	4


22. When students are caught fighting, how often is third-party mediation used?

    Never	1
    Rarely	2
    Sometimes	3
    Almost always or always	4


23. Has this school adopted a policy prohibiting weapon possession or use by students?

    Yes	1
No	2	==>	Skip to Q 27

24. Does that policy specifically prohibit the possession or use of...

     	Yes	No	

a. Mace or pepper spray?	1	2
b. Knives, either pocket knives or other kinds?	1	2
c. Hand guns?	1	2
d. Other firearms, such as rifles and shotguns?	1	2
e. Ammunition?	1	2
f. Other things that look like weapons, such as toy guns or
        plastic knives?	1	2


25. Does that policy specifically prohibit weapon possession or use at offcampus, schoolsponsored events?

     Yes	1
     No	2


26. Does that policy include guidelines on what actions the school should take when students are caught possessing a weapon?

     Yes	1
     No	2


27. During the 1998-99 school year, about how many times were students caught...

     	Times

a.	Using a handgun or other fire arm?	________
b.	Using any other weapon?	________
c.	Possessing any weapon?	________






SHOW CARD 4


28. Which of the things listed on this card help determine what actions the school takes when students are caught possessing a weapon?
     MARK ALL THAT APPLY.

     Zero-tolerance	1
     Effect or severity of the violation	2
     Grade level of student	3
     Repeat offender status	4
     Type of weapon	5
     None	6


SHOW CARD 5


29. When students are caught possessing a weapon, how often are they...

        				Almost
        			Some-	Always or
        	Never	Rarely	Times	Always

a. Referred to a school counselor?	1	2	3	4
b. Referred to a school administrator?	1	2	3	4
c. Encouraged, but not required, to participate 
        in an assistance program? 	1	2	3	4
d. Required to participate in an assistance
        program?	1	2	3	4
e. Referred to legal authorities?	1	2	3	4
f. Placed in detention?	1	2	3	4
g. Given in-school suspension?	1	2	3	4
h. Suspended from school?	1	2	3	4
i. Expelled from school?	1	2	3	4
j. Reassigned to an alternative school?	1	2	3	4


30. When students are caught possessing a weapon, how often are parents or guardians notified?

    Never	1
    Rarely	2
    Sometimes	3
    Almost always or always	4


31. Has this school adopted a policy prohibiting gang activities?

    Yes	1
No	2	==>	Skip to Q 34


32. Are students at your school prohibited from wearing gang colors or gang attire?

    Yes	1
    No	2


33. During the 1998-99 school year, about how many times were students caught violating any rule on gang activities?

    _____	Times


Now, Id like to ask about procedures that your school might use to involve students, families, and other community members in your violence prevention efforts.


34. During the past 2 years, have...

        	Yes	No

a. Students helped develop, communicate, or implement 
        violence prevention policies or activities?	1	2
b. Parents or guardians helped develop, communicate, or 
        implement violence prevention policies or activities?	1	2
c. Community members helped develop, communicate, or 
        implement violence prevention policies or activities?	1	2
        
35. Does your school have procedures to inform all students...

        	Yes	No

a. About violence-related rules?	1	2
b. About what happens if they break the rules?	1	2


36. Does your school have procedures to inform the parents or guardians of all students...

        	Yes	No

a. About violence-related rules?	1	2
b. About what happens if students break the rules?	1	2


36y.	Does your school have a written plan for responding to violence at the school?

    Yes	1	
    No	2	==>	Skip to Q 37


36z.	Did...

        	Yes	No

a.	Students help develop the plan?	1	2
b. Parents help develop the plan?	1	2
c. Community members help develop the plan?	1	2


37. Does your school post signs marking a weapons-free school zone, that is, a specified distance from school grounds where weapons are not allowed?

