Form Approved
OMB No: 0920-0445
Expiration Date: xx/xx/xxxx
Physical
Education and Activity
School Questionnaire
6 January 2011
§
Public reporting burden for this collection of information is estimated to average 40 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).
Physical Education and
Activity
School Questionnaire
Questions
MODULE 1
Standards 1–4
Required Physical Education 5–14
Instructional Content 15–38
Student Assessment 39–41
Use of Protective Gear 42
Physical Activity and Discipline 43–48
Students with Disabilities 49–54
Facilities 55–60
Staffing and Professional Development 61–66
Collaboration 67–68
Promotion 69–72
Intramural Activities and Physical Activity Clubs 73–84
Community Use of School Facilities 85–90
Physical Education Coordinator 91–102
MODULE 2
Interscholastic Sports 103–121
NOTE: THROUGHOUT THIS QUESTIONNAIRE, TEXT THAT APPEARS IN ALL CAPITAL LETTERS WILL NOT BE READ ALOUD TO RESPONDENTS.
THIS QUESTIONNAIRE WILL BE ADMINISTERED USING COMPUTER ASSISTED PERSONAL INTERVIEW TECHNOLOGY. THE INTERVIEWER WILL READ THE QUESTIONS ALOUD AND TYPE RESPONSES TO THE QUESTIONS INTO THE LAPTOP 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.
What is your job title at the school? (In which role do you spend more time?)
1) Principal 2) Asst. Principal/Other School Administrator 3) School Secretary 4) Physical Ed Teacher 5) Athletic Director 6) Health Ed Teacher 7) Other Teacher 8) Food Service Manager 9) Commercial Food Service Provider 10) Other School Food Service Staff 11) School Counselor |
12) Social Worker 13) Psychologist
14) Other Mental Health/ 15) Nurse 16) Health Aide 17) Physician 18) Other Health Services Provider 19) SBHC Health Services Staff
20) SBHC Mental Health/ 50) Other Staff |
During this interview, I will ask about physical education at your school. By “physical education,” I mean class time that is spent teaching a physical education curriculum. Please do not include instruction on physical activity topics that are part of health education or any other subject. Also, do not consider regularly scheduled recess. You have been identified as the person who knows the most about how physical education is provided throughout all grades at the school. As you think about the questions that I ask, please consider all physical education provided to students at your school. Also, please think about the physical education requirements for students in general, even though there may be some exceptions.
The first questions ask about your school’s physical education standards. These standards might cover student expectations and performance outcomes for physical education.
Does your school follow any national, state, or district physical education standards?
Yes 1
No 2
Are those who teach physical education at your school provided with…
Yes No
Standards for physical education? 1 2
A framework or course of study for physical education? 1 2
One or more physical education curricula? 1 2
Instructional strategies for physical education? …………………1 2
Lesson plans or learning activities for physical education? 1 2
Plans or tools for assessing or evaluating
students
in physical education? 1 2
IF THOSE WHO TEACH PHYSICAL EDUCATION ARE PROVIDED WITH STANDARDS FOR PHYSICAL EDUCATION (Q3A IS “YES”), ANSWER Q4. OTHERWISE, SKIP TO THE INTRODUCTION TO Q5.
Do your school’s standards for physical education specifically address…
Yes No
Competence in motor skills and
movement patterns
needed to perform a variety of physical
activities? 1 2
Understanding of movement concepts,
principles,
strategies, and tactics as they apply to the
learning
and performance of physical activities? 1 2
Regular participation in physical activity? 1 2
Achievement and maintenance of a
health-enhancing
level of physical fitness? 1 2
Responsible personal and social behavior
that respects
self and others in physical activity
settings? 1 2
Value for physical activity for health,
enjoyment,
challenge, self-expression, and/or social
interaction? 1 2
Now I’d like to ask you about required physical education.
Must students attending your school take any physical education as a requirement for graduation or promotion to the next grade level or school level?
Yes 1
No 2 SKIP TO THE INSTRUCTIONS BEFORE Q34
The next several questions are about physical education that students must take for graduation or promotion to the next grade level or school level. During the rest of the interview, I will refer to this physical education as required physical education.
I am going to read a list of reasons why students could be exempted for one grading period or longer from taking required physical education.
Can students at your school be exempted for…
Yes No
Religious reasons? 1 2
Long-term physical or medical disability? 1 2
Cognitive disability? 1 2
Achievement of positive, passing, or high
physical
competency test scores? 1 2
Achievement of positive, passing, or high
physical
fitness test scores? 1 2
Participation in school activities other
than sports,
such as band or chorus? 1 2
Participation in community sports activities? 1 2
Participation in community service activities? 1 2
Standardized test preparation for other subjects? 1 2
ANSWER J, K, AND L FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO Q7.
