Businesses - Sponsors and Providers
Study of Nutrition and Activity in Child Care Settings
Appendix D6 Enviromental Observation Form
Businesses - Sponsors and Providers
OMB: 0584-0615
D.6 Environmental Observation Form
OMB
Control No: 0584-XXXX OMB
Approval Expiration Date: XX/XX/XXXX
LOGO
Study of Nutrition and Activity in Child Care Settings (SNACS)
Environmental Observation Form
Child
Care Center ID
Classroom
ID
Target
Week
Observer ID #: | | | | | | | |
Site Name: ___________________________________________________________________________________
Date of observation: ______ / ____ / ________ Start time: ____ : ____ End time: ____ : _____
Month Day Year
Day of the week:___________________
Observed Classroom/Area: Teacher________________________ Room number (if applicable): ________________
Number of children in observed classroom (mark the maximum number observed): ________
Ages of toddlers/children in classroom (mark all that apply):
12-17mo. 18-23mo. 2yrs 3 yrs
4yrs 5yrs 6yrs 7+yrs
Session Form
The Session Form is to be used to help record all events that take place during the day chronologically. It is used primarily to help data collectors keep a record of all events that happen during your day on site in order to later calculate minutes and location of different types of activities.
Start Time: |
End Time: |
Outside/ Inside |
Activity |
Physical Activity |
Sitting or Standing |
Notes |
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
|
|
□ Outside □ Indoor Gym □ Classroom □ Cafeteria □ Other_____________ |
□ Meal/snack □ Management □ Free play □ Nap □ Organized teacher activity |
□ |
□ |
|
Environmental Observation Form
Outdoor Activity-Related Information
OUTDOOR ACTIVE PLAYTIME (Structured Physical Activity and Staff Behavior under Outdoor Active Playtime should start to be filled out as soon as you head outdoors with the observed classroom and be filled out continuously throughout the time you are outdoors with the observed classroom. You will fill this section out any time you see a teacher leading or joining in physical activity with one or more children or restricting active play for one or more children while outdoors.)
No Active Outdoor Playtime observed Skip to Question 9
Structured Physical Activity
Was structured physical activity (teacher leading some type of active play with one or more children) observed during time outdoors?
Yes (use box below to track minutes and number of occasions)
Total number of times/occasions while outdoors: ___________
Total number of times/occasions optional: ____________
Total minutes of structured physical activity observed while outdoors: _________
No
-
Start Time
End Time
Optional
# children
Primary Activity
1
Y N
2
Y N
3
Y N
4
Y N
5
Y N
6
Y N
7
Y N
8
Y N
9
Y N
10
Y N
Which of the following types of teacher led/structured activities occurred outdoors? (Check all that apply)
Musical games and dancing
Ball games (throwing or catching skills with another person)
Aiming games (bowling or bean bag toss at an object)
Parachute
Climbing games
Balancing games
Jumping games (hop like a bunny)
Running games (tag, Red Rover)
Instruction games (Mother May I; Red Light Green Light)
Calisthenics
Walking
No teacher led activities outdoors
Other ___________________________________________________
Staff Behavior
Did staff join in active play while outdoors?
Yes
How many times per day did you observe staff joining active play while outdoors? _____________ (Use box below to track number of times)
No
Did you observe staff restricting active play as a disciplinary action for misbehavior for one or more children while outdoors?
Yes
How many times per day did you observe staff restricting active play as a disciplinary action while outdoors? __________ (Use box below to track number of times)
No
Outdoor Sedentary Behavior (Please fill out the Screen Time Form for each time you see one or more children using a screen or screen-related device).
Did you observe one or more children using screens or screen-related devices while outdoors?
Yes
No
OUTDOOR ACTIVE PLAYTIME (Outdoor Conditions, Outdoor Portable Equipment and Outdoor Water Availability should be filled out near the end of the outdoor active playtime session)
Outdoor Conditions
For each session of outdoor physical activity observed, complete one line of the grid below. Circle the location the activity was observed (if other, fill in location). If activity takes place in the same place for multiple sessions, use one of the “other” rows for the subsequent sessions, being sure to fill in the location. Complete columns 2 – 7 for each location where physical activity is observed. Columns 4 and 5 are to be completed only if response to column 3 is YES.