    Yes	1
No	2	



38. Does your school have or participate in...

     	Yes	No

a. A peer mediation program?	1	2
b. A safe-passages to school program?	1	2
c. A program to prevent gang violence?	1	2

Answered if this school is an elementary, middle, or junior high school.
d. A program to prevent bullying?	1	2




Harassment Prevention



The next questions ask about policies on harassment of students.  By harassment, I mean persistent threats or attacks based on gender, race, or any other personal characteristic.


39. Has this school adopted a policy prohibiting harassment of students by other students?

    Yes	1
    No	2	==>	Skip to Q 41


40. Does that policy specifically prohibit harassment based on...

     	Yes	No

a. Gender?	1	2
b. Race or ethnicity?	1	2
c. Religion?	1	2
d. Sexual orientation?	1	2
e. Physical or cognitive disability?	1	2





Tobacco Use Prevention



41. Has this school adopted a policy prohibiting cigarette smoking by students?

    Yes	1
No	2	==>	Skip to Q 44


42. Does that policy specifically prohibit cigarette smoking by students...

     	Yes	No

a. In school buildings?	1	2
b. Outside, on school grounds?	1	2
c. In school buses or other vehicles used to transport 
        students?	1	2
d. At offcampus, schoolsponsored events?	1	2


43. Does that policy include guidelines on what actions the school should take when students are caught smoking cigarettes?

    Yes	1
    No	2


44. During the 1998-99 school year, about how many times were students caught smoking cigarettes?

    _______	Times



 


SHOW CARD 6


45. Which of the things listed on this card help determine what actions the school takes when students are caught smoking cigarettes?
    MARK ALL THAT APPLY.

    Zero-tolerance	1
    Effect or severity of the violation	2
    Grade level of student	3
    Repeat offender status	4
    None	5


SHOW CARD 7


46. When students are caught smoking cigarettes, how often are they...

        				Almost
        			Some-	Always or
        	Never	Rarely	Times	Always

a. Referred to a school counselor?	1	2	3	4
b. Referred to a school administrator?	1	2	3	4
c. Encouraged, but not required, to participate in an
        assistance, education, or cessation program?	1	2	3	4
d. Required to participate in an assistance, 
        education, or cessation program?	1	2	3	4
e. Referred to legal authorities?	1	2	3	4
f. Placed in detention?	1	2	3	4
g. Given in-school suspension?	1	2	3	4
h. Suspended from school?	1	2	3	4
i. Expelled from school?	1	2	3	4
j. Reassigned to an alternative school?	1	2	3	4



SHOW CARD 7


47. When students are caught smoking cigarettes, how often are parents or guardians notified?

    Never	1
    Rarely	2
    Sometimes	3
    Almost always or always	4


48. Has this school adopted a policy prohibiting cigar or pipe smoking by students?

    Yes	1
    No	2


49. Has this school adopted a policy prohibiting smokeless tobacco use by students?

    Yes	1
No	2	==>	Skip to Q 52


50. Does that policy specifically prohibit smokeless tobacco use by students...

     	Yes	No

a. In school buildings?	1	2
b. Outside, on school grounds?	1	2
c. In school buses or other vehicles used to transport 
        students?	1	2
d. At offcampus, schoolsponsored events?	1	2


51. Does that policy include guidelines on what actions the school should take when students are caught using smokeless tobacco?

    Yes	1
    No	2



52. During the 1998-99 school year, about how many times were students caught using smokeless tobacco?

    _______	Times


SHOW CARD 8


53. Which of the things listed on this card help determine what actions the school takes when students are caught using smokeless tobacco?
    MARK ALL THAT APPLY.

    Zero-tolerance	1
    Effect or severity of the violation	2
    Grade level of student	3
    Repeat offender status	4
    None	5


SHOW CARD 9


54. When students are caught using smokeless tobacco, how often are they...

        				Almost
        			Some-	Always or
        	Never	Rarely	Times	Always

a. Referred to a school counselor?	1	2	3	4
b. Referred to a school administrator?	1	2	3	4
c. Encouraged, but not required, to participate in
        an assistance, education, or cessation program?	1	2	3	4
d. Required to participate in an assistance, 
        education, or cessation program?	1	2	3	4
e. Referred to legal authorities?	1	2	3	4
f. Placed in detention?	1	2	3	4
g. Given in-school suspension?	1	2	3	4
h. Suspended from school?	1	2	3	4
i. Expelled from school?	1	2	3	4
j. Reassigned to an alternative school?	1	2	3	4
a. 
55. When students are caught using smokeless tobacco, how often are parents or guardians notified?