Enrollment in other courses, such as math or science? 1 2
Participation in school sports? 1 2
Participation in vocational training? 1 2
Does your school prohibit exemptions from physical education requirements?
Yes 1
No 2
In required physical education, are students at your school taught…
Yes No
ANSWER A FOR ELEMENTARY SCHOOL ONLY. OTHERWISE, SKIP TO B.
Movement concepts and skills? 1 2
Individual or paired activities? 1 2
Group or team activities? 1 2
Aquatic activities? 1 2
Dance activities? 1 2
ANSWER Q9 IF STUDENTS ARE TAUGHT INDIVIDUAL OR PAIRED ACTIVITIES IN REQUIRED PHYSICAL EDUCATION AT THIS SCHOOL (Q8B IS “YES”). OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q10.
SHOW CARD 1
Looking at this card, which is in
alphabetical order, please tell me which individual or paired
activities are taught
in required physical education at your school. Please include the
activity itself, lead-up skills, skills specific to the activity, or
modified versions of the activity that are taught.
MARK ALL
THAT APPLY
Aerobics, such as step or low-impact 1
Archery 2
Badminton 3
Bowling 4
Canoeing or kayaking 5
Cardiovascular exercise machines, such as
rowers, ski machines,
stair climbers,
stationary bikes, or treadmills 6
Climbing ropes or wall ladders 7
(Q9 continued)
Climbing walls 8
Physical activity or fitness stations 9
Frisbee or frisbee golf 10
Golf 11
Gymnastics 12
Hiking, backpacking, or orienteering 13
Jumping rope 14
Martial arts 15
Non-stationary bicycling 16
Pilates 17
Racquet sports, other than tennis, such as
racquetball,
handball, squash, or paddleball 18
Rock climbing 19
Running or jogging 20
Skating, such as roller, in-line, or ice skating 21
Skiing, such as cross country, downhill,
or water skiing 22
Student-designed games 23
Table tennis or ping pong 24
Tennis 25
Track and field 26
Walking 27
Weight training 28
Wrestling 29
Yoga 30
None of the above 31
ANSWER Q10 IF STUDENTS ARE TAUGHT GROUP OR TEAM ACTIVITIES IN REQUIRED PHYSICAL EDUCATION AT THIS SCHOOL (Q8C IS “YES”). OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q12.
SHOW CARD 2
Looking at this card, please tell
me which group or team activities are taught
in required physical education at your school. Please include the
activity itself, lead-up skills, skills specific to the activity, or
modified versions of the activity that are taught.
MARK ALL
THAT APPLY
Baseball, softball, or whiffleball 1
Basketball 2
Dodgeball or bombardment 3
Football, such as touch or flag football 4
Hockey, such as field, floor, roller,
or ice hockey 5
Kickball 6
Lacrosse 7
Soccer 8
Student-designed games 9
Ultimate frisbee 10
Volleyball 11
None of the above 12
ANSWER Q11 IF THIS SCHOOL IS AN ELEMENTARY SCHOOL THAT TEACHES GROUP OR TEAM ACTIVITIES IN REQUIRED PHYSICAL EDUCATION (Q8C IS “YES”). OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q12.
SHOW CARD 3
Looking at this card, please tell
me which group or team activities are taught
in required physical education at your school.
MARK ALL THAT
APPLY
Duck-duck-goose 1
Elimination tag 2
King of the hill or capture the flag 3
Red rover 4
Relay races 5
None of the above 6
ANSWER Q12 IF STUDENTS ARE TAUGHT DANCE ACTIVITIES IN REQUIRED PHYSICAL EDUCATION AT THIS SCHOOL (Q8E IS “YES”). OTHERWISE, SKIP TO THE INTRODUCTION TO Q13.
SHOW CARD 4
Looking at this card, please tell
me which dance activities are taught
in required physical education at your school. Please include the
activity itself, lead-up skills, skills specific to the activity, or
modified versions of the activity that are taught.
MARK ALL
THAT APPLY
Folk or multi-cultural dances 1
Performing art dances, such as ballet,
jazz, tap, or modern
dances 2
Social dances, such as ballroom dances,
line dances, hip hop, or
party dances 3
Square dances 4
None of the above 5
The next questions ask about physical education requirements at your school.
I’m going to read you three statements that describe requirements for physical education. Please listen to all three statements before giving your answer. You may choose more than one option.
How would you describe the
physical education requirements at your school?
MARK ALL THAT
APPLY
It is required, but not in a specific grade 1 SKIP TO THE INSTRUCTIONS BEFORE Q19
It is required in specific grades 2 SKIP TO Q15
It is not required 3
Earlier you indicated that students at your school are required to take physical education for graduation or promotion to the next grade level or school level. Is physical education required at your school?
