6 Healthy and Safe School Environment District Questionnai

Form Approved

OMB No: 0920-0445

Expiration Date: xx/xx/xxxx

Healthy and Safe School Environment
District Questionnaire

6 January 2011

§

Public reporting burden for this collection of information is estimated to average 60 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-74, Atlanta, GA 30333; Attention PRA (0920-0445).

Healthy and Safe School Environment
District Questionnaire

Questions

MODULE 1

General School Environment 1–29

Elementary Schools 1–9

Middle Schools 10–19

High Schools 20–29

Violence Prevention 30–37

Tobacco Use Prevention 38–55

Student Drug Testing 56–57

Injury Prevention and Safety 58–65

MODULE 2

Physical School Environment 66–106

MODULE 3

Crisis Preparedness, Response, and Recovery 107–118

MODULE 4

Community Service and Service Learning 119–121

Foods and Beverages Available Outside of the School Meal Programs 122–132

Transporation To and From School 133–135

Joint Use Agreements 136–138

Professional Development 139

School Health Coordination 140–166

THIS QUESTIONNAIRE WILL BE ADMINISTERED USING WEB-BASED INTERVIEW TECHNOLOGY. AS THE RESPONDENT TYPES RESPONSES TO THE QUESTIONS INTO THE COMPUTER, THE INTERVIEW PROGRAM WILL 1) DISPLAY THE CORRECT TENSE OF VERBS, 2) PROVIDE ALTERNATE ANSWERS TO QUESTIONS (E.G., NOT APPLICABLE, “I DON’T KNOW”), 3) NAVIGATE COMPLEX SKIP PATTERNS, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE.

1. This questionnaire focuses on your district’s policies and practices regarding school policy and environment.

2. For the purposes of this questionnaire, “policy” means any law, rule, regulation, administrative order, or similar kind of mandate issued by the local school board or other local agency with authority over schools in your district. SHPPS is most interested in what is required by the district, not what is recommended or contained in non-binding guidance documents, unless the question specifically asks about recommendations.

3. If a district policy is worded in such a way that it requires schools to develop and adopt their own policies on a given topic, for the purpose of this questionnaire please consider it the same as a district-wide requirement.

4. District may sometimes grant policy exceptions or waivers, but please answer each question based on what is considered the general policy and standard practice in your district.

5. Please do not consider school practices or policies when answering the questions. This information is gathered during data collection from schools across the country.

6. For the purposes of this questionnaire, “elementary school” refers to a school that contains any of grades K–5. “Middle school” refers to a school that contains any of grades 6–8. Some jurisdictions may refer to these schools as “junior high schools.” “High school” refers to a school that contains any of grades 10–12. Some jurisdictions may refer to these schools as “senior high schools.”

ANSWER Q1–Q9 IF DISTRICT CONTAINS ELEMENTARY SCHOOLS. OTHERWISE, SKIP TO INSTRUCTIONS BEFORE Q10.

The first questions ask about policies affecting elementary schools in your district.

1. Has your district adopted a policy stating that elementary schools will maintain closed campuses, meaning that students are not allowed to leave school during the school day, including during lunchtime?

Yes 1

No 2

2. Has your district adopted a policy stating that elementary schools will assign staff or adult volunteers to monitor…

Yes No

1. School halls during classes? 1 2

2. School halls between classes? 1 2

3. Bathrooms? 1 2

4. School grounds? 1 2

3. Has your district adopted a policy requiring students at the elementary school level to wear school uniforms?

Yes 1 SKIP TO Q5

No 2

4. Has your district adopted a policy stating that elementary schools will enforce a student dress code?

Yes 1

No 2

5. Has your district adopted a policy requiring that…

Yes No

1. Students at the elementary school level wear
   identification badges? 1 2

2. Faculty and staff in elementary schools wear
   identification badges? 1 2

3. Visitors to elementary schools wear
   identification badges? 1 2

6. Has your district adopted a policy stating that elementary schools will use…

Yes No

1. Security or surveillance cameras, either inside
   or outside the building? 1 2

2. Metal detectors, including wands? 1 2

3. Communication devices such as cell phones,
   2-way radios, walkie-talkies, or intercoms for

security purposes?..........................................................................1 2

7. Has your district adopted a policy requiring elementary school students to refrain from using personal communication devices, such as cell phones, during the school day?

Yes 1

No 2

8. Has your district adopted a policy stating that elementary schools will use police, school resource officers, or security guards during the regular school day?

Yes 1

No 2

9. What is the standard distance elementary school students must live from a school to be eligible for riding a school bus? Do not include students with special needs or those eligible for hazard busing.

More than ½ mile 1

More than ¾ mile 2

More than 1 mile 3

More than 1½ miles 4

More than 2 miles 5

ANSWER Q10–Q19 IF DISTRICT CONTAINS MIDDLE SCHOOLS. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q20.

The next questions ask about policies affecting middle schools in your district.

10. Has your district adopted a policy stating that middle schools will maintain closed campuses, meaning that students are not allowed to leave school during the school day, including during lunchtime?

Yes 1

No 2

11. Has your district adopted a policy stating that middle schools will assign staff or adult volunteers to monitor…

Yes No

1. School halls during classes? 1 2

2. School halls between classes? 1 2

3. Bathrooms? 1 2

4. School grounds? 1 2

12. Has your district adopted a policy stating that middle schools will routinely conduct locker searches?

Yes 1

No 2

13. Has your district adopted a policy requiring students at the middle school level to wear school uniforms?

Yes 1 SKIP TO Q15

No 2

14. Has your district adopted a policy stating that middle schools will enforce a student dress code?

Yes 1

No 2

15. Has your district adopted a policy requiring that…

Yes No

1. Students at the middle school level wear
   identification badges? 1 2

2. Faculty and staff in middle schools wear
   identification badges? 1 2

3. Visitors to middle schools wear
   identification badges? 1 2

16. Has your district adopted a policy stating that middle schools will use…

Yes No

1. Security or surveillance cameras, either inside
   or outside the building? 1 2

2. Metal detectors, including wands? 1 2

3. Communication devices such as cell phones,
   2-way radios, walkie-talkies, or intercoms

for security purposes? 1 2

17. Has your district adopted a policy requiring middle school students to refrain from using personal communication devices, such as cell phones, during the school day?