    Never	1
    Rarely	2
    Sometimes	3
    Almost always or always	4


56. Is tobacco advertising prohibited...

        	Yes 	No

a. In the school building?	1	2
b. On school grounds, including on the outside of the 
        school building, on playing fields, or other areas of
        the campus?	1	2
c. On school buses?	1	2
d. In school publications?	1	2
e. Through sponsorship of school events?	1	2


57. Are students at your school prohibited from wearing tobacco brand-name apparel or carrying merchandise with tobacco company names, logos, or cartoon characters on it?

    Yes	1
    No	2



Now, Id like to ask about procedures that your school might use to involve students, families, and other community members in your tobacco use prevention efforts.


58. During the past 2 years, have...

        	Yes	No

a. Students helped develop, communicate, or implement 
        tobacco use prevention policies or activities?	1	2
b. Parents or guardians helped develop, communicate, or 
        implement tobacco use prevention policies or activities?	1	2
c. Community members?	1	2


59. Does your school have procedures to inform all students...

        	Yes	No

a. About rules related to tobacco use by students?	1	2
b. About what happens if they break the rules?	1	2


60. Does your school have procedures to inform the parents or guardians of all students...

        	Yes	No

a. About rules related to tobacco use by students?	1	2
b. About what happens if students break the rules?	1	2


61. Does your school post signs marking a tobacco-free school zone, that is, a specified distance from school grounds where tobacco use by students is not allowed?

    Yes	1
    No		2



Answer Q 62 if this school is a middle, junior high, or senior high school.


62. Does your school have or participate in a youth empowerment or advocacy program related to tobacco use prevention?

    Yes	1
    No	2


    These next questions are about tobacco use by faculty and staff.


63. Has this school adopted a policy prohibiting cigarette smoking by faculty and staff during any school-related activity?

    Yes	1
No	2	==>	Skip to Q 65


64. Does that policy specifically prohibit cigarette smoking by faculty and staff...

     	Yes	No

a. In school buildings? 	1	2
b. Outside, on school grounds? 	1	2
c. In school buses or other vehicles used to transport 
        students?	1	2
d. At offcampus, schoolsponsored events?	1	2


65. Has this school adopted a policy prohibiting cigar or pipe smoking by faculty and staff during any school-related activity?

    Yes	1
No	2	



66. Has this school adopted a policy prohibiting smokeless tobacco use by faculty and staff during any school-related activity?

    Yes	1
No	2	==>	Skip to the introduction to Q 68


67. Does that policy specifically prohibit smokeless tobacco use by faculty and staff...

     	Yes	No

a. In school buildings? 	1	2
b. Outside, on school grounds? 	1	2
c. In school buses or other vehicles used to transport 
        students?	1	2
d. At offcampus, schoolsponsored events ?	1	2


    These next questions are about tobacco use by visitors to the school.


68. Has this school adopted a policy prohibiting cigarette smoking by school visitors?

    Yes	1
No	2	==>	Skip to Q 70


69. Does that policy specifically prohibit cigarette smoking by visitors...

     	Yes	No

a. In school buildings? 	1	2
b. Outside, on school grounds? 	1	2
c. In school buses or other vehicles used to transport 
        students?	1	2
d. At offcampus, schoolsponsored events? 	1	2



70. Has this school adopted a policy prohibiting cigar or pipe smoking by school visitors?

    Yes	1
No	2	


71. Has this school adopted a policy prohibiting smokeless tobacco use by school visitors?

    Yes	1
No	2	==>	Skip to Q 73


72. Does that policy specifically prohibit smokeless tobacco use by visitors...

     	Yes	No

a. In school buildings? 	1	2
b. Outside, on school grounds? 	1	2
c. In school buses or other vehicles used to transport 
        students?	1	2
d. At offcampus, schoolsponsored events? 	1	2


If this school has adopted any policies prohibiting tobacco use by visitors (Q 68, 70 or 71 is Yes), answer Q 73.