1 |
2 |
3 |
4 |
5 |
6 |
7 |
Location of physical activity session |
Outdoor active playtime observed at location |
Is there shade? |
If YES to shade, what type? |
If YES to shade, how much is covered? |
Precipitation |
Ground Conditions |
On-site main playground |
|
|
|
|
|
|
On-site
alternate playground. Specify: |
|
|
|
|
|
|
Other
on-site outdoor play space (may be a field, open space outdoors,
etc.) Specify: |
|
|
|
|
|
|
Shared
space with private entity. Specify:
|
|
|
|
|
|
|
Other:
_______________________ |
|
|
|
|
|
|
Other:
_______________________ |
|
|
|
|
|
|
Outdoor Portable Play Equipment (Check off all portable play equipment – equipment or toys that can be easily moved - that is available during the outdoor active playtime)
Outdoor PORTABLE play equipment |
Yes, available |
No, not available |
Ball play and striking equipment (balls, bean bags, noodles, rackets) |
|
|
Floor play equipment (mats, portable tunnels, etc.) |
|
|
Jumping play equipment (jump ropes, hula hoops, trampoline) |
|
|
Parachute |
|
|
Push-pull toys (wagons, wheelbarrows, big dump trucks, shopping carts, doll strollers, etc.) |
|
|
Riding toys (tricycles, cars, etc.) |
|
|
Rocking and twisting toys (rocking horse, sit-n-spin, etc.) |
|
|
Sand/water play toys (buckets, scoops, shovels) |
|
|
Twirling play equipment (ribbons, scarves, batons, etc.) |
|
|
Other: |
|
|
Outdoor Water Availability
Was drinking water for children available outdoors?
Available for self-service (water fountain/ jug/ water bottles)
Easily visible and available on request
Available during designated water breaks
Water not availableSkip to Other Weather Conditions
Other: _______________________________________
How did the children get drinking water while outdoors?
Water fountain
Water cooler(such as in an office setting)
Communal water pitcher / jug /thermos
Individual water bottles
Other: _________________________
While outdoors, did you witness teachers prompting children to drink water?
Yes
No
OUTDOOR ACTIVE PLAYTIME (These questions can be filled out at any time during the entire observation day and do not need to be filled out while outdoors with the classroom)
Other Weather Conditions (You will look these up online for the time scheduled for the active playtime session)
Weather during scheduled outdoor playtime: High temperature: ______°F Low temperature: ______ °F
Air quality: Good Moderate USG Unhealthy Very Unhealthy Hazardous
No Outdoor Active Playtime
Was the NO outdoor active play due to weather (too hot, too cold, rain/snow)?
Yes (Check all that apply)
Too hot
Too cold
Too rainy
Too snowy
Too windy/wind chill
Ground too wet/muddy/snowy
Poor air quality
Other:___________________
No
Did you see a water source located in the outdoor playspace?
Yes
No
OUTDOOR ACTIVE PLAYSPACE (These questions may be filled out at any time during your observation day, while outdoors or during down time, such as naps. You may need to ask which on-site outdoor spaces are usually used by children, if not able to observe).
Outdoor Playspace—General
Is there an on-site outdoor playspace at this program?
Yes
NoSkip to Question 13
If yes, what is available on-site? (Check all that apply)
Main playground
Alternate playground (specify: ______________________)
Field, grassy area or open space
Parking lot used by children for play
Other, specify:______________________________________
(SKIP to Outdoor Playspace Grid)
If no, what is usually used instead? (Check all that apply)
Public park
A walk around the block
Shared space with some other entity (e.g. school)
Dedicated area to center, but off-site
Other:__________________________________
(END outdoor playspace questions)
Outdoor Playspace—Specific
Answer the questions below for each on-site outdoor playspace. The grid allows for up to four outdoor spaces to be described.