Yes 1

No 2

18. Has your district adopted a policy stating that middle schools will use police, school resource officers, or security guards during the regular school day?

Yes 1

No 2

19. What is the standard distance middle school students must live from a school to be eligible for riding a school bus? Do not include students with special needs or those eligible for hazard busing.

More than ½ mile 1

More than ¾ mile 2

More than 1 mile 3

More than 1½ miles 4

More than 2 miles 5

ANSWER Q20–Q29 IF DISTRICT CONTAINS HIGH SCHOOLS. OTHERWISE, SKIP TO THE INTRODUCTION TO Q30.

The next questions ask about policies affecting high schools in your district.

20. Has your district adopted a policy stating that high schools will maintain closed campuses, meaning that students are not allowed to leave school during the school day, including during lunchtime?

Yes 1

No 2

21. Has your district adopted a policy stating that high schools will assign staff or adult volunteers to monitor…

Yes No

1. School halls during classes? 1 2

2. School halls between classes? 1 2

3. Bathrooms? 1 2

4. School grounds? 1 2

22. Has your district adopted a policy stating that high schools will routinely conduct locker searches?

Yes 1

No 2

23. Has your district adopted a policy requiring students at the high school level to wear school uniforms?

Yes 1 SKIP TO Q25

No 2

24. Has your district adopted a policy stating that high schools will enforce a student dress code?

Yes 1

No 2

25. Has your district adopted a policy requiring that…

Yes No

1. Students at the high school level wear
   identification badges? 1 2

2. Faculty and staff in high schools wear
   identification badges? 1 2

3. Visitors to high schools wear identification badges? 1 2

26. Has your district adopted a policy stating that high schools will use…

Yes No

1. Security or surveillance cameras, either inside
   or outside the building? 1 2

2. Metal detectors, including wands? 1 2

3. Communication devices such as cell phones,
   2-way radios, walkie-talkies, or intercoms

for security purposes? 1 2

27. Has your district adopted a policy requiring high school students to refrain from using personal communication devices, such as cell phones, during the school day?

Yes 1

No 2

28. Has your district adopted a policy stating that high schools will use police, school resource officers, or security guards during the regular school day?

Yes 1

No 2

29. What is the standard distance high school students must live from a school to be eligible for riding a school bus? Do not include students with special needs or those eligible for hazard busing.

More than ½ mile 1

More than ¾ mile 2

More than 1 mile 3

More than 1½ miles 4

More than 2 miles 5

The next questions ask about policies affecting all schools in your district. The first question asks about your district’s policies regarding gang activity.

30. Has your district adopted a policy prohibiting gang activity, such as recruiting or wearing gang colors, symbols, or other gang attire?

Yes 1

No 2

The next questions ask about bullying. For the purposes of these questions, “bullying” means when one or more students tease, threaten, spread rumors about, hit, shove, or hurt another student over and over again. It is not bullying when two students of about the same strength or power argue or fight or tease each other in a friendly way.

31. Has your district adopted a policy prohibiting bullying on school property?

Yes 1

No 2

32. Has your district adopted a policy prohibiting bullying at off-campus, school-sponsored events?

Yes 1

No 2

The next questions ask about electronic aggression, sometimes called cyber-bullying. For the purposes of these questions, “electronic aggression” means when students use a cell phone, the Internet, or other communication devices to send or post text, pictures, or videos intended to threaten, harass, humiliate, or intimidate other students or staff.

33. Has your district adopted a policy prohibiting electronic aggression or cyber-bullying on school property?

Yes 1

No 2

34. Has your district adopted a policy prohibiting electronic aggression or cyber-bullying at off-campus, school-sponsored events?

Yes 1

No 2

35. Has your district adopted a policy prohibiting any electronic aggression or cyber-bullying that interferes with the educational environment, even if it does not occur on school property or at school-sponsored events?

Yes 1

No 2

36. Has your district adopted a policy stating that schools will have a plan for the actions to be taken when a student at risk for suicide is identified?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q38

37. Does the policy require that…

Yes No

1. The student’s family will be informed? 1 2

2. The student will be referred to a mental health provider? 1 2

3. A visit with a mental health provider will be documented
   before the student returns to school? 1 2

The next questions ask about your district’s policies regarding tobacco use.

38. Has your district adopted a policy prohibiting cigarette smoking by students?

Yes 1

No 2 SKIP TO Q40

39. Does that policy specifically prohibit cigarette smoking by students…

Yes No

1. In school buildings? 1 2

2. Outside on school grounds, including parking lots
   and playing fields? 1 2

3. On school buses or other vehicles used to
   transport students? 1 2

4. At off-campus, school-sponsored events? 1 2

40. Has your district adopted a policy prohibiting cigar or pipe smoking by students?

Yes 1

No 2

41. Has your district adopted a policy prohibiting smokeless tobacco use by students?

Yes 1

No 2 SKIP TO Q43

42. Does that policy specifically prohibit smokeless tobacco use by students…

Yes No

1. In school buildings? 1 2

2. Outside on school grounds, including parking lots
   and playing fields? 1 2

3. On school buses or other vehicles used to
   transport students? 1 2

4. At off-campus, school-sponsored events? 1 2

43. Has your district adopted a policy prohibiting tobacco advertisements…

Yes No

1. In the school building? 1 2

2. Outside, on school grounds, including on the outside
   of the school building, on playing fields, or other
   areas of the campus? 1 2

3. On school buses or other vehicles used to
   transport students? 1 2

4. In school publications? 1 2

44. Has your district adopted a policy that prohibits students from wearing tobacco brand-name apparel or carrying merchandise with tobacco company names, logos, or cartoon characters on it?

Yes 1

No 2

45. Has your district adopted a policy prohibiting tobacco advertising through sponsorship of school events?

Yes 1

No 2

46. Has your district adopted a policy prohibiting cigarette smoking by faculty and staff during any school-related activity?

Yes 1

No 2 SKIP TO Q48

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

Yes No

1. In school buildings? 1 2

2. Outside on school grounds, including parking lots
   and playing fields? 1 2

3. On school buses or other vehicles used to
   transport students? 1 2

4. At off-campus, school-sponsored events? 1 2

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

Yes 1

No 2

49. Has your district 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 Q51

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

Yes No

1. In school buildings? 1 2

2. Outside on school grounds, including parking lots
   and playing fields? 1 2

3. On school buses or other vehicles used to
   transport students? 1 2

4. At off-campus, school-sponsored events? 1 2

The next question asks about your district’s policy regarding cigarette smoking by school visitors. For the purposes of these questions, “visitors” means anyone other than students or faculty and staff, including family members, community members, contractors, and repair workers. These people might visit school during or outside of school hours.