73. Does your school have procedures to inform visitors...

        	Yes	No

a. About rules related to tobacco use by visitors?	1	2
b. About what happens if they break the rules?	1	2


Alcohol Use Prevention



74. Has this school adopted a policy prohibiting alcohol use by students?

    Yes	1
No	2	==>	Skip to Q 76


75. Does that policy include guidelines on what actions the school should take when students are caught drinking alcohol?

    Yes	1
    No	2


76. During the 1998-99 school year, about how many times were students caught drinking alcohol?

    _______	Times


SHOW CARD 10


77. Which of the things listed on this card help determine what actions the school takes when students are caught drinking alcohol?
    MARK ALL THAT APPLY.

    Zero-tolerance	1
    Effect or severity of the violation	2
    Grade level of student	3
    Repeat offender status	4
    None	5



SHOW CARD 11


78. When students are caught drinking alcohol, how often are they...

        				Almost
        			Some-	Always or
        	Never	Rarely	Times	Always

a. Referred to a school counselor?	1	2	3	4
b. Referred to a school administrator?	1	2	3	4
c. Encouraged, but not required, to participate 
        in an assistance program?	1	2	3	4
d. Required to participate in an assistance 
        program?	1	2	3	4
e. Referred to legal authorities?	1	2	3	4
f. Placed in detention?	1	2	3	4
g. Given in-school suspension?	1	2	3	4
h. Suspended from school?	1	2	3	4
i. Expelled from school?	1	2	3	4
j. Reassigned to an alternative school?	1	2	3	4


79. When students are caught drinking alcohol, how often are parents or guardians notified?

    Never	1
    Rarely	2
    Sometimes	3
    Almost always or always	4



Now, Id like to ask about procedures that your school might use to involve students, families, and other community members in your alcohol use prevention efforts.


80. During the past 2 years, have...

        	Yes	No

a. Students helped develop, communicate, or implement 
        alcohol use prevention policies or activities?	1	2
b. Parents or guardians helped develop, communicate, or 
        implement alcohol use prevention policies or activities?	1	2
c. Community members?	1	2


81. Does your school have procedures to inform all students...

        	Yes	No

a. About rules related to alcohol use by students?	1	2
b. About what happens if they break the rules?	1	2


82. Does your school have procedures to inform the parents or guardians of all students...

        	Yes	No

a. About rules related to alcohol use by students?	1	2
b. About what happens if students break the rules?	1	2


83. Does your school have or participate in a community-based alcohol use prevention program, such as Students Against Drunk Driving or Students Against Destructive Decisions?

    Yes	1
    No	2


Illegal Drug Use Prevention



    The next questions ask about policies on illegal drug use. 


84. Has this school adopted a policy prohibiting illegal drug possession or use by students?

    Yes	1
No	2	==>	Skip to Q 86


85. Does that policy include guidelines on what actions the school should take when students are caught possessing or using illegal drugs?

    Yes	1
    No	2


86. During the 1998-99 school year, about how many times were students caught possessing or using illegal drugs?

    ______	Times


SHOW CARD 12


87. Which of the things listed on this card help determine what actions the school takes when students are caught possessing or using illegal drugs?
    MARK ALL THAT APPLY.

