BuSO Don Bosco, Lenniksesteenweg 2, 1500 Halle
(Belgium)
Tel.:
00-32-(0)2 363 09 86
Email: donboscobuso@dbhbuso.telenet.be
Website: http://dbhbuso.telenet.be
Co-ordinators
in the school: Ellen De Ryst, Leen Bultι, Vera Sermon
Director
school: Jos Walravens
Name of the student
(optional):
Age (birthday):
Weight:
Gender: male/female
01. Questions about your breakfast
01.01. Do you eat breakfast? Is there a difference between schooltime and
vacation time for eating breakfast?
(Put a cross in the right column)
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Schooltime |
Vacation and Sunday |
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Yes |
No |
Yes |
No |
Each morning
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Mostly
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Never
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01.02. At what time do you eat breakfast?
(Put a cross in the right column or give the correct
time)
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Schooltime |
Vacation and Sunday |
Between 6.00 a.m.
and 7.00 a.m. (morning)
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Between 7.00 a.m.
and 8.00 a.m. (morning)
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Other time ΰ
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01.03. For those who eat breakfast during schooltime Where do you eat your
breakfast ?
(Put a cross in the right column. More answers are possible.)
At home
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On the road to
school on foot
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On the road to
school in the car
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On the road to
school on the bus
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On the road to
school on the train
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On the road to
school on the bycicle
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On the playground
just before schooltime
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I dont eat
breakfast
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01.04. What do you eat mostly as breakfast?
(Put a cross in the right column. More answers are possible.)
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Schooltime |
Vacation and Sunday |
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Bread
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Spice cake ?
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Grains / whole wheat bread
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Yoghurt
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Cheese
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Fruit
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Marmelade
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Chocolate paste
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Meat
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Candybars
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Chocolate bars
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Chips
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Cakes
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Others ΰ
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01.05. What do you drink as breakfast?
(Put a cross in the right column. More answers are possible.)
Hot drinks
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Cold drinks
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(Put a cross in the right column. More answers are possible.)
Milk
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Chocolate
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Coffee
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Soft drinks (cola,
)
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Water
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Tea
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Other drinks ΰ
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02. Questions about your eating
habits in schooltime between breakfast & noon
02.01. Do you eat something between breakfast & noon?
(Put a cross in the right column)
Yes
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No |
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02.02. Where do you eat between breakfast & noon?
(Put a cross in the right column. More answers are possible.)
During the lessons
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Between the lessons
still in the classroom
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Between the
lessons but on the playground or the school cafeteria
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Others ΰ
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02.03. What do you eat at that moment?
Bread
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Spice cake ?
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Grains
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Yoghurt
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Cheese
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Candybars
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Chocolate bars
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Chips
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Cakes
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Fruit (apple,
orange,
)
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Others ΰ
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03. Questions about your eating
habits at noon
03.01. Do you eat lunch or dinner at noon?
(Put a cross in the right column.)
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Schooltime |
Vacation and Sunday |
Lunch
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Dinner
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03.02. Where do you eat mostly lunch or dinner at schooltime? Irrelevant for us, as all the students eat lunch in school
(Put a cross in the right column. More answers are possible.)
At school
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At home
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By family who live
nearer by the school than your home
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By friends
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Snackbar in the
city
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Others ΰ
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03.03. At what time do you eat at noon?
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Schooltime |
Vacation and Sunday |
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Between 12.00 and
12.30 H
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Between 12.30 and
13.00 H
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Between 13.00 and
13.30 H
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Others ΰ
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03.04. What do you eat for lunch or dinner? Irrelevant
for the school periods
(Put a cross in the right column. More answers are possible.)
Soupe
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Meat
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Vegetables
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Potatoes
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Paste
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Pizza
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Bread
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Spice cake
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Grains
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Yoghurt
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Cheese
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Candybars
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Chocolate bars
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Chips
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Cakes
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Fruit (apple,
orange,
)
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Others ΰ
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04. Questions about your eating
habits from noon till evening
04.01. Do you eat mostly something between noon till evening meal?
(Put a cross in the right column.)
Yes
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No |
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04.02. If your answer is Yes. What do
you eat than?
(Put a cross in the right column. More answers are possible.)
Pizza
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Bread
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Candybars
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Chocolate bars
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Chips
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Cakes
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Fruit (apple,
orange,
)
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Yoghurt
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Others ΰ
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04.03. Do you eat something when you come home before the evening meal?
(Put a cross in the right column. More answers are possible.)
Pizza
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Bread
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Candybars
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Chocolate bars
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Chips
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Cakes
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Fruit (apple,
orange,
)
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Yoghurt
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Others ΰ
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05. Questions about your eating
habits at evening
05.01. What time do you eat in the evening?
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Schooltime |
Vacation and Sunday |
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Between 16.00 and
17.00 H
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Between 17.00 and
18.00 H
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Between 18.00 and
19.00 H
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Between 19.00 and
20.00 H
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Between 20.00 and
21.00 H
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Others ΰ
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05.02. What do you mostly eat as eveningmeal?
(Put a cross in the right column. More answers are possible.)
Soupe
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Meat
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Vegetables
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Potatoes
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Paste
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Pizza
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Bread
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Spice cake
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Grains
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Yoghurt
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Cheese
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Candybars
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Chocolate bars
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Chips
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Cakes
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Fruit (apple,
orange,
)
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Others ΰ
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05.03. Do you eat/drink mostly something just before you go to sleep?
Yes
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No |
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Milk
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Chocolate
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Coffee
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Soft drinks (cola,
)
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Tea
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Water
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Others ΰ
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Food
Spice cake
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Grains
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Yoghurt
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Cheese
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Candybars
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Chocolate bars
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Chips
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Cakes
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Fruit (apple,
orange,
)
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Others ΰ
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05.04. What time do you go to sleep normally?
|
|
During
Schooltime |
During Vacation and Sunday |
Hour
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06. Personal opinions
06.01. Do you think your eating habits are healthy?
If No. Why your
eating habits are not healthy?
06.02.
Do you think that the eating habits from most of the students of your
age are similar with yours?
If No. Where is
the difference?
06.03.
Is there is an offer of food and drinks in your school, is it healthy in
your opinion? Whats healthy and what
isnt?
Healthy:
Not healthy:
06.04.
What do you like to add to the food and drink offer of the school?
Explain why?