Yes 1 RETURN TO Q13
No 2 RETURN TO Q5 AND THEN SKIP TO THE INSTRUCTIONS BEFORE Q34
At your
school, in which grades do students receive required instruction in
physical education?
MARK ALL THAT APPLY
K 0
1st 1
2nd 2
3rd 3
4th 4
5th 5
6th 6
7th 7
8th 8
9th 9
10th 10
11th 11
12th 12
ANSWER Q16–Q18 FOR EACH GRADE ABOVE.
How many weeks during the school year are _____ grade students scheduled to take physical education?
Weeks
On average, how many days per week are _____ grade students scheduled to take physical education?
1 day 1
2 days 2
3 days 3
4 days 4
5 days 5
0 days one week, 1 day the next week 6
1 day one week, 2 days the next week 7
2 days one week, 3 days the next week 8
3 days one week, 4 days the next week 9
4 days one week, 5 days the next week 10
Other 11
On average, how many minutes is each session of physical education scheduled to last?
Minutes
IF Q13 IS 2 ONLY, SKIP TO THE INSTRUCTIONS BEFORE Q34.
Now, I’m asking about courses that include instruction in physical education that students are required to take while at your school. I am asking about required courses that students do not have to take during any particular grade. Any courses that are chosen by students or are optional for students we will list in the next set of questions. Are students at your school required to take specific courses that include instruction in physical education?
Yes 1
No 2 SKIP TO Q26
Please tell me the names of these specific courses that include instruction in physical education that are required for students at your school.
Course 1 Course 9
Course 2 Course 10
Course 3 Course 11
Course 4 Course 12
Course 5 Course 13
Course 6 Course 14
Course 7 Course 15
Course 8 Course 16
Course 17
Course 18
Course 19
Course 20
ANSWER Q22–25 FOR EACH COURSE LISTED IN Q20 AND Q21.
In what grade do students usually take ?
K 0
1st 1
2nd 2
3rd 3
4th 4
5th 5
6th 6
7th 7
8th 8
9th 9
10th 10
11th 11
12th 12
No usual grade 13
How many weeks is the course scheduled to last?
Weeks
On average, how many days per week is the course scheduled to meet?
1 day 1
2 days 2
3 days 3
4 days 4
5 days 5
0 days one week, 1 day the next week 6
1 day one week, 2 days the next week 7
2 days one week, 3 days the next week 8
3 days one week, 4 days the next week 9
4 days one week, 5 days the next week 10
Other 11
On average, how many minutes is each class period scheduled to last?
Minutes
Some schools have a general physical education requirement for which students must select a certain number of courses from a larger set of courses to fulfill the requirement. These courses are sometimes called “required electives.” Next, I am going to ask you about courses that meet this type of general physical education requirement. However, please do not include any of the required physical education courses that I have already asked you about, including any physical education courses required in a certain grade or any other required courses. Are there any courses at your school that students must choose from to meet this type of general physical education requirement?
Yes 1
No 2 SKIP TO Q34
Please tell me the names of these courses that meet a general physical education requirement at your school.
Course 1 Course 9
Course 2 Course 10
Course 3 Course 11
Course 4 Course 12
Course 5 Course 13
Course 6 Course 14
Course 7 Course 15
Course 8 Course 16
Course 17
Course 18
Course 19
Course 20
Of the courses you just listed, how many must students take to fulfill the general physical education requirement?
Number of courses for general physical education requirement
ANSWER Q30–Q33 FOR EACH COURSE LISTED IN Q27 AND Q28.
In what grade do students usually take ?
K 0
1st 1
2nd 2
3rd 3
4th 4
5th 5
6th 6
7th 7
8th 8
9th 9
10th 10
11th 11
12th 12
No usual grade 13
How many weeks is the course scheduled to last?
Weeks
On average, how many days per week is the course scheduled to meet?
1 day 1
2 days 2
3 days 3
4 days 4
5 days 5
0 days one week, 1 day the next week 6
1 day one week, 2 days the next week 7
2 days one week, 3 days the next week 8
3 days one week, 4 days the next week 9
4 days one week, 5 days the next week 10
Other 11
On average, how many minutes is each class period scheduled to last?
Minutes
Now, I’d like you to think about all physical education, not just required physical education.
IF THIS IS A SINGLE SEX SCHOOL, SKIP TO Q35.
Are there any physical education classes or courses at your school that are taught…
Yes No
Only to boys? 1 2
Only to girls? 1 2
Does your school offer any physical education courses that are taught…
Yes No
Online only? 1 2
Partially online and partially in-person? 1 2
Does your school offer any physical education electives that are not required?