    Zero-tolerance	1
    Effect or severity of the violation	2
    Grade level of student	3
    Repeat offender status	4
    Type of drug	5
    None	6


SHOW CARD 13


88. When students are caught possessing or using illegal drugs, how often are they...

           				Almost
           			Some-	Always or
           	Never	Rarely	Times	Always

a. Referred to a school counselor?	1	2	3	4
b. Referred to a school administrator?	1	2	3	4
c. Encouraged, but not required, to participate
        in an assistance program?	1	2	3	4
d. Required to participate in an assistance
        program?	1	2	3	4
e. Referred to legal authorities?	1	2	3	4
f. Given detention?	1	2	3	4
g. Given in-school suspension?	1	2	3	4
h. Suspended from school?	1	2	3	4
i. Expelled from school?	1	2	3	4
j. Reassigned to an alternative school?	1	2	3	4


89. When students are caught possessing or using illegal drugs, how often are parents or guardians notified?

    Never	1
    Rarely	2
    Sometimes	3
    Almost always or always	4



Now, Id like to ask about procedures that your school might use to involve or inform students, families, and other community members in your illegal drug use prevention efforts.


90. During the past 2 years, have...

        	Yes	No

a. Students helped develop, communicate, or implement
        illegal drug use prevention policies or activities?	1	2
b. Parents or guardians helped develop, communicate, or 
        implement illegal drug use prevention policies or 
        activities?	1	2
c. Community members?	1	2


91. Does your school have procedures to inform all students...

        	Yes	No

a. About rules related to illegal drug use by students?	1	2
b. About what happens if they break the rules?	1	2


92. Does your school have procedures to inform the parents or guardians of all students...

        	Yes	No

a. About rules related to illegal drug use by students?	1	2
b. About what happens if students break the rules?	1	2


93. Does your school post signs marking a drug-free school zone, that is, a specified distance from school grounds where illegal drugs are not allowed?

    Yes	1
    No	2



94. Does your school have or participate in a community-based illegal drug use prevention program?

    Yes	1
    No	2


Accident and Injury Prevention



Now, please think about accident  and injury prevention procedures related to sports or playground activities, school lab or workshop activities, the use of school vehicles, and fire safety.


95. During the past 12 months, have...

        	Yes	No

a. School buses or other vehicles used to transport students
        been inspected and provided with appropriate
        maintenance?	1	2

Answer b if this school is an elementary, a middle, or a junior high school.
b. Playground facilities and equipment, such as playing 
        surfaces, benches, monkey bars, and swings been 
        inspected and provided with appropriate maintenance?	1	2
c. Indoor athletic facilities and equipment, such as playing 
        surfaces, benches, tumbling mats, and weight lifting 
        equipment been inspected and provided with 
        appropriate maintenance?	1	2
d. Outdoor athletic facilities and equipment, such as 
        playing fields and bleachers?	1	2
e. Environmental hazards such as asbestos, pesticides, or
        chemicals in labs or workshops?	1	2
f. School kitchen facilities and equipment?	1	2
g. Special classroom areas, such as chemistry labs, 
        workshops, and art rooms?	1	2
h. Other areas of the school, such as halls, stairs, and 
        regular classrooms?	1	2
i. Smoke detectors?	1	2
j. Fire extinguishers?	1	2
k. Lighting inside school buildings?	1	2
l. Lighting outside school buildings?	1	2


96. Must students wear appropriate protective gear when engaged in...

        	Yes	No

a. Classes such as wood shop or metal shop?	1	2
b. Lab activities for photography, chemistry, biology,
        or other science classes?	1	2


Answer Q 97 if this school is an elementary school.


97. Does your school use the safety checklist and equipment guidelines published in the Handbook for Public Playground Safety by the U.S. Consumer Product Safety Commission?

    Yes	1
    No	2


98. During the past 2 years, have...

        	Yes	No

a. Students helped develop, communicate, or implement 
        accident and injury prevention policies or activities?	1	2
b. Parents or guardians helped develop, communicate, or 
        implement accident and injury prevention policies 
        or activities?	1	2
c. Community members?	1	2


99. Does your school have procedures to inform all students about rules related to school safety and injury prevention?

    Yes	1
    No	2



100. Does your school have procedures to inform the parents or guardians of all students about rules related to school safety and injury prevention?