Outdoor Playspace #1
Which outdoor playspace are you assessing?
Main playground
Alternate playground (specify:___________________)
Field, grassy area, or open space
Parking lot used by children for play
Other, specify:
What type of surface does the on-site outdoor playspace have?
Mulch
Happy Landing
Rubberized Mats
Loose rubberized shreds/ nuggets/ strips
Gravel/ pea gravel/ rocks
Grass
Dirt
Concrete
Asphalt/ tar/ black top
Sand
Unable to observe
Other, specify:
Was outdoor playspace…
Unobstructed with plenty of space for group games (tag, red rover, etc.) without moving any equipment or restricting play
Adequate space for group games but certain equipment or activities are restricted
Some obstruction, but enough space for small group (less than 5 children) to play
Little open space or completely obstructed
Unable to observe
No outdoor running space
Outdoor Playspace #2
Which outdoor playspace are you assessing?
Main playground
Alternate playground (specify:___________________)
Field, grassy area, or open space
Parking lot used by children for play
Other, specify:
What type of surface does the on-site outdoor playspace have?
Mulch
Happy Landing
Rubberized Mats
Loose rubberized shreds/ nuggets/ strips
Gravel/ pea gravel/ rocks
Grass
Dirt
Concrete
Asphalt/ tar/ black top
Sand
Unable to observe
Other, specify:
Was outdoor playspace…
Unobstructed with plenty of space for group games (tag, red rover, etc.) without moving any equipment or restricting play
Adequate space for group games but certain equipment or activities are restricted
Some obstruction, but enough space for small group (less than 5 children) to play
Little open space or completely obstructed
Unable to observe
No outdoor running space
Outdoor Playspace #3
Which outdoor playspace are you assessing?
Main playground
Alternate playground (specify:___________________)
Field, grassy area, or open space
Parking lot used by children for play
Other, specify:
What type of surface does the on-site outdoor playspace have?
Mulch
Happy Landing
Rubberized Mats
Loose rubberized shreds/ nuggets/ strips
Gravel/ pea gravel/ rocks
Grass
Dirt
Concrete
Asphalt/ tar/ black top
Sand
Unable to observe
Other, specify:
Was outdoor playspace…
Unobstructed with plenty of space for group games (tag, red rover, etc.) without moving any equipment or restricting play
Adequate space for group games but certain equipment or activities are restricted
Some obstruction, but enough space for small group (less than 5 children) to play
Little open space or completely obstructed
Unable to observe
No outdoor running space
Outdoor Playspace #4
Which outdoor playspace are you assessing?
Main playground
Alternate playground (specify:___________________)
Field, grassy area, or open space
Parking lot used by children for play
Other, specify:
What type of surface does the on-site outdoor playspace have?
Mulch
Happy Landing
Rubberized Mats
Loose rubberized shreds/ nuggets/ strips
Gravel/ pea gravel/ rocks
Grass
Dirt
Concrete
Asphalt/ tar/ black top
Sand
Unable to observe
Other, specify:
Was outdoor playspace…
Unobstructed with plenty of space for group games (tag, red rover, etc.) without moving any equipment or restricting play
Adequate space for group games but certain equipment or activities are restricted
Some obstruction, but enough space for small group (less than 5 children) to play
Little open space or completely obstructed
Unable to observe
No outdoor running space
Outdoor Fixed Play Equipment (Check off all fixed play equipment – equipment or toys that cannot be easily moved - that is available in the outdoor playspace)
Outdoor FIXED play equipment |
Yes, available |
No, not available |
Balancing surfaces (balance beams, boards, etc.) |
|
|
Basketball hoop |
|
|
Climbing structures (jungle gyms, ladders, etc.) |
|
|
Dramatic play structure (playhouse) |
|
|
Merry-go-round |
|
|
Pool |
|
|
Sand box |
|
|
See-saw |
|
|
Slides |
|
|
Swinging equipment (swings, rope, etc.) |
|
|
Tricycle track |
|
|
Tunnels |
|
|
Other__________________________________ |
|
|
Indoor Activity-Related Information
INDOOR ACTIVE PLAYTIME (Structured Physical Activity and Staff Behavior under Indoor Active Playtime should start to be filled out at the beginning of any time indoors with the observed classroom and be filled out continuously throughout the time you are indoors with the observed classroom. You will fill this section out any time you see a teacher leading or joining in physical activity with one or more children or restricting active play for one or more children while indoors).