Yes 1
No 2
ANSWER Q37 FOR ELEMENTARY SCHOOL ONLY. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q38.
SHOW CARD 5
My next question is about who teaches physical education.
Looking at this card, please tell
me who teaches physical education to students at your school.
MARK
ALL THAT APPLY
Physical education teacher(s) or specialist(s) 1
Regular classroom teacher(s) 2
Other(s) 3
ANSWER Q38 FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q39.
SHOW CARD 6
My next question is about who teaches physical education.
Looking at this card, please tell
me who teaches physical education to students at your school.
MARK
ALL THAT APPLY
Physical education teacher(s) 1
Health education teacher(s) 2
Other teacher(s) 3
Other(s) 4
IF THIS SCHOOL DOES NOT HAVE ANY REQUIRED PHYSICAL EDUCATION (Q5 IS “NO”), SKIP TO THE INTRODUCTION TO Q43. OTHERWISE, CONTINUE WITH Q39.
These next questions ask about grading students in required physical education.
What type of grade do students
receive for required physical education at your school?
MARK
ALL THAT APPLY
Letter or numerical grade 1
Pass/Fail 2
Other 3
No grades given for physical education 4 SKIP TO THE INTRODUCTION TO Q42
Are grades from required physical education counted the same as grades from other subject areas when determining grade point averages, honor roll status, or other indicators of academic standing?
Yes 1
No 2
School does not calculate grade point
averages or have any other
indicators
of academic standing 3
If students fail required physical education, are they required to repeat it?
Yes 1
No 2
My next question is about protective gear.
Must students wear appropriate protective gear during required physical education?
Yes 1
No 2
Students do not engage in any physical
activities that require
protective gear 3
My next questions are about the use of physical activity as punishment for bad behavior and excluding students from physical education as punishment for bad behavior.
Are staff at your school allowed to use physical activity, such as laps or push-ups, to punish students for bad behavior in physical education?
Yes 1
No 2 SKIP TO Q45
Are staff at your school actively discouraged from using physical activity to punish students for bad behavior in physical education?
Yes 1
No 2
Are physical education teachers at your school allowed to exclude students from all or part of physical education as punishment for bad behavior in physical education class?
Yes 1
No 2 SKIP TO Q47
Are physical education teachers at your school actively discouraged from excluding students from all or part of physical education as punishment for bad behavior in physical education class?
Yes 1
No 2
Are staff at your school allowed to exclude students from all or part of physical education as punishment for bad behavior or failure to complete class work in another class?
Yes 1
No 2 SKIP TO THE INTRODUCTION TO Q49
Are staff at your school actively discouraged from excluding students from all or part of physical education to punish students for bad behavior or failure to complete class work in another class?
Yes 1
No 2
My next questions ask about physical education for students with long-term physical, medical, or cognitive disabilities, such as Down syndrome or conditions that require permanent use of a wheelchair.
Currently, are there any students with long-term physical, medical, or cognitive disabilities enrolled at your school?
Yes 1
No 2 SKIP TO THE INTRODUCTION TO Q55
Is physical education ever included in Individualized Education Programs, or IEPs, or 504 plans for students with long-term physical, medical, or cognitive disabilities?
Yes 1
No 2
Are there any students with long-term physical, medical, or cognitive disabilities who participate in required physical education at your school?
Yes 1
No 2 SKIP TO THE INTRODUCTION TO Q55
Do any of these students participate…
Yes No
In adapted physical education
only, that is separate
from regular physical education? 1 2
In regular physical education only? 1 2
In both adapted and regular physical education? 1 2
IF Q52A IS “YES” AND Q52C IS “NO,” SKIP TO THE INSTRUCTIONS BEFORE Q54.
SHOW CARD 7
Looking at this card, please tell
me who assists the physical education teacher with teaching students
with long-term
physical, medical, or cognitive disabilities in regular physical
education.
MARK ALL THAT APPLY
Special education teacher(s) 1
Special education teacher’s aide(s) 2
Adapted physical education teacher(s)
or specialist(s) 3
Physical or occupational therapist(s) 4
Physical education teacher(s) or specialist(s) 5
Regular classroom teacher(s) 6
Other(s) 7
IF Q52B IS “YES”AND Q52C IS “NO,” SKIP TO THE INTRODUCTION TO Q55.
SHOW CARD 8
Looking at this card, please tell
me who teaches adapted physical education.
MARK ALL THAT APPLY
Regular physical education teacher(s) 1
Adapted physical education teacher(s)
or specialist(s) 2
Special education teacher(s) 3
Special education teacher’s aide(s) 4
Physical or occupational therapist(s) 5
Regular classroom teacher(s) 6
Other(s) 7
In these next questions, I’ll ask about the facilities that your school might have for physical education.