51. Has your district adopted a policy prohibiting cigarette smoking by school visitors?

Yes 1

No 2 SKIP TO Q53

52. Does that policy specifically prohibit cigarette smoking by school visitors…

Yes No

1. In school buildings? 1 2

2. Outside on school grounds, including parking lots
   and playing fields? 1 2

3. On school buses or other vehicles used to
   transport students? 1 2

4. At off-campus, school-sponsored events? 1 2

53. Has your district adopted a policy prohibiting cigar or pipe smoking by school visitors?

Yes 1

No 2

54. Has your district adopted a policy prohibiting smokeless tobacco use by school visitors?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q56

55. Does that policy specifically prohibit smokeless tobacco use by school visitors…

Yes No

1. In school buildings? 1 2

2. Outside on school grounds, including parking lots
   and playing fields? 1 2

3. On school buses or other vehicles used to
   transport students? 1 2

4. At off-campus, school-sponsored events? 1 2

ANSWER Q56 IF DISTRICT CONTAINS MIDDLE OR HIGH SCHOOLS. OTHERWISE, SKIP TO THE INTRODUCTION TO Q58.

The next questions ask about your district’s policies regarding student drug testing.

56. Has your district adopted a student drug-testing policy?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q58

57. The next questions ask about how students are chosen for drug testing under your district’s policy.

Yes No

1. Is student drug testing conducted randomly among
   members of specific groups of students, such as
   athletes, students who participate in other
   extracurricular activities, or student drivers? 1 2

2. Is student drug testing conducted when it is suspected
   that a student is using drugs at school, that is, for cause? 1 2

3. Is student drug testing voluntary for all students
   or specific groups of students? 1 2

4. Are students chosen for drug testing using criteria
   other than the ones we just discussed? 1 2

The next questions ask about your district’s policies regarding injury prevention and safety.

58. Has your district adopted a policy on the inspection or maintenance of…

Yes No

ANSWER A IF DISTRICT CONTAINS ELEMENTARY SCHOOLS. OTHERWISE, SKIP TO B.

1. Playground facilities and equipment, such as
   playing surfaces, benches, monkey bars, and swings? 1 2

2. Indoor athletic facilities and equipment, such as
   playing surfaces, benches, tumbling mats,
   and weight lifting equipment? 1 2

3. Outdoor athletic facilities and equipment,
   such as playing fields and bleachers? 1 2

4. Special classroom areas, such as chemistry labs,
   workshops, and art rooms? 1 2

5. Other school areas, such as halls, stairs,
   and regular classrooms? 1 2

6. Smoke alarms? 1 2

7. Fire extinguishers? 1 2

8. Sprinkler systems? 1 2

9. Lighting inside school buildings? 1 2

10. Lighting outside school buildings? 1 2

11. Automated external defibrillators (AEDs)? 1 2

59. Has your district adopted a policy requiring that students wear appropriate protective gear when engaged in…

Yes No N/A

1. Classes such as wood shop or metal shop? 1 2 3

2. Lab activities for photography, chemistry,
   biology, or other science classes? 1 2 3

60. Has your district adopted a policy requiring that students use hearing protection devices during classes or activities where they are exposed to potentially unsafe noise levels, such as industrial arts classes or marching band? A hearing protection device is any piece of equipment or apparatus that is made to reduce the loudness of sound, such as earplugs or earmuffs.

Yes 1

No 2

ASK Q61–63 ONLY IF DISTRICT CONTAINS ELEMENTARY SCHOOLS. OTHERWISE, SKIP TO Q64.

61. Has your district adopted a policy that addresses the following issues related to playground safety?

Yes No

1. Ratio of playground monitors to students 1 2

2. Criteria for selecting playground monitors 1 2

3. Duties of playground monitors 1 2

4. Training for playground monitors 1 2

5. A discipline procedure for students who are not
   following the rules 1 2

6. A procedure for what to do in case of an injury 1 2

7. Criteria for the selection, placement, and installation
   of playground equipment 1 2

8. Criteria for the selection, placement, and installation
   of playground surfacing materials 1 2

9. The posting of rules for the safe use of specific types of
   equipment, such as swings, slides, or climbing structures 1 2

10. The identification of an individual responsible
    for enforcing the policy 1 2

62. During the past 2 years, has your district provided training for playground monitors?

Yes 1

No 2

63. Has your district adopted a policy requiring schools to 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

64. Has your district ever been sued because of an injury that occurred on school property or at an off-campus, school-sponsored event? Please include any claim filed with a court, regardless of the outcome.

Yes 1

No 2

The next question asks about sun safety.

65. Does your district require or recommend that schools will…

Require Recommend Neither

1. Schedule outdoor activities to avoid
   times when the sun is at peak intensity? 1 2 3

2. Allow students to apply sunscreen
   while at school? 1 2 3

3. Encourage students to wear protective
   clothing (such as long sleeve shirts
   or long pants) when in the sun during
   the school day? 1 2 3

4. Encourage students to wear hats or visors
   when in the sun during the school day? 1 2 3

5. Encourage students to wear sunglasses
   when in the sun during the school day? 1 2 3

The next section asks about the physical school environment, such as building maintenance, indoor air quality, pest control, and chemicals.

66. Has your district adopted a policy requiring that schools conduct periodic inspections…

Yes No

1. For condensation in and around the school facilities? 1 2

2. Of the building foundation, walls, and roof for cracks,
   leaks, or past water damage? 1 2

3. For mold? 1 2

4. Of the plumbing system? 1 2

5. Of the heating, ventilation, and air conditioning (HVAC)
   system? 1 2

6. That test drinking water outlets for lead? 1 2

7. For clutter that prevents effective cleaning
   and maintenance? 1 2

67. Do any schools in your district have a main instructional building that was constructed before 1980?

Yes 1

No 2 SKIP TO Q70

68. Has your district adopted a policy requiring that schools constructed before 1980 conduct inspections for cracked or peeling paint that may contain lead?