    Yes	1
    No	2




Other Influences on Healthy Lifestyles



SHPPS 2000 is designed to gather information on many aspects of students experiences while at school, including experiences that might affect the development of healthy lifestyles.  

If this is an elementary school, please continue.  Otherwise, skip to Q 106.


I would like to ask about times when students participate in regularly scheduled recess at this school.  Please do not include activities that students engage in during physical education class.


101. In what grade or grades do students participate in regularly scheduled recess during the school day?
     MARK ALL THAT APPLY.

     Kindergarten	0
     1ST Grade	1
     2ND Grade	2
     3RD Grade	3
     4TH Grade	4
     5TH Grade	5
     6TH Grade	6
     7TH Grade	7
     8TH Grade	8
     9TH Grade	9
     10TH Grade	10
     11TH Grade	11
     12TH Grade	12
None	13	==>	Skip to Q 106


102. On average, how many days per week are the students scheduled to have recess?

_______	Days/Week


103. On average, how many minutes each day do students spend in recess?

_______	Minutes


104. About how many classes have regularly scheduled recess immediately before lunch?

a. None,	1
b. Less than half,	2
c. Half,		3
d. More than half, or	4
e. All?		5


105. About how many classes have regularly scheduled recess immediately after lunch?

a. None,	1
b. Less than half,	2
c. Half,		3
d. More than half, or	4
e. All?		5


     The next questions ask about influences on students dietary behavior while at school.


106. Are faculty and staff at this school prohibited from using food or food coupons as a reward for good behavior or good academic performance?

Yes	1	==>	Skip to Q 108
No		2	


107. Are faculty and staff at your school discouraged, for example through memoranda or in meetings, from using food or food coupons as a reward for good behavior or good academic performance?

     Yes	1
     No	2



SHOW CARD 14


Next, Ill ask about policies your school might have adopted on foods offered at times such as those listed on this card.  Do not include foods offered in the cafeteria, vending machines, or school store.


     At student parties
     In after-school or extended day programs
     At staff meetings
     At meetings attended by students families
     At concession stands


108. Has this school adopted a policy stating that fruits or vegetables will be offered at these times?

     Yes	1
     No	2


109. Junk foods are foods which provide calories primarily through fats or added sugars and have minimal amounts of vitamins and minerals. Has your school adopted a policy prohibiting junk foods from being offered at these times?

     Yes	1
     No		2


110. Can students purchase food or beverages from...

     	Yes	No

a. One or more vending machines at the school?	1	2
b. A school store, canteen, or snack bar?	1	2



111.	Can students purchase...

        	Yes	No

     a.	Chocolate candy?	1	2
b. Other kinds of candy?	1	2
c. Cookies, crackers, cakes, pastries, or other baked 
        goods that are not low in fat?	1	2
d. Salty snacks that are not low in fat, such as regular
        potato chips?	1	2
e. Ice cream or frozen yogurt that is not low in fat?	1	2
f. 2% or whole milk?	1	2


112. Can students purchase these items...

     	Yes	No

a. Before classes begin in the morning?	1	2
b. During any school hours when meals are not being 
        served?	1	2
c. During school lunch periods?	1	2


113. Can students purchase...

        	Yes	No

a. Fruits or vegetables, not juice?	1	2
b. Low-fat cookies, crackers, cakes, pastries, or other 
low-fat baked goods?	1	2
c. Salty snacks that are low in fat, such as pretzels,
        baked chips, or other low-fat chips?	1	2
d. Bread sticks, rolls, bagels, pita bread, or other bread 
        products?	1	2
e. Low-fat or fat-free ice cream, frozen yogurt, or sherbet?	1	2
f. Low-fat or non-fat yogurt?	1	2
g. 1% or skim milk?	1	2
h. Bottled water?	1	2
i. 100% fruit juice?	1	2
j. 100% vegetable juice?	1	2
a. 
114. Can students purchase these items...