Does your school have locker rooms with showers for students?
Yes 1
No 2
SHOW CARD 9
This card lists facilities that your school might have access to for indoor physical education either on or off school property. As I read the list, please tell me which facilities your school has access to for indoor physical education.
Does your school have access to…
Yes No
A gymnasium? 1 2
An indoor track? 1 2
An indoor pool? 1 2
A weight room? 1 2
A cardiovascular fitness center? 1 2
A wrestling room? 1 2
A dance studio? 1 2
A racquetball or squash court? 1 2
I am going to read you another list of facilities your school might use for physical activity during indoor physical education.
Does your school use…
Yes No N/A
Regular
classrooms for indoor
physical education? 1 2
A
cafeteria, auditorium, or other
multi-purpose room for
indoor
physical education? 1 2
Any
trailers or mobile buildings
for indoor physical
education? 1 2 3
IF Q56A IS “NO” AND Q57B IS “NO,” SKIP TO THE INTRODUCTION TO Q59.
How crowded is your _________________ during a typical physical education class? Would you say it is…
Less than 50% full? 1
50 to 75% full? 2
76 to 100% full? 3
Over capacity? 4
SHOW CARD 10
As I read this list, please tell me which facilities your school has access to for outdoor physical education either on or off school property.
Does your school have access to…
Yes No
A track for walking, jogging, or running? 1 2
An outdoor pool? 1 2
An outdoor volleyball court? 1 2
An outdoor basketball court? 1 2
An outdoor tennis court? 1 2
A baseball or softball field? 1 2
A soccer or football field? 1 2
A general use field? 1 2
Physical activity or fitness stations? 1 2
ANSWER J FOR ELEMENTARY SCHOOL ONLY. OTHERWISE, SKIP TO Q60.
Playground equipment? 1 2
Does your school use a parking lot or black top area for outdoor physical education?
Yes 1
No 2
ANSWER Q61 AND Q62 IF THIS SCHOOL HAS ANY REQUIRED PHYSICAL EDUCATION (Q5 IS “YES”). OTHERWISE, SKIP TO Q63.
My next questions ask about staffing for physical education at your school.
Is there a maximum student-to-teacher ratio allowed for required physical education at your school?
Yes 1
No 2 SKIP TO Q63
What is the maximum student-to-teacher ratio allowed for physical education?
Students per teacher
Are newly hired staff who teach physical education required to have undergraduate or graduate training in physical education or a related field?
Yes 1
No 2
Are newly hired staff who teach physical education required to be certified, licensed, or endorsed by the state in physical education?
Yes 1
No 2
State does not offer certification, licensure,
or endorsement 3
Are all staff who teach physical education required to earn continuing education credits on physical education topics or instructional strategies?
Yes 1
No ………..2 SKIP TO THE INTRODUCTION TO Q67
How often are all staff who teach physical education required to earn continuing education credits on physical education topics or instructional strategies?
Every year 1
Every 2 to 3 years 2
Every 4 to 5 years 3
More than every 5 years 4
Other time frame 5
No specified time 6
Now I’m going to ask you about collaboration among physical education staff and other school and local agency staff.
67a. During the past 12 months, have the physical education staff worked on physical education activities with health education staff from your school?
Yes 1
No 2
School does not have health education staff 3
67b. What about with health services staff from your school?
Yes 1
No 2
School does not have health services staff 3
67c. What about with mental health or social services staff from your school?
Yes 1
No 2
School does not have mental health
or social services staff 3
67d. What about with nutrition or food service staff from your school?
Yes 1
No 2
School does not have nutrition
or food service staff 3
During the past 12 months, have your school’s physical education staff worked on physical education activities with staff or members from…
Yes No N/A
A local health department? 1 2 3
A local hospital? 1 2 3
A local
mental health or social
services agency? 1 2 3
A health
organization, such as
the American Heart Association or
the
American Cancer Society? 1 2 3
A local college or university? 1 2 3
A local business? 1 2
A local parks or recreation department? 1 2 3
A local
youth organization, such as
the Boys and Girls Clubs? 1 2 3
Alliance for a Healthier Generation? 1 2
A local
service club, such as
the Rotary Club? 1 2 3
A local health or fitness club? 1 2 3
A local professional sports team? 1 2 3
A local
department of transportation
or public works? 1 2 3
A local law enforcement agency? 1 2 3
During the past 12 months has your school used fitness test scores for advocacy or policy change, such as to advocate for more physical education?
Yes 1
No 2
School does not conduct fitness tests 3
The next question asks about physical education promotion that might occur at your school.