Yes 1

No 2

Lead paint previously identified
and remediated 3

69. Has your district adopted a policy requiring that schools constructed before 1980 conduct inspections for caulking around windows and doors that may contain PCBs?

Yes 1

No 2

PCBs in caulking previously identified
and remediated 3

70. How often are schools in your district required to conduct a campus-wide inspection for pests such as ants, roaches, bees, mice, or rats? For the purposes of this question, “campus‑wide” means inside the buildings and on the school grounds.

Weekly 1

Monthly 2

Quarterly 3

Every 6 months 4

Once per year 5

As needed 6

Other time frame 7

71. How often are schools in your district required to notify staff, students, and families prior to the application of pesticides?

Never 1

Each time 2

Once per year 3

Other time frame 4

Schools do not apply pesticides 5

72. Does your district require that schools….

Yes No

1. Seal openings in walls, floors, doors, and windows
   with caulk or weather stripping? 1 2

2. Keep vegetation, shrubs, and wood mulch at least
   1 foot away from buildings to control pests? 1 2

3. Allow eating only in designated areas to control pests? 1 2

4. Store waste in plastic, glass, or metal containers
   with tight lids so that it is inaccessible to pests? 1 2

5. Repair cracks in pavement and sidewalks? 1 2

6. Remove infested or diseased plants? 1 2

7. Use spot treatments and baiting rather than widespread
   applications of pesticides? 1 2

8. Mark indoor and outdoor areas that have been treated
   with pesticides? 1 2

9. Store food in plastic, glass, or metal containers
   with tight lids so that it is inaccessible to pests? 1 2

For the next questions, please answer based on what your district requires while school is in session.

73. How often are schools in your district required to clean student lockers, cubbies, or inside of desks in order to remove any food remains?

Daily 1

Weekly 2

Monthly 3

Quarterly 4

Every 6 months 5

Once per year 6

As needed 7

Other time frame 8

74. How often are schools in your district required to clean or sanitize desk tops?

Daily 1

Weekly 2

Monthly 3

Quarterly 4

Every 6 months 5

Once per year 6

As needed 7

Other time frame 8

75. How often are schools in your district required to disinfect trash containers?

Daily 1

Weekly 2

Monthly 3

Quarterly 4

Every 6 months 5

Once per year 6

As needed 7

Other time frame 8

76. Does your district use an outside company for pest management?

Yes 1

No 2 SKIP TO Q78

77. Is this company third-party certified for practices that reduce the use or risk of pesticides or integrated pest management? For the purposes of this question, “third-party certified” means that the pest control company was trained by an organization such as the National Pest Management Association or Integrated Pest Management of North America in ways to limit the use and risk of pesticides.

Yes 1

No 2

78. Has your district adopted a policy requiring that schools meet ASHRAE ventilation standards? For the purposes of this question, “ASHRAE ventilation standards” means those set by the American Society of Heating, Refrigeration, and Air Conditioning Engineers, which is the organization that sets national standards for ventilation in occupied buildings, including schools.

Yes 1

No 2

79. Has your district adopted a policy regarding how schools should address mold problems?

Yes 1

No 2

80. Has your district adopted a policy stating that schools will respond to moisture-related issues, such as floods, leaks, or condensation within 48 hours or less?

Yes 1

No 2

81. Does your district have an indoor air quality (IAQ) management program?

Yes 1

No 2 SKIP TO Q83

82. Is your program based on the Environmental Protection Agency’s (EPA) Indoor Air Quality Tools for Schools?

Yes 1

No 2

83. Has your district adopted a policy requiring schools be tested for radon?

Yes 1

No 2

84. Do any schools in your district have a school-operated water system, in which the school obtains drinking water from its own well, spring, or small reservoir?

Yes 1 SKIP TO Q86

No 2

85. Has your district adopted a policy requiring schools to do the following at least once a year…

Yes No

1. Test drinking water for bacteria? 1 2

2. Test drinking water for coliforms? 1 2

3. Test drinking water for other contaminants? 1 2

86. Has your district adopted a policy requiring schools to flush drinking water outlets after periods of non-use, such as after weekends or school vacations?

Yes 1

No 2

The next questions ask about school buses and other vehicles.

87. Has your district implemented an engine idling reduction program for…

District does
not have
Yes No school buses

1. School buses? 1 2 3

2. Cars? 1 2

3. Delivery trucks? 1 2

IF Q87A IS NO OR NA, SKIP TO THE INTRODUCTION TO Q89.

88. During the past two years, has your district provided bus drivers with training related to the engine idling reduction program?

Yes 1

No 2

The next question asks about low-emitting products. Many commonly used products, such as floor coverings, furniture, paint, cleaners, markers, textiles, or adhesives emit chemical fumes or vapors. Some of these types of products are designed to give off little or no chemical fumes or vapors and are called low-emitting products.

89. Has your district adopted a policy to purchase low-emitting products for use in and around the school and school grounds, including in common areas, art classes, industrial art classes, and science laboratories?

Yes 1

No 2

The next questions ask about hazardous materials. Hazardous materials are chemicals or materials that may be harmful to people or the environment. Some examples are chemicals used for science experiments or art classes, cleaning products, and pesticides.

90. Does your district provide guidance on how to reduce the use of hazardous materials or chemicals in schools?

Yes 1

No 2

91. Does your district require that schools keep an inventory of hazardous materials or chemicals in the school?

Yes 1

No 2 SKIP TO Q93

92. How often are schools in your district required to review or update their inventory of hazardous materials or chemicals?

Daily 1

Weekly 2

Monthly 3

Quarterly 4

Every 6 months 5

Once per year 6

As needed 7

Other time frame 8

93. Is district approval of the following products required before they are used by teachers, administrative or custodial staff, or contractors at a school in your district?

Yes No

1. Cleaning and maintenance products, such as
   disinfectants, air fresheners, polishes, or waxes 1 2

2. Pesticides 1 2

3. Chemicals or other potentially hazardous materials

used in science labs, vocational education, art, or other classes 1 2

4. Art supplies, such as paints 1 2

5. General classroom supplies, such as white board markers 1 2

94. During the past two years, has your district provided funding for or offered training to custodial or maintenance staff on…

Yes No

1. Use of hazardous materials? 1 2

2. Labeling of hazardous materials? 1 2

3. Storage of hazardous materials? 1 2

4. Disposal of hazardous materials? 1 2

5. How to reduce the use of hazardous materials? 1 2

6. How to address mold problems? 1 2

7. Indoor air quality? 1 2

8. School drinking water quality? 1 2

9. Pest management practices that limit the use
   of pesticides? 1 2

The next questions ask about green building design. Green building design is a way of designing a building so that it minimizes impact on the environment. For example, the design of such a building conserves resources such as energy and water, protects the existing landscape, and provides healthy indoor air.