Structured Physical Activity
Was structured physical activity (teacher leading some type of active play with one or more children) observed during time indoors?
Yes (Use box below to track minutes and number of occasions)
Total number of times/occasions while indoors: ___________
Total number of times/occasions optional: ____________
Total minutes of structured physical activity observed while indoors: _________
No
-
Start Time
End Time
Optional
# children
Primary Activity
1
Y N
2
Y N
3
Y N
4
Y N
5
Y N
6
Y N
7
Y N
8
Y N
9
Y N
10
Y N
Which of the following types of teacher led/structured activities occurred indoors? (Check all that apply)
Musical games and dancing
Ball games (throwing or catching skills with another person)
Aiming games (bowling or bean bag toss at an object)
Parachute
Climbing games
Balancing games
Jumping games (hop like a bunny)
Running games (tag, Red Rover)
Instruction games (Mother May I; Red Light Green Light)
Calisthenics
Walking
No teacher led activities indoors
Other ___________________________________________________
Staff Behavior
Did staff join in active play while indoors?
Yes
How many times per day did you observe staff joining active play while indoors? __________ (Use box below to track number of times)
No
Did you observe staff restricting active play as a disciplinary action for misbehavior for one or more children while indoors?
Yes
How many times per day did you observe staff restricting active play as a disciplinary action while indoors? ___________ (Use box below to track number of times)
No
Indoor Sedentary Behavior (Please fill out the Screen Time Form for each time you see one or more children using a screen or screen-related device).
Did you observe one or more children using screens or screen-related devices while indoors?
Yes
No
INDOOR ACTIVE PLAYTIME (Indoor Portable Equipment and Indoor Water Availability should be filled out once during the observation day, but you will need to look for portable play equipment and water availability throughout the day)
Indoor Portable Play Equipment (Check off all portable play equipment – equipment or toys that can be easily moved - that is available to the children indoors)
Indoor PORTABLE play equipment |
Yes, available |
No, not available |
Ball play and striking equipment (balls, bean bags, noodles, rackets) |
|
|
Dramatic play structure (playhouse) |
|
|
Floor play equipment (mats, portable tunnels, etc.) |
|
|
Jumping play equipment (jump ropes, hula hoops, trampoline) |
|
|
Parachute |
|
|
Push-pull toys (wagons, wheelbarrows, big dump trucks, shopping carts, doll strollers, etc.) |
|
|
Riding toys (tricycles, cars, etc.) |
|
|
Rocking and twisting toys (rocking horse, sit-n-spin, etc.) |
|
|
Sand/water play toys (buckets, scoops, shovels) |
|
|
Twirling play equipment (ribbons, scarves, batons, etc.) |
|
|
Other |
|
|
Indoor Water Availability
How was drinking water for children available indoors?
Available for self-service (water fountain/ jug/ water bottles/cooler)
Easily visible and available on request
Available during designated water breaks
Only during meals and snacks
Water not available for children
Other: _______________________________________
How did the children get drinking water while indoors?
Water fountain
Faucet from sink
Water cooler (such as in an office setting)
Communal water pitcher / jug /thermos
Individual water bottles
Other: _________________________
While indoors, did you witness teachers prompting children throughout the day to drink water?
Yes, regularly (multiple times throughout the day, not just specific occasions such as coming in from outdoor play)
Yes, at specific times only (such as coming in from outdoor play)
No
INDOOR ACTIVE PLAYSPACE (These questions may be filled out at any time during your observation day, while indoors or during down time, such as naps.)
