WELLBEING QUESTIONNAIRE

Answer the following questions as honestly as possible:

How much sleep do you have per night?

a) Less than 7 hours

b) Between 7-9 hours
c) More than 9 hours
d) It changes every night

How often to do you eat the following:

Everyday - 2-3 times per week - once per week - barely ever

Junk food e.g burgers/pizza/doughnuts __________________

Vegetables/Salad __________________
Fruit __________________
Water __________________
Juice/Soda __________________
Carbohydrates e.g. rice/potatoes/pasta __________________
Meat __________________

Looking at the above would you say your diet is:

a) Varied
b) Has a little variety
c) Has no variety

How much time per day do you spend looking at a screen (phone/laptop/ipad/tv):

* The average person will be awake for around 16 hours. 6 of these are spent in lessons.

a) Over 12 hours
b) Between 7 - 10 hours
c) Between 4 - 7 hours
d) Between 1 - 4 hours
e) Less than 1 hour

When was the last time you spent a day without your mobile phone?

a) Yesterday
b) Over the christmas holidays
c) A month ago
d) Before I had a phone
e) I don’t remember

How many friends do you have?

_____________

How many of these friends to you speak with (face to face) at least once per week?

_____________

How many ECAs did you attend in Term 1?

_____________

When was the last time you learnt a new skill and what was it?

______________________________________________________________________________

What are the best things about your life?

______________________________________________________________________________

Choose 3 positive words that best describe you:

______________________________________________________________________________

Reflection

From the above, identify 2 areas where you feel you are helping towards your own positive
wellbeing:

1. ________________________________________________________________________
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2. ________________________________________________________________________
________________________________________________________________________
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Now consider 1 area that you could improve:

1. ________________________________________________________________________
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