95. Has your district adopted a policy to include green design when building new school buildings or renovating existing buildings?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q97

96. Buildings constructed or renovated under a green building policy may be inspected by an independent or third party, and rated, certified, or labeled as meeting certain green building conditions. Examples of third party rating or labeling systems include Collaborative for High Performance Schools (CHPS), LEED for Schools from the U.S. Green Building Council, and Green Globes. Does your district’s policy on green building design require the use of a third party green building certification, labeling, or rating system?

Yes 1

No 2

97. Has your district adopted a policy that addresses the following practices for new school buildings or renovations of existing buildings?

Yes No

1. Use of natural light for visual comfort
   or energy conservation 1 2

2. Use of energy efficient lighting and electrical systems 1 2

3. Use of renewable energy, such as solar or wind power 1 2

4. Conservation of water such as using rainwater
   or plumbing fixtures that conserve water 1 2

5. Implementation of recycling programs 1 2

6. Orienting buildings to optimize energy conservation,
   use of daylight, and noise reduction 1 2

7. Use of landscaping that includes only native
   planting materials 1 2

8. Use of alternative transportation including
   public transportation, walking, or biking 1 2

9. Preservation of green space or protection
   of the existing landscape 1 2

10. Use of building materials such as floor and wall
    coverings, paints, sealants, caulk, adhesives, or furniture
    that are low- or no-volatile organic compound (VOC)
    emitting materials 1 2

11. Use of procedures or systems to protect indoor air quality 1 2

12. Use of radon resistant new construction practices 1 2

98. During the past five years, has your school district initiated the construction of a school facility on a new school site?

Yes 1

No 2 SKIP TO Q100

99. How influential were the following factors in deciding where to build the new school? Please consider the most recent new school construction in the past five years.

Not a Somewhat Very
Factor Influential Influential

1. Local government officials’ input 1 2 3

2. Need for athletic facilities 1 2 3

3. Need for parking 1 2 3

4. Availability of existing roads
   and infrastructure 1 2 3

5. Land prices 1 2 3

6. Site donated 1 2 3

7. Site already owned 1 2 3

8. Ability for students to walk or bike
   to school 1 2 3

9. Demographic characteristics of students
   who would attend that school, such as
   race, ethnicity, and poverty status 1 2 3

10. Compatibility with local community
    growth plan related to future residential
    development 1 2 3

11. Environmental concerns related to on-site
    contamination or potential nearby sources
    of pollution 1 2 3

12. Potential clean up costs of
    contaminated sites 1 2 3

100. Has your district adopted a policy that requires formal consultation or input from the public about…

Yes No

1. Whether to construct a new school? 1 2

2. Where to construct that new school? 1 2

3. Environmental review of candidate site(s)? 1 2

101. Has your district adopted a policy that requires formal consultation or input from local government transportation officials about…

No Local
Government
Transportation
Yes No Officials

1. Whether to construct a new school? 1 2 3

2. Where to construct that new school? 1 2 3

3. Environmental review of
   candidate site(s)? 1 2 3

102. Has your district adopted a policy that requires formal consultation or input from local government land use or community planning officials about…

No Local
Government
Land Use or
Community
Yes No Planning Officials

1. Whether to construct a new school? 1 2 3

2. Where to construct that new school? 1 2 3

3. Environmental review of
   candidate site(s)? 1 2 3

103. Has your district adopted a policy that requires formal consultation or input from public health or environmental health officials about…

No Local
Public Health or
Environmental
Yes No Health Officials

1. Whether to construct a new school? 1 2 3

2. Where to construct that new school? 1 2 3

3. Environmental review of
   candidate site(s)? 1 2 3

104. Has your district adopted a policy that requires formal consultation or input from state government officials about…

Yes No

1. Whether to construct a new school? 1 2

2. Where to construct that new school? 1 2

3. Environmental review of candidate site(s)? 1 2

The next question asks about Phase I environmental site assessments. Phase I environmental site assessments can include a physical survey of the property and surrounding properties to assess general land use and occupants of the area, an on-site visual inspection of the site to identify environmental concerns, an assessment of current and past uses of the property particularly if any hazardous materials were stored or disposed of at the site, a review of owner records, and a review of local, state, and federal regulatory agency records maintained for the site.

105. Has your district adopted a policy requiring Phase I environmental site assessments prior to constructing a new school facility?

Yes 1

No 2

No new facilities planned 3

The next question asks about formal training for a newly hired person who oversees custodial, maintenance, and environmental issues, such as hazardous materials and pest management, for schools in your district. For the purposes of this question, “formal training” means college classes, including community college; workshops; seminars; conferences; or any other kind of in-service or pre-service.

106. In your district, is a newly hired person who oversees custodial, maintenance, and environmental issues required to have any formal training in issues related to the physical environment of buildings and health hazards likely to be encountered in schools?

Yes 1

No 2

The next questions ask about crisis preparedness, response, and recovery in the event of a natural disaster or other emergency situation.

107. Has your district used any materials from the U.S. Department of Education, such as Practical Information on Crisis Planning: A Guide for Schools and Communities, to develop policies or plans related to crisis preparedness, response, and recovery?

Yes 1

No 2

108. Does your district have a comprehensive district-level plan to address crisis preparedness, response, and recovery in the event of a natural disaster or other emergency or crisis situation?