Indoor Playspace—General
Is there an indoor playspace at this program other than the classroom (separate room or gym for active play)?
Yes
No
a. If no, what is usually used instead? (Check all that apply)
Classroom
Cafeteria
Shared space with some other entity (e.g. school)
Dedicated area to program, but off-site
Other:_______________________________
Is there more than one indoor playspace at this program?
Yes
a. If yes, how many? _________
No
Indoor Playspace—Specific
Answer the questions below for each on-site indoor playspace. The grid allows for up to four indoor spaces to be described.
Indoor
Playspace #1
Which
indoor playspace are you assessing?
Separate
room or gym
Classroom
Cafeteria
Shared
indoor space with some other entity (e.g. school)
Other,
specify:________________________________________________
Was
indoor play space suitable for….
Quiet
play (room is small and not a lot of room for movement)
Limited
movement/some active play (enough space for a few children to move
by walking, skipping, hopping, jumping, etc.)
All
activities (enough space for all children in the class to engage in
running activities, such as tag)
Indoor
Playspace #2
Which
indoor playspace are you assessing?
Separate
room or gym
Classroom
Cafeteria
Shared
indoor space with some other entity (e.g. school)
Other,
specify:________________________________________________
Was
indoor play space suitable for….
Quiet
play (room is small and not a lot of room for movement)
Limited
movement/some active play (enough space for a few children to move
by walking, skipping, hopping, jumping, etc.)
All
activities (enough space for all children in the class to engage in
running activities, such as tag)
Separate room or gym
Classroom
Cafeteria
Shared indoor space with some other entity (e.g. school)
Other, specify:________________________________________________
Quiet play (room is small and not a lot of room for movement)
Limited movement/some active play (enough space for a few children to move by walking, skipping, hopping, jumping, etc.)
All activities (enough space for all children in the class to engage in running activities, such as tag)
Separate room or gym
Classroom
Cafeteria
Shared indoor space with some other entity (e.g. school)
Other, specify:________________________________________________
Quiet play (room is small and not a lot of room for movement)
Limited movement/some active play (enough space for a few children to move by walking, skipping, hopping, jumping, etc.)
All activities (enough space for all children in the class to engage in running activities, such as tag)
Indoor
Playspace #3
Which
indoor playspace are you assessing?
Separate
room or gym
Classroom
Cafeteria
Shared
indoor space with some other entity (e.g. school)
Other,
specify:_________________________________________________
Was
indoor play space suitable for….
Quiet
play (room is small and not a lot of room for movement)
Limited
movement/some active play (enough space for a few children to move
by walking, skipping, hopping, jumping, etc.)
All
activities (enough space for all children in the class to engage in
running activities, such as tag)
Indoor
Playspace #4
Which
indoor playspace are you assessing?
Separate
room or gym
Classroom
Cafeteria
Shared
indoor space with some other entity (e.g. school)
Other,
specify:_________________________________________________
Was
indoor play space suitable for….
Quiet
play (room is small and not a lot of room for movement)
Limited
movement/some active play (enough space for a few children to move
by walking, skipping, hopping, jumping, etc.)
All
activities (enough space for all children in the class to engage in
running activities, such as tag)
Indoor Fixed Play Equipment (Check off all fixed play equipment – equipment or toys that cannot be easily moved - that is available in the indoor playspace. Please assess fixed equipment in the classroom, if no additional indoor playspace available)
Indoor FIXED play equipment |
Yes, available |
No, not available |
Balancing surfaces (balance beams, boards, etc) |
|
|
Basketball hoop |
|
|
Climbing structures (jungle gyms, ladders, etc) |
|
|
Dramatic play structure (playhouse) |
|
|
Merry-go-round |
|
|
Pool |
|
|
Sand box |
|
|
See-saw |
|
|
Slides |
|
|
Swinging equipment (swings, rope, etc.) |
|
|
Tricycle track |
|
|
Tunnels |
|
|
Other__________________________________ |
|
|
Classroom Environment
Which of the following screens or screen-related devices are in the classroom and how many are there? (Please count devices that are used by children but may belong to a teacher or a child)
TV; How many? ______
DVD/VCR; How many? ______
Video game console; How many? ______
Desktop or laptop computer for children’s use; How many? _____
Tablet computer or iPad for children’s use; How many? _______
Smart phone for children’s use; How many?__________________
Other screen: __________________; How many? _______
What is the condition of the classroom itself?