During the past 12 months, has your school…
Yes No
Met with a parents’
organization, such as the PTA,
to discuss school physical
education? 1 2
Provided families of all students with
information
on school physical education? 1 2
Discussed student performance in physical
education
as part of parent-teacher conferences? 1 2
Invited families of all students to attend physical
education classes? 1 2
Collected suggestions from students about
school
physical education? 1 2
Collected suggestions from students’
families
about school physical education? 1 2
The next question asks about physical activity promotion that might occur at your school.
During the past 12 months, has your school…
Yes No
Provided families of all students
with information
on physical activity? 1 2
Offered school-wide physical activity or
sports events,
such as fun runs, to families of all
students? 1 2
Invited families of all students to
volunteer
at physical activity programs, such as field day? 1 2
During the past two years, have…
Yes No
Students helped develop,
communicate,
or implement physical education or physical
activity
policies or activities? 1 2
Students’ families helped develop,
communicate,
or implement physical education or physical
activity
policies or activities? 1 2
Community members helped develop,
communicate,
or implement physical education or physical
activity
policies or activities? 1 2
My next questions ask about opportunities that students at your school might have to participate in intramural activities and physical activity clubs. By “intramural activities” and “physical activity clubs,” I mean any physical activity program that is voluntary for students, in which students are given an equal opportunity to participate regardless of physical ability, and in which students have the opportunity to be involved in the planning, organization, and administration of the program, under the supervision of a qualified adult.
Does your school offer opportunities for students to participate in intramural activities or physical activity clubs?
Yes 1
No 2 SKIP TO THE INSTRUCTIONS BEFORE Q85
Are students provided with information about intramural activities or physical activity clubs…
Yes No
During school announcements? 1 2
On a school Web site or in a school publication? 1 2
On posters or other materials on display in the school? 1 2
SHOW CARD 11
This card lists different intramural activities or physical activity clubs that might be offered to students at your school. As I read this list, please tell me if the activity is offered.
Yes No
Aerobics, such as step or low-impact 1 2
Archery 1 2
Badminton 1 2
Baseball, softball, or whiffleball 1 2
Basketball 1 2
Bowling 1 2
Canoeing or kayaking 1 2
Cardiovascular fitness 1 2
Dance, such as ballroom, folk, or square dance 1 2
Football, such as touch or flag football 1 2
(Q75 continued)
Yes No
Frisbee, frisbee golf, or ultimate frisbee 1 2
Golf 1 2
Gymnastics 1 2
Hiking, backpacking, or orienteering 1 2
Hockey, such as field, floor, roller, or ice hockey 1 2
Jump rope 1 2
Lacrosse 1 2
Martial arts 1 2
Non-stationary bicycling 1 2
Pilates 1 2
Racquet sports, other than tennis, such as
racquetball,
handball, squash, or paddleball 1 2
Rock climbing 1 2
Running or jogging 1 2
Skating, such as roller, in-line, or ice skating 1 2
Skiing, such as cross country, downhill, or water skiing 1 2
Soccer 1 2
Swimming, diving, or water polo 1 2
Table tennis or Ping-Pong 1 2
Tennis 1 2
Volleyball 1 2
Walking 1 2
Weight training 1 2
Wrestling 1 2
Yoga 1 2
Are any of these intramural activities or physical activity clubs offered…
Yes No
Only to boys? 1 2
Only to girls? 1 2
Does your school provide transportation home for students who participate in after-school intramural activities or physical activity clubs?
Yes 1
No 2
Intramurals/physical activity clubs
do not meet after school 3
Must students pay an activity fee to participate in any intramural activities or physical activity clubs?
Yes 1
No 2 SKIP TO Q80
Is the fee waived if the student cannot afford to pay?
Yes 1
No 2
Are staff paid to supervise, lead, or coach intramural activities or physical activity clubs?
Yes 1
No 2
Do community members volunteer to supervise, lead, or coach intramural activities or physical activity clubs?
Yes 1
No 2
Do those who supervise, lead, or coach intramural activities or physical activity clubs receive any training from your school or district?
Yes 1
No 2
Does your school follow any national, state, or district guidelines for intramural activities or physical activity clubs?
Yes 1
No 2
Must students wear appropriate protective gear when engaged in intramural activities or physical activity clubs?
Yes 1
No 2
Students do not engage in any intramural
activities or physical
activity clubs
that require protective gear 3
ANSWER Q85–Q90 IF THIS SCHOOL HAS ANY INDOOR OR OUTDOOR FACILITIES THAT COULD BE USED FOR PHYSICAL EDUCATION OR ACTIVITY (ANY Q56 OR Q59 IS “YES”). OTHERWISE, SKIP TO Q91.
The following questions are about the use of facilities on school property for programs sponsored by community organizations such as a YMCA, parks and recreation department, or Boys and Girls Clubs. Do not include school-sponsored interscholastic sports, intramural activities, or physical activity clubs.