Yes 1

No 2 SKIP TO Q110

109. Does your district’s crisis preparedness, response, and recovery plan include…

Yes No

1. Evacuation protocols for crises involving more than
   one school? 1 2

2. Protocols for communicating with building-level
   managers during a crisis? 1 2

3. Plans for supplying food, water, and medical supplies
   to schools in extended shelter-in-place? 1 2

4. Requirements to conduct district-level
   crisis-response drills? 1 2

5. Plans for training school staff, for example in triage
   or first aid skills? 1 2

6. Plans for serving as a community shelter or coordinating
   center during a community-wide crisis? 1 2

7. Plans to resume normal activities after buildings
   or facilities have been damaged? 1 2

8. Mechanisms for evaluating outside offers of assistance
   during or after a crisis? 1 2

9. Provision of mental health services for students, faculty,
   and staff after a crisis has occurred, for example to treat
   post-traumatic stress disorder? 1 2

10. Establishment of an incident command system? 1 2

(Q109 continued)

Yes No

11. Mechanisms for communicating with school personnel? 1 2

12. Procedures for responding to media inquiries? 1 2

13. Requirements to periodically review and revise
    emergency response plans? 1 2

14. Procedures for responding to pandemic flu or other
    infectious disease outbreaks? 1 2

15. Procedures for implementing unplanned school dismissal
    or school closure? 1 2

110. Has your district adopted a policy requiring that schools have a comprehensive plan to address crisis preparedness, response, and recovery in the event of a natural disaster or other emergency or crisis situation?

Yes 1

No 2 SKIP TO THE INSTRUCTIONS BEFORE Q112

111. Has your district adopted a policy requiring schools’ crisis preparedness, response, and recovery plans to include…

Yes No

1. Evacuation plans? 1 2

2. Procedures to stop people from leaving or entering school
   buildings, that is, lock down plans? 1 2

3. Procedures to control the exterior of the building
   and school grounds? 1 2

4. Plans to seek immediate shelter and remain in that area
   during a chemical, biological, or radiological emergency
   rather than evacuating, or shelter-in-place plans? 1 2

5. Requirements to conduct regular emergency drills,
   other than fire drills? 1 2

6. Family reunification procedures? 1 2

7. Provisions for students and staff with special needs? 1 2

8. Plans to resume normal activities after buildings
   or facilities have been damaged? 1 2

9. Provision of mental health services for students, faculty,
   and staff after a crisis has occurred, for example to treat
   post-traumatic stress disorder? 1 2

(Q111 continued)

Yes No

10. Mechanisms for communicating with school personnel? 1 2

11. Establishment of an incident command system? 1 2

12. Procedures for responding to media inquiries? 1 2

13. Mechanisms for communicating the plan to
    students’ families? 1 2

14. Requirements to periodically review and revise
    emergency response plans? 1 2

15. Procedures for responding to pandemic flu or other
    infectious disease outbreaks? 1 2

16. Procedures for implementing unplanned school dismissal
    or school closure? 1 2

IF Q108 AND Q110 ARE BOTH “NO,” SKIP TO Q113.

112. During the past two years, has your district provided funding for or offered training on the crisis preparedness, response, and recovery plan to…

Yes No

1. School faculty and staff? 1 2

2. Students? 1 2

3. Students’ families? 1 2

113. During the past two years, has your district offered education on crisis preparedness, response, and recovery to students’ families?

Yes 1

No 2

IF Q108 AND Q110 ARE BOTH “NO,” SKIP TO Q116.

114. In developing the crisis preparedness, response, and recovery plans, did your district work with …

Yes No N/A

1. Staff from individual schools
   within your district? 1 2

2. Students or their families? ……………………..1 2

3. A local fire department? 1 2

4. A local law enforcement agency? 1 2

5. Local emergency medical services? 1 2

6. The local public transportation
   department? 1 2 3

7. A local health department? 1 2

8. A local mental health or
   social services agency? 1 2

9. A local hospital? 1 2

10. A local homeland security office
    or emergency management agency? 1 2 3

11. Other community members? …………………...1 2

115. During the past 12 months, has your district’s crisis preparedness, response, and recovery plan been evaluated or assessed?

Yes 1

No 2

116. Some communities have a group of local agencies that coordinates crisis preparedness, response, and recovery efforts. Such a group might be called a local emergency planning committee, an emergency management team, or something else. Is your district a member of such a group?

Yes 1

No 2

No such group 3

117. Are any of the schools in your district designated to serve as staging areas or community shelters during local emergencies?

Yes 1

No 2

118. Has your district adopted a policy that all schools must have a National Oceanic and Atmospheric Administration (NOAA) weather radio?

Yes 1

No 2

The next questions ask about community service and service-learning. For the purposes of these questions, “community service” is unpaid work that helps the community, and “service-learning” is a particular type of community service that is designed to meet specific learning objectives for a course.

119. Has your district adopted a policy requiring students at any school level to participate in community service?

Yes 1

No 2

120. Does your district require or recommend that schools provide service-learning opportunities to students?

Require 1

Recommend 2

Neither 3

ANSWER Q121A IF DISTRICT CONTAINS ELEMENTARY SCHOOLS. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q121B.

121a. Has your district adopted a policy stating that elementary schools will participate in programs 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

ANSWER Q121B IF DISTRICT CONTAINS MIDDLE SCHOOLS. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q121C.

121b. Has your district adopted a policy stating that middle schools will participate in programs 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

ANSWER Q121C IF DISTRICT CONTAINS HIGH SCHOOLS. OTHERWISE, SKIP TO THE INTRODUCTION TO Q122.

121c. Has your district adopted a policy stating that high schools will participate in programs 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

The next questions ask about foods and beverages available outside of the school meal programs.

122. Does your district require or recommend that schools provide students with access to a free source of drinking water, such as fountains, dispensers, or other bottled sources, throughout the school day?

Require 1

Recommend 2

Neither 3

Junk foods are foods or beverages that have low nutrient density, that is, they provide calories primarily through fats or added sugars and have minimal amounts of vitamins and minerals.

121. Does your district require or recommend that schools prohibit advertisements for junk food or fast food restaurants on school property?

Require 1

Recommend 2

Neither 3

ANSWER Q124 IF DISTRICT CONTAINS ELEMENTARY SCHOOLS. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q125.

122. Does your district require or recommend that elementary schools prohibit student access to vending machines for at least part of the school day?

Require 1

Recommend 2

Neither 3

ANSWER Q125 IF DISTRICT CONTAINS MIDDLE SCHOOLS. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q126.

123. Does your district require or recommend that middle schools prohibit student access to vending machines for at least part of the school day?

Require 1

Recommend 2

Neither 3

ANSWER Q126 IF DISTRICT CONTAINS HIGH SCHOOLS. OTHERWISE, SKIP TO Q127.

124. Does your district require or recommend that high schools prohibit student access to vending machines for at least part of the school day?