Walls
Clean or newly painted, no holes, cracks, chips or marks
Some marks or discolorations, or minor cracks or chips
Holes in wall, cracks wider than ¼ inch, or major discoloration – areas at least as large as this page (8 ½ x 11”)
Floor
Smooth with no stains
Few or light colored stains or some unevenness
Discolored, or holes or cracks, or very uneven
What are the wall or ceiling decorations in the classroom?
Murals
Student Art
Professional Art
Banners
Posters
Other (specify):________________________
None If no decorations, observation is done
Do any of the wall or ceiling decorations in the classroom….
Provide nutrition information?
Promote healthy eating habits?
Promote physical activity?
Promote food safety (e.g. wash hands)?
CALCULATIONS (At the end of the observation day please use Session Form and Screen Time Table to fill in the charts below)
Physical Activity Calculations
Please fill in the table below for physical activity by recording the number of minutes and occasions that took place indoors and outdoors. (Use Session Form to calculate).
|
Indoor Physical Activity |
Outdoor Physical Activity |
Total
Physical Activity |
|||
|
Indoor Occasions |
Indoor Minutes |
Outdoor occasions |
Outdoor minutes |
||
Active time |
______
|
______
|
_____
|
_____ minutes |
_____ occasions |
_____ minutes |
Sedentary Time Calculations
Please fill in the table below for sedentary activity by recording the number of minutes of seated/standing time (Use Session Form to calculate).
|
Minutes of seated or standing time |
Total Seated or Standing Time (outdoor and indoor combined) |
|
|
Indoor Minutes |
Outdoor minutes |
|
Sedentary time |
______ minutes |
______ minutes |
_____ minutes |
Please fill in the table below for minutes of screen time by recording the number of minutes from the Screen Time Table.
|
Total Screen Time |
Screen time |
_____ minutes |
SCREEN TIME TABLE For each occasion of screen time observed (each time a screen is turned on for children), record the following information in the table:
Screen time occasion |
Which of the following screen time devices are turned on? |
Were children mostly active while the screen was on? |
If it is interactive, are other children watching while one child interacts with a screen? |
Did there appear to be a limit on the amount of time spent on the screen? |
Total minutes |
Notes |
Occasion 1
|
|
Yes
No |
Yes No
Does not apply
|
Yes No
Does not apply
|
|
|
Occasion 2
|
Other screen: ____________ |
Yes
No |
Yes No
Does not apply
|
Yes No
Does not apply
|
|
|
Occasion 3
|
Other screen: ____________ |
Yes
No |
Yes No
Does not apply
|
Yes No
Does not apply
|
|
|
Occasion 4 |
Other screen: ____________ |
Yes
No |
Yes No
Does not apply
|
Yes No
Does not apply
|
|
|
Occasion 5 |
|
Yes
No |
Yes No
Does not apply
|
Yes No
Does not apply
|
|
|
Occasion 6 |
|
Yes
No |
Yes No
Does not apply
|
Yes No
Does not apply
|
|
|
Occasion 7 |
|
Yes
No |
Yes No
Does not apply
|
Yes No
Does not apply
|
|
|
Occasion 8 |
|
Yes
No |
Yes No
Does not apply
|
Yes No
Does not apply
|
|
|
TOTAL MINUTES OF SCREEN TIME ADD all screen time minutes together and enter in box |
|
|
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Environmental
Observation Form, p.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Morgan Jones |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |
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