Outside of school hours or when school is not in session, do children or adolescents use any of your school’s physical activity or athletic facilities for…
Yes No
Community-sponsored sports teams? 1 2
Community-sponsored classes or lessons,
such
as tennis or gymnastics? 1 2
Community-sponsored supervised “open-gym”
or
“free-play?” 1 2
IF ALL ANSWERS TO Q85 ARE “NO,” SKIP TO Q87. OTHERWISE, CONTINUE WITH Q86.
Are any of these physical activity programs for children and adolescents offered…
Yes No
Before school? 1 2
After school? 1 2
In the evenings? 1 2
On the weekends? 1 2
During school vacations? 1 2
Outside of school hours or when school is not in session, do adults who are not school employees use any of your school’s physical activity or athletic facilities for…
Yes No
Community-sponsored sports teams? 1 2
Community-sponsored physical activity
classes
or lessons, such as tennis or aerobics? 1 2
Community-sponsored “open-gym?” 1 2
IF ALL ANSWERS TO Q87 ARE “NO,” SKIP TO Q89. OTHERWISE, CONTINUE WITH Q88.
Are any of these physical activity programs for adults offered…
Yes No
Before school? 1 2
After school? 1 2
In the evenings? 1 2
On the weekends? 1 2
During school vacations? 1 2
Can children or adults in the community use any of your school’s outdoor physical activity and athletic facilities without being in a supervised program?
Yes 1
No 2 SKIP TO Q91
School does not have outdoor
physical activity/athletic
facilities 3 SKIP TO Q91
Can children or adults in the community use your school’s outdoor physical activity and athletic facilities without being in a supervised program…
Yes No
Before school? 1 2
After school? 1 2
In the evenings? 1 2
On the weekends? 1 2
During school vacations? 1 2
Currently, does someone at your school oversee or coordinate physical education?
Yes 1
No 2 SKIP TO Q102
Are you this person?
Yes 1
No 2 SKIP TO Q102
My last set of questions asks about your teaching experience and educational background.
Counting this year as a full year and including years spent teaching physical education at any other elementary, middle, or high schools, how many years of experience do you have teaching physical education?
Years
Do you coach an interscholastic sport?
Yes 1
No 2
Do you have an undergraduate degree?
Yes 1
No 2 SKIP TO Q101
What did you major in?
MARK
ALL THAT APPLY
Physical education 1
Health education 2
Other education 3
Kinesiology, exercise physiology,
or exercise science 4
Other (Specify) 5
Did you have an undergraduate minor?
Yes 1
No 2 SKIP TO Q99
What did you minor in?
MARK
ALL THAT APPLY
Physical education 1
Health education 2
Other education 3
Kinesiology, exercise physiology,
or exercise science 4
Other (Specify) 5
Do you have a graduate degree?
Yes 1
No 2 SKIP TO Q101
In what area or areas?
MARK
ALL THAT APPLY
Physical education 1
Health education 2
Other education 3
Kinesiology, exercise physiology,
or exercise science 4
Other (Specify) 5
Currently, are you certified, endorsed, or licensed by the state to teach physical education in…
State does not
offer certification,
licensure,
or
endorsement
to teach
physical
education
Yes No at this level
Elementary school? 1 2 3
Middle school? 1 2 3
High school? 1 2 3
My supervisor may wish to call you to ask about how I conducted this interview. Would you please tell me a telephone number where we might reach you starting with the area code?
( ) -
1) Daytime or
2) Evening/Weekend
Thank you very much for taking the time to complete this interview.
What is your job title at the school? (In which role do you spend more time?)
1) Principal 2) Asst. Principal/Other School Administrator 3) School Secretary 4) Physical Ed Teacher 5) Athletic Director 6) Health Ed Teacher 7) Other Teacher 8) Food Service Manager 9) Commercial Food Service Provider 10) Other School Food Service Staff 11) School Counselor |
12) Social Worker 13) Psychologist
14) Other Mental Health/ 15) Nurse 16) Health Aide 17) Physician 18) Other Health Services Provider 19) SBHC Health Services Staff
20) SBHC Mental Health/ 50) Other Staff |
I am going to read a list of interscholastic sports that might be offered to students at your school. As I read the list, please tell me if the sport is offered.
Yes No
Badminton 1 2
Baseball 1 2
Basketball 1 2
Bowling 1 2
Cheerleading or competitive spirits 1 2
Cross-country 1 2
Downhill or cross country skiing 1 2
Fast pitch or slow pitch softball 1 2
Field hockey 1 2
Football 1 2
Golf 1 2
Gymnastics 1 2
Ice hockey 1 2
Lacrosse 1 2
(Q104 continued)
Riflery 1 2
Soccer 1 2
Swimming or diving 1 2
Tennis 1 2
Track and field 1 2
Volleyball 1 2
Water polo 1 2
Weight lifting 1 2
Wrestling 1 2
IF THIS IS A SINGLE SEX SCHOOL, SKIP TO Q106.