     	Yes	No

a. Before classes begin in the morning?	1	2
b. During any school hours when meals are not being 
        served?	1	2
c. During school lunch periods?	1	2


115. Can students purchase soft drinks, sports drinks, or fruit drinks that are not 100% juice in vending machines?

     Yes	1
No	2	==>	Skip to Q 119


116. Can students purchase these items...

     	Yes	No

a. Before classes begin in the morning?	1	2
b. During any school hours when meals are not being 
        served?	1	2
c. During school lunch periods	1	2


117. During the past 12 months, have any organizations at this school, such as student clubs, sports teams, or the PTA sold food at school or in the community to raise money?  

     Yes	1
No	2	==>	Skip to Q 122



118. During the past 12 months, have any of the following items been sold as part of fund-raising for any school organization? Has...

        	Yes	No

a. Chocolate candy been sold as part of fund-raising for 
        any school organization?	1	2
b. Other candy?	1	2
c. Soft drinks, sports drinks, or fruit drinks that are not
        100% juice?	1	2
d. Cookies, crackers, cakes, pastries, or other baked goods
        that are not low in fat?	1	2


119. Could students purchase these items...

     	Yes	No

a. Before school classes began in the morning?	1	2
b. During any school hours when meals were not being 
        served?	1	2
c. During school lunch periods?	1	2


120. During the past 12 months, have any of the following items been sold as part of fund-raising for any school organization? Have...

        	Yes	No

a. Fruits or vegetables been sold as part of fund-raising
        for any school organization?	1	2
b. 100% fruit juice or vegetable juice?	1	2
c. Low-fat cookies, crackers, cakes, pastries, or other 
        low-fat baked goods?	1	2



121. Could students purchase these items...

     	Yes	No

a. Before classes began in the morning?	1	2
b. During any school hours when meals were not being 
        served?	1	2
c. During school lunch periods	1	2


122. Does this school have a contract with a soft drink bottler, such as Coca-Cola, Pepsi-Cola, or Dr. Pepper, giving the company exclusive rights to sell soft drinks at your school?

     Yes	1
No		2	==>	Skip to Q 126


123. Does your school receive a specified percentage of the soft drink sales receipts?

     Yes	1
     No		2


124. Does your school receive incentives, such as cash awards or donations of equipment, supplies, or other donations, once receipts total a specified amount?

     Yes	1
     No		2


125. Is the soft drink bottler allowed to advertise...

        	Yes	No

a. In the school building?	1	2
b. On school grounds, including on the outside of the 
        school building, on playing fields, or other areas of
        the campus?	1	2
c. On school buses?	1	2



126. At this school, is student consumption of candy, meals from fast food restaurants, or soft drinks promoted...

        	Yes	No

a. With posters or other materials on display in the school?	1	2
b. With advertisements on textbook covers?	1	2
c. With advertisements on school food service menus?	1	2
d. With lesson plans or curricula sponsored by  corporations
        that make or sell these products?	1	2
e. With coupons for free or reduced prices on these 
        products?	1	2
f. In a school newsletter, newspaper, or other publication?	1	2
g. Through sponsorship of school events?	1	2


127. My supervisor may wish to call you to ask about how I conducted this interview.  Would you please tell me a telephone number where we might reach you starting with the area code?


     (      )            -

     1) Daytime or
     2) Evening/Weekend



     Thank you very much for taking the time to complete this interview.



School Policy and Environment School Questionnaire- Final Version    Revised: 10/26/99




11
School Policy and Environment School Questionnaire- Final Version    Revised: 10/26/99

General School Environment



	General School Environment





	Violence Prevention




23
School Policy and Environment School Questionnaire- Final Version    Revised: 10/26/99

Violence Prevention







Tobacco Use Prevention




42
School Policy and Environment School Questionnaire- Final Version    Revised: 10/26/99



Alcohol Use Prevention





Illegal Drug Use Prevention





Accident and Injury Prevention





Other Influences on Healthy Lifestyles



Other Influences on Healthy Lifestyles