NCES Quick Response Information System

U.S. DEPARTMENT OF EDUCATION FORM APPROVED

NATIONAL CENTER FOR EDUCATION STATISTICS O.M.B. No.: 1850–0733

WASHINGTON, D.C. 20006-5651 EXPIRATION DATE: 09/2006

Foods and Physical Activity in Public Elementary Schools: 2005

FAST RESPONSE SURVEY SYSTEM

This survey is authorized by law (P.L. 103-382). While you are not required to respond, your cooperation is needed to make the results of

this survey comprehensive, accurate, and timely.

Focus of Survey

This survey focuses on two topics: availability of foods, and opportunities for physical activity for students at your school. Please note that in this survey:

• The term “foods” is used broadly to include both foods and beverages.

• Before- and after-school activities refer only to school-sponsored activities.

• Questions 12 through 15 ask for information only for elementary grades above kindergarten (typically grades 1 through 5 or 6), even though your school may have higher or lower grades.

• Physical education refers to class time that is spent teaching a physical education curriculum, excluding regularly scheduled recess and instruction on physical activity topics that are part of health education or any other subject.

Please fill in the following information:

Name of person completing form: Telephone:

Title/position: E-Mail:

Name of School:

Best days and times to reach you (in case of questions):

THANK YOU. PLEASE KEEP A COPY OF THE COMPLETED SURVEY FOR YOUR FILES.

PLEASE RETURN COMPLETED FORM TO: IF YOU HAVE ANY QUESTIONS, CONTACT:

WESTAT Basmat Parsad

Attention: Parsad 8096.03.03 800-937-8281, ext. 8222

1650 Research Boulevard Fax: 800-254-0984

Rockville, Maryland 20850 E-mail: basmatparsad@westat.com

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information is 1850–0733. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collected. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202–4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: National Center for Education Statistics, 1990 K Street, N.W., Washington, D.C. 20006

FRSS Form No. 87, 03/2005

Questions 1 through 11 ask about the availability of food services or foods at your school. Please note:

(a) the term “foods” is used broadly to include both foods and beverages; and

(b) before- and after-school activities refer only to school-sponsored activities.

1. Does your school offer any food service (e.g., school meals, a la carte items, or vending machine foods) in a cafeteria or lunchroom? Please include the service of both foods and beverages in the cafeteria or lunchroom.

Yes 1 (Continued with question 2.)

No 2 (Skip to question 4.)

2. Does your school offer full school meals (i.e., School Breakfast Program or National School Lunch Program) to any students? Include free, reduced-price, and full-price school meals.

Yes 1

No 2

3. Indicate whether students can purchase the following foods separate from full school meals (e.g., as a la carte foods or from vending machines) during mealtimes in the school cafeteria/lunchroom. (Circle one on each line.)

	Yes	No
a. 100% fruit or vegetable juice	1	2
b. Sports drinks or fruit drinks that are not 100% juice	1	2
c. Soft drinks	1	2
d. Bottled water	1	2
e. Low-fat or skim milk	1	2
f. Milk that is not low fat or skim	1	2
g. Yogurt	1	2
h. Ice cream or frozen yogurt	1	2
i. French fried potatoes	1	2
j. Green salad or fruit	1	2
k. Candy	1	2
l. Low-fat salty snacks (e.g., pretzels and baked or other low-fat chips)	1	2
m. Salty snacks that are not low in fat (e.g., regular potato chips and cheese puffs)	1	2
n. Low-fat cookies, cakes, pastries, and other baked goods	1	2
o. Cookies, cakes, pastries, and other baked goods that are not low in fat	1	2

4. When are vending machine foods available to students in the school? Consider foods that are available before, during, or after school (including before- and after-school activities and programs). (Circle all that apply.)

Never 1 (Skip to question 6.)

At mealtimes 2

Other times during the school day 3

Outside of the school day (e.g., school-sponsored before- or after-school activities) 4

Other times (Please specify.) 5

5. Are the following vending machine foods available to students? Consider foods that are available before, during, or after school (including before- and after-school activities and programs). (Circle one on each line.)

	Yes	No
a. 100% fruit or vegetable juice	1	2
b. Sports drinks or fruit drinks that are not 100% juice	1	2
c. Soft drinks	1	2
d. Bottled water	1	2
e. Candy	1	2
f. Low-fat salty snacks (e.g., pretzels and baked or other low-fat chips)	1	2
g. Salty snacks that are not low in fat (e.g., regular potato chips and cheese puffs)	1	2
h. Low-fat cookies, cakes, pastries, and other baked goods	1	2
i. Cookies, cakes, pastries, and other baked goods that are not low in fat	1	2

6. When are school store or snack bar foods available to students in the school? Consider foods that are available before, during, or after school (including before- and after-school activities and programs). (Circle all that apply.)

Never 1 (Skip to question 8.)

At mealtimes 2

Other times during the school day 3

Outside of the school day (e.g., school-sponsored before- or after-school activities) 4

Other times (Please specify.) 5

7. Are the following school store or snack bar foods available to students? Consider foods that are available before, during, or after school (including before- and after-school activities and programs). (Circle one on each line.)