Require 1

Recommend 2

Neither 3

125. Does your district require or recommend that schools restrict the distribution of products promoting junk food, fast food restaurants, or soft drinks to students, such as t-shirts, hats, or book covers?

Require 1

Recommend 2

Neither 3

126. Does your district allow schools to sell soft drinks, such as sports drinks, soda pop, or fruit drinks that are not 100% juice to students in any venue?

Yes 1

No 2 SKIP TO Q132a

127. Does your district receive a specified percentage of the soft drink sales receipts?

Yes 1

No 2 SKIP TO Q131

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

Yes 1

No 2

129. Is your district prohibited from selling soft drinks produced by more than one company?

Yes 1

No 2

132a. Are soft drink companies allowed to advertise soft drinks, such as sports drinks, soda pop, or fruit drinks in school buildings?

Yes 1

No 2

132b. What about on school grounds, including on the outside of school buildings, on playing fields, or other areas of campuses?

Yes 1

No 2

The next questions ask about transportation to and from school.

133. Has your district adopted a policy that supports or promotes walking or biking to and from school?

Yes 1

No 2

130. Does your district support or promote the use of public transportation for its students to travel to and from school?

Yes 1

No 2

No public transportation available 3

131. Does your district support or promote the use of public transportation for its faculty and staff to travel to and from school?

Yes 1

No 2

No public transportation available 3

The next questions ask about joint use agreements.

A joint use agreement is a formal agreement between the school district and another public or private entity to jointly use either school facilities or community facilities in order to share costs and responsibilities. For example, joint use agreements might be designed to increase access to spaces for recreation and physical activity, library services, school health centers, preschool programs, child care centers, before- or after-school programs, adult education, or other programs that benefit students and the community. These could be indoor or outdoor education or recreational facilities.

132. Does your district have such an agreement for shared use of school or community property? Do not include situations where the community can use school property but no formal agreement with another entity exists.

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q139

133. Does this agreement apply to the use of facilities for…

Yes No

1. Indoor recreation or physical activity? 1 2

2. Outdoor recreation or physical activity? 1 2

3. Library services? 1 2

4. Preschool or child care programs? 1 2

5. Before or after school programs? 1 2

6. Adult education programs? 1 2

7. Other activities or programs? 1 2

134. Does your school district have a joint use agreement with…

Yes No

1. A local parks or recreation department? 1 2

2. A local youth organization, such as the YMCA,
   Boys or Girls Clubs, or the Boy Scouts or Girl Scouts? 1 2

3. A local faith-based organization? 1 2

4. A local health club? 1 2

5. Any other public or private entity? 1 2

The next questions are about professional development, which might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service.

135. During the past two years, has your district provided funding for or offered professional development for school faculty and staff on how to implement school-wide policies and programs related to…

Yes No

1. Classroom management? 1 2

2. Electronic aggression or cyber-bullying prevention? 1 2

3. Other bullying prevention? 1 2

4. Dating violence prevention? 1 2

5. Other violence prevention? 1 2

6. Injury prevention and safety? 1 2

7. Sun safety? 1 2

8. Tobacco use prevention? 1 2

9. Alcohol use prevention? 1 2

10. Illegal drug use prevention? 1 2

11. Crisis preparedness, response, and recovery? 1 2

12. Indoor air quality? 1 2

13. Access to free drinking water throughout the day? 1 2

14. Drinking water quality? 1 2

15. Integrated pest management? 1 2

16. Green building design? 1 2

17. Radon testing and mitigation? 1 2

18. Faculty and staff health promotion? 1 2

The next questions ask about school health coordination.

136. Is there one or more than one group—for example, a school health council, committee, or team—at the district level that offers guidance on the development of policies or coordinates activities that are health-related?

Yes 1

No 2 SKIP TO Q147

137. Do any of these groups address…

Yes No

1. Tobacco use prevention? 1 2

2. Alcohol or other drug use prevention? 1 2

3. Food service or nutrition? 1 2

4. Physical education or physical activity? 1 2

5. Pregnancy prevention? 1 2

6. Human immunodeficiency virus (HIV) prevention? 1 2

7. Other sexually transmitted disease (STD) prevention? 1 2

8. Violence prevention for example, bullying, fighting, or
   dating violence prevention? 1 2

9. Injury prevention and safety? 1 2

10. Health education? 1 2

11. Health services? 1 2

12. Mental health or social services? 1 2

13. The psychological and social environment,
    or school climate? 1 2

14. Faculty and staff health promotion? 1 2

15. Family and community involvement in school
    health programs? 1 2

16. Physical school environment? 1 2

17. Crisis preparedness, response, and recovery? 1 2

18. Management of chronic health conditions, such as asthma
    or diabetes? 1 2

19. Management of infectious diseases, such as influenza
    or foodborne illnesses? 1 2

20. Management of food allergies? 1 2

21. Local wellness policies? 1 2

138. Do any of the district school health councils, committees, or teams include…

Yes No N/A

1. Health education teachers? 1 2 3

2. Physical education teachers? 1 2 3

3. Health services staff (e.g., school nurses)? 1 2 3

4. Nutrition or food service staff? 1 2 3

5. Mental health and social services staff? 1 2 3

6. Maintenance or transportation staff? 1 2 3

7. Technology staff? 1 2 3

8. Library or media center staff? 1 2 3

9. District administrators? 1 2 3

10. School-level administrators? 1 2

11. Students? 1 2

12. Students’ parents or families? 1 2

139. Do any of the district school health councils, committees, or teams include representatives from any of the following local agencies or organizations?

Yes No N/A

1. Health department 1 2 3

2. Mental health or social services agencies 1 2 3

3. Healthcare providers, such as
   pediatricians or dentists 1 2 3

4. Health organizations,
   such as the local Red Cross chapter 1 2 3

5. Youth organizations,
   such as the Boys and Girls Clubs 1 2 3

6. Businesses 1 2 3

7. Hospitals 1 2 3

8. Service clubs, such as the Rotary Club 1 2 3

9. Public safety agencies, such as police,
   fire, or emergency services 1 2 3

10. Faith-based organizations 1 2 3

11. Other local government agencies 1 2 3

140. Do any of these groups…

Yes No

1. Identify student health needs based on a review
   of relevant data, such as Youth Risk Behavior Survey data? 1 2

2. Develop or review a district-wide health and safety plan? 1 2

3. Recommend new or revised health and safety policies and
   activities to the Superintendent or the school board? 1 2

4. Seek funding or leverage resources to support
   school health and safety priorities for students and staff? 1 2

5. Recommend or review health-related curricula or
   instructional materials? 1 2

6. Communicate the importance of health and safety
   policies and activities with the school board, schools,
   and community? 1 2

For the next question, please think about the school health council, committee, or team that met the most during the past 12 months.