Are any of these interscholastic sports offered…
Yes No
Only to boys? 1 2
Only to girls? 1 2
SHOW CARD 12
Which of the following statements best describes your school’s tryout procedures for interscholastic sports?
Students must try out to be able to participate
on all
interscholastic sports teams 1
Students must try out to be able to participate
on some
interscholastic sports teams 2
Students are not required to try out to be able
to participate
on any interscholastic
sports teams 3
Does your school distribute a handbook containing policies, regulations, rules, and enforcement measures for students who participate in interscholastic sports?
Yes 1
No 2
Are coaches at your school allow to use physical activity, such as laps or push-ups, to punish students for poor performance or bad behavior in interscholastic sports?
Yes 1
No 2 SKIP TO Q110
Are coaches at your school actively discouraged from using physical activity to punish students for poor performance or bad behavior in interscholastic sports?
Yes 1
No 2
Does your school provide transportation home for students who participate in interscholastic sports?
Yes 1
No 2
Must students pay an activity fee to participate in any interscholastic sports?
Yes 1
No 2 SKIP TO Q113
Is the fee waived if the student cannot afford to pay?
Yes 1
No 2
Must students wear appropriate protective gear when engaged in interscholastic sports?
Yes 1
No 2
Students do not engage in any interscholastic
sports that
require protective gear 3
How often does the interscholastic sports program at your school…
Almost
Some- Always or
Never Rarely times Always
Require
physical examination by a health
care provider before
participation? 1 2 3 4
Require
neurocognitive testing
before
participation? 1 2 3 4
Require
student athletes and their parents
to review and sign a
concussion
information sheet before participation? 1 2 3 4
Avoid
excesses in training regime
that may result in injuries, such
as
heat stroke, exhaustion, dehydration,
sprains, or
strains? 1 2 3 4
Reward
students for good sportsmanship,
teamwork, and adherence to
safety rules? 1 2 3 4
Strictly
enforce prohibitions against
alcohol or drug use? 1 2 3 4
Actively
discourage student use of
steroids, hormones, or other
substances
to enhance athletic performance? 1 2 3 4
Strictly
enforce prohibitions against
violence and aggression by
students,
spectators, coaches, and other persons
during
sporting events? 1 2 3 4
Strictly
enforce prohibitions against
dangerous athletic behaviors, such
as
spearing in football, high sticking in
hockey, or bat
throwing in baseball? 1 2 3 4
Report all
sports-related injuries
to the appropriate authority? 1 2 3 4
Does the interscholastic sports program…
Yes No
Establish criteria, including
clearance by a healthcare
provider, before allowing further
participation in practice
or reentry into game play after a
suspected concussion? 1 2
Establish criteria for safe playing
conditions,
for example avoiding extreme temperatures
or
dangerous field conditions? 1 2
Is a head coach at your school required to…
Yes No
Have previous coaching experience in any sport? 1 2
Have previous coaching experience in the
sports
they will be coaching? 1 2
Have a teaching certificate? 1 2
Complete a coaches’ training course? 1 2
Be certified in first aid? 1 2
Be certified in CPR? 1 2
Have training on how to prevent, recognize,
and respond
to concussions among student athletes? 1 2
Be employed by your school or school district? 1 2
Are assistant coaches or volunteer athletic aides required to complete a training course?
Yes 1
No 2
School does not have assistant
coaches/volunteer athletic
aides 3
Do any certified athletic trainers provide services for the interscholastic sports teams?
Yes 1
No 2
During the past 12 months, has your school…
Yes No
Provided educational materials to
students or parents
on preventing, recognizing, and responding
to concussions? 1 2
Provided educational sessions to students or
parents
on preventing, recognizing, and responding to
concussions? 1 2
IF RESPONDENT ANSWERS YES TO Q119A, THEN ASK:
Were “Heads Up” materials from the Centers for Disease Control and Prevention included in these materials?
Yes 1
No 2
My supervisor may wish to call you to ask about how I conducted this interview. Would you please tell me a telephone number where we might reach you starting with the area code?
( ) -
1) Daytime or
2) Evening/Weekend
Thank you very much for taking the time to complete this interview with me.
Physical Education School Questionnaire—National Review Version
File Type | application/msword |
File Title | Form Approved |
Author | dallen |
Last Modified By | arp5 |
File Modified | 2011-03-09 |
File Created | 2011-03-03 |