	Yes	No
a. 100% fruit or vegetable juice	1	2
b. Sports drinks or fruit drinks that are not 100% juice	1	2
c. Soft drinks	1	2
d. Bottled water	1	2
e. Candy	1	2
f. Low-fat salty snacks (e.g., pretzels and baked or other low-fat chips)	1	2
g. Salty snacks that are not low in fat (e.g., regular potato chips and cheese puffs)	1	2
h. Low-fat cookies, cakes, pastries, and other baked goods	1	2
i. Cookies, cakes, pastries, and other baked goods that are not low in fat	1	2

8. Do any companies have a contract to sell drinks or snack foods at your school? Consider foods that are available to students before, during, or after school, including before- and after-school activities and programs.

Yes 1 (Continue with question 9.)

No 2 (Skip to question 10.)

Don’t know 3 (Skip to question 10.)

9. Are there agreements with those companies for your school or district to receive the following? (Circle one on each line.)

	Yes	No	Don’t know
a. A specific percentage of the sales receipts	1	2	3
b. Sales incentives such as cash awards or donations of equipment or supplies for a specified amount of sales receipts	1	2	3
c. Other agreement (Please specify.)	1	2	3

10. Consider the foods and beverages that students can buy separately from full school meals (e.g., foods sold a la carte in the cafeteria/lunchroom and foods sold at vending machines, school stores, and snack bars). Are any of these foods sold to generate funds to support food service operations at your school or district? (Circle one.)

Yes 1

No 2

Don’t know 3

Not applicable; no foods or beverages sold separately from full school meals 4

11. Which of the following operates the food service operations at your school? (Circle one.)

Not applicable; no food service operations at this school 1

Your school or school district 2

A private entity under contract to your school or school district 3

Other entity (Please specify.) 4

For questions 12 through 15, please report only for elementary grades above kindergarten (typically grades 1 through 5 or 6), even though your school may have higher or lower grades.

12. Please provide the following information about scheduled recess during a typical week for elementary grades above kindergarten. If your school does not have any of the listed grades or does not consider a particular grade as elementary, leave that row blank. (See definition of elementary grades in box above.)

Grade	How many days per week is recess scheduled? (If none, enter “0.”)	How many times per day is recess scheduled? (If none, enter “0.”)	What is the total number of minutes per day for recess? (If none, enter “0.”)
a. Grade 1
b. Grade 2
c. Grade 3
d. Grade 4
e. Grade 5
f. Grade 6

13. Please provide the following information about scheduled physical education during a typical week for elementary grades above kindergarten. If your school does not have any of the listed grades or does not consider a particular grade as elementary, leave that row blank. (See definition of elementary grades in box above question 12.)

Grade	How many days per week is physical education scheduled? If the schedule is the same every week, enter the number of days. (If none, enter “0” days.) If the schedule varies by week, specify the schedule.			How long (in minutes) is each physical education class? (If none, enter “0.”)
a. Grade 1	Enter number of days _______	OR	Specify schedule if it varies by week __________________________________________	Enter minutes per class _______
b. Grade 2	Enter number of days _______	OR	Specify schedule if it varies by week __________________________________________	Enter minutes per class _______
c. Grade 3	Enter number of days _______	OR	Specify schedule if it varies by week __________________________________________	Enter minutes per class _______
d. Grade 4	Enter number of days _______	OR	Specify schedule if it varies by week __________________________________________	Enter minutes per class _______
e. Grade 5	Enter number of days _______	OR	Specify schedule if it varies by week __________________________________________	Enter minutes per class _______
f. Grade 6	Enter number of days _______	OR	Specify schedule if it varies by week __________________________________________	Enter minutes per class _______

14. Does your school do the following to encourage physical activity among students in elementary grades? (See definition of elementary grades in box above question 12.) (Circle one on each line.)

	Yes	No
a. Use nontraditional physical education activities (e.g., dance or kick-boxing) to make physical education enjoyable	1	2
b. Provide opportunities during the school day for organized physical activities (e.g., walking or running laps at recess), excluding physical education	1	2
c. Offer school-sponsored before- or after-school activities that emphasize physical activity (e.g., walking or running, sports, dance, or group games)	1	2
d. Participate in the President’s Challenge Physical Activity and Fitness Award program	1	2
e. Other activity/program (Please specify.)	1	2

15. How often are height, weight, and body mass index measured for students in elementary grades at your school? If measured, please indicate whether this information is sent to parents. (See definition of elementary grades in box above question 12.)

Height, weight, body mass index	How often measured?				If measured, is information sent to parents?
	Never	In selected grades only	Yearly for all students	Other approach	Yes	No
a. Measure students’ height	1	2	3	4	1	2
b. Measure students’ weight	1	2	3	4	1	2
c. Calculate students’ body mass index	1	2	3	4	1	2

16. What percent of the students in your school are eligible for the federally funded free or reduced-price lunch program? (If none, enter “0.”) _________%

17a. Which of the following grades are taught at your school? (Circle all that apply.)

PK

K

1

2

3

4

5

6

7

8

9

10

11

12

Ungraded

17b. Of the grades taught at your school, which grades are considered elementary? (Circle all that apply.)

PK

K

1

2

3

4

5

6

7

8

9

10

11

12

Ungraded