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Healthy Habits Post Survey

Total questions: 21

Worksheet time: 18mins

Name
Class
Date
1.

I choose to eat fruit at every meal every day.

a)

All of the time

b)

Most of the time

c)

Sometimes

d)

Never

2.

I choose to eat vegetables at every meal every day.

a)

All of the time

b)

Most of the time

c)

Sometimes

d)

Never

3.

I choose to eat fruit or vegetables instead of a sweet snack.

a)

All of the time

b)

Most of the time

c)

Sometimes

d)

Never

4.

I choose to eat fruit or vegetables as a snack even when others around me are eating a sweet snack.

a)

All of the time

b)

Most of the time

c)

Sometimes

d)

Never

5.

I eat when I feel hungry.

a)

Strongly agree

b)

Agree

c)

Disagree

d)

Strongly disagree

6.

I stop eating when I feel full.

a)

Strongly agree

b)

Agree

c)

Disagree

d)

Strongly disagree

7.

If I really want a certain food, and it is available, I allow myself to have it.

a)

Strongly agree

b)

Agree

c)

Disagree

d)

Strongly disagree

8.

I encourage others to make healthier food choices.

a)

Strongly agree

b)

Agree

c)

Disagree

d)

Strongly disagree

9.

When I'm feeling sad, I eat, even if I do not feel hungry.

a)

Strongly agree

b)

Agree

c)

Disagree

d)

Strongly disagree

10.

I find other ways besides eating to make myself feel better when I am upset.

a)

Strongly agree

b)

Agree

c)

Disagree

d)

Strongly Disagree

11.

I can talk to at least one adult about healthy eating.

a)

Strongly agree

b)

Agree

c)

Disagree

d)

Strongly disagree

12.

I think about how the choices I make now can affect my health in the future.

a)

Not true at all

b)

Not very true

c)

Sort of true

d)

Very true

13.

When I set goals for my health, I think about challenges that might get in my way.

a)

Not true at all

b)

Not very true

c)

Sort of true

d)

Very true

14.

It is easy for me to choose healthy foods in the Club.

a)

Not true at all

b)

Not very true

c)

Sort of true

d)

Very true

15.

It is easy for me to choose healthy foods outside of the Club.

a)

Not true at all

b)

Not very true

c)

Sort of true

d)

Very true

16.

I am confident in my abilities to choose healthy foods.

a)

Not true at all

b)

Not very true

c)

Sort of true

d)

Very true

17.

I enjoyed Healthy Habits

a)

Strongly Agree

b)

Agree

c)

Disagree

d)

Strongly Disagree

18.

Healthy Habits has helped me make healthier eating choices

a)

Strongly Agree

b)

Agree

c)

Disagree

d)

Strongly Disagree

19.

What did you like best about Healthy Habits?

4 lines
20.

What did you like the least about Healthy Habits?

4 lines
21.

What would you change about Healthy Habits?

4 lines