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Self Care - Poll

Total questions: 20

Worksheet time: 16mins

Name
Class
Date
1.

I know what foods to eat to maintain a healthy weight.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

2.

I know the difference between foods that are nutritious and those that are not.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

3.

I know the steps to treat a simple cut on my hand.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

4.

I know how to make my own medical and dental appointments.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

5.

I know my family medical history.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

6.

I know how to get health insurance.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

7.

If my family is not around, I have at least one trusted adult who would visit me if I were in the hospital.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

8.

I bathe (wash up) daily.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

9.

I know to exercise on a regular basis.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

10.

I know the difference between weight training and cardiovascular exercise.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

11.

I brush my teeth daily

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

12.

I know how to get myself away from harmful situations.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

13.

I know what the average body temperature is.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

14.

I know the name of my dentist.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

15.

I know why flossing is important?

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

16.

I know the name of my doctor.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

17.

I know how to measure medicine in a liquid form.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

18.

I know how to improve my sleep.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

19.

I know what my blood pressure numbers mean?

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time

20.

I know how to relax.

a)

Not at all

b)

Very little

c)

About half and half

d)

Most of the time

e)

All the time