141. During the past 12 months, how many times did this group meet?

0 times 1

1 or 2 times 2

3 or 4 times 3

5 or 6 times 4

More than 6 times 5

142. During the past two years, has your district provided any funding for or offered to help schools establish a group—for example, a school health council, committee, or team—that offers guidance on the development of policies or coordinates activities that are health‑related?

Yes 1

No 2

143. Has your district ever used a self-assessment tool, such as the Healthy Schools Report Card or the Healthy Schools Builder, to assess your district’s health and safety policies and activities?

Yes 1

No 2

The next questions ask about a plan your district might have developed to improve your district’s health and safety policies and activities.

144. Does your district have a district-wide health and safety plan to improve its health-related policies and activities for students and staff?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q152

145. Did your district analyze the following types of data when developing the plan?

Yes No

1. Health behavior data, such as Youth Risk Behavior
   Survey data 1 2

2. Educational achievement data, such as standardized
   test scores 1 2

3. Educational data, such as absences, dropouts,
   or grade retention 1 2

4. Health services data, such as the number of

visits to the school nurse 1 2

5. Other types of data, such as school meal participation 1 2

146. Does the plan address any of the following school health-related areas?

Yes No

1. Health education 1 2

2. Physical education and physical activity 1 2

3. Nutrition services and foods and beverages available
   at school 1 2

4. Health services 1 2

5. Mental health and social services 1 2

6. Healthy and safe school environment 1 2

(Q150 Continued)

7. Faculty and staff health promotion 1 2

8. Family and community involvement 1 2

147. How often is the district-wide health and safety plan reviewed?

Every year 1

Every 2 to 3 years 2

Every 4 to 5 years 3

More than every 5 years 4

As needed 5

Other time frame 6

Never 7

The next questions ask about a district-level school improvement plan. Such plans are developed to improve the district’s overall instructional and environmental policies and activities.

148. Does your district-level school improvement plan include health and safety goals and objectives?

Yes 1

No 2

The district does not have a district-level
school improvement plan 3

149. The Elementary and Secondary Education Act requires certain schools to have a written School Improvement Plan (SIP). Many states and school districts also require schools to have a written SIP. Does your district require schools to include health and safety goals and objectives in their written SIP?

Yes 1

No 2

Schools in this district do not have SIPs 3

The next questions ask about district and community collaboration to improve your district’s health and safety policies and activities.

150. During the past two years, did any community agencies, organizations, or healthcare providers provide resources such as funding, materials, services, facilities, or data to help protect and improve the health and safety of students and staff in your district?

Yes 1

No 2

151. During the past two years, did your district provide resources such as funding, materials, services, facilities, or data to help community agencies, organizations, or healthcare providers protect and improve the health and safety of students and staff?

Yes 1

No 2

The next questions ask about the person responsible for overseeing or coordinating your district’s health and safety policies and activities.

152. Currently, does someone in your district oversee or coordinate the district’s health and safety policies and activities, for example a district health coordinator?

Yes 1

No 2 That is the last question. Thank you very much for taking the time to complete this questionnaire.

153. Are you this person?

Yes 1

No 2 That is the last question. Thank you very much for taking the time to complete this questionnaire.

154. Have you ever received any training in your role as a coordinator of your district’s health and safety policies and activities, such as school health coordinator training sponsored by your state education or health agency, colleges, universities, or health organizations such as the American Cancer Society?

Yes 1

No 2

155. Are the following activities included in your responsibilities as coordinator of your district’s health and safety policies and activities?

Yes No NA

1. Developing or assisting in the development
   of school health and safety policy language,
   policy guidance, or other policy materials 1 2

2. Securing funding or other resources
   to support school health and safety policies
   and activities 1 2

3. Communicating school health and safety
   priorities to district decision-makers,
   such as the Superintendent, school board,
   or other district-level administrators 1 2

4. Facilitating linkages between the district’s
   health-related programs and services, and
   health-related resources in the community 1 2

5. Facilitating collaboration among
   district-level staff responsible for the health
   and safety of students and staff 1 2

6. Serving as a liaison between the district
   office and those who oversee or implement
   health and safety policies and activities
   at the school level 1 2

(Q159 continued)

Yes No NA

7. Conducting district school health council,
   committee, or team meetings 1 2 3

8. Directing implementation and evaluation
   of the district-wide health and safety plan 1 2 3

9. Facilitating the provision of school health-related
   professional development 1 2 3

156. Counting this year as a full year, how many years have you been responsible for coordinating health and safety policies and activities at the district level?

______ Years

The last questions ask about your educational background.

157. Do you have an undergraduate degree?

Yes 1

No 2 SKIP TO END

158. What did you major in?

Health education 1

Physical education 2

Other education 3

Kinesiology, exercise physiology,
or exercise science 4

Nursing 5

Nutrition 6

Public health 7

Biology or other science 8

Home economics or family
and consumer science 9

Other (specify) 10

159. Did you have an undergraduate minor?

Yes 1

No 2 SKIP TO Q165

160. What did you minor in?

Health education 1

Physical education 2

Other education 3

Kinesiology, exercise physiology,
or exercise science 4

Nursing 5

Nutrition 6

Public health 7

Biology or other science 8

Home economics or family
and consumer science 9

Other (specify) 10

161. Do you have a graduate degree?

Yes 1

No 2 SKIP TO END

162. In what area or areas?

Health education 1

Physical education 2

Education administration 3

Other education 4

Kinesiology, exercise physiology,
or exercise science 5

Nursing 6

Nutrition 7

Public health 8

Biology or other science 9

Home economics or family
and consumerscience 10

Other (specify) 11

Thank you very much for taking the time to participate in this study.

If you would like more information about this study or would like clarification of any questions in this questionnaire, please call 800-287-1815.

Healthy and Safe School Environment District Questionnaire—Public Use Version