FOOD SURVEY

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FOOD SURVEY

ERASMUS+ HEALTHY MIND, HEALTHY LEARNER 2019-2021

Email *

What's your name? *

How old are you?

Gender

Male

Female

Clear selection

Do you have the 3 meals recommended during the day ? *

Everyday

Often

Sometimes

Never

Which is your main meal? *

Breakfast

Lunch

Dinner

Do you have your breakfast ? *

Everyday

Often

Sometimes

Never

If you have a breakfast, what do you usually have? *

Water

tea, coffee

chocolate drinks

fruit juice

dairy products (yoghurt, cheese...)

fruits

cereal

bread

butter

jam

salted products

Others: …………………………………………………………………………………………………………………..

Required

Do you usually feel tired or hungry, in the morning ? *

Yes

Sometimes

During lunch or dinner, do you take the full recommended meals (starter, main course, dessert) *

Yes

Not all the time

Do you eat at the high school canteen ? *

Yes

If you don’t eat there, what do you usually have for lunch ? *

a home made meal

a sandwich

a salad

a take-away meal

other

Do you take a snack in the afternoon ? *

Never

Often

Sometimes

Always

If yes, what do you eat? *

Do you take your dinner with your family ? *

Everyday

Often

Sometimes

Never

Which meals do you take while watching TV ? *

Breakfast

Lunch

Snack

Dinner

Do you nibble ? *

Never

Sometimes

Often

Everyday

If yes, what do you nibble ?

Do you nibble while you watch TV or in front of your computer ?

Never

Sometimes

Often

Always

Clear selection

How often do you eat these products ? *

Everyday

Often

Rarely

Never

sweet things

pastry, biscuits

crisps, aperitif biscuits

fruits

vegetables

meat

fish

dairy products

cereals, starchy

Are you a vegetarian or a vegan? *

Yes

Which drinks do you have during your lunch or your dinner ? *

Water

Sodas (limonade, cola, ...)

milk

fruit juice

water and syrup

Which drinks do you consume out of meals ? *

water

sodas (limonade, cola, ...)

milk

fruit juice

water and syrup

During the dinner, do you eat in ……… quantity : *

light

regular

important

Do you think that you usually eat *

normally

too much

insufficiently

Do you think that your weight is *

regular

too low

too much

Have you ever tried a diet ? *

Yes

Do you go in fast-foods ? *

never

sometimes

often

very often

Do you think that you have a balanced diet ? *

Yes

I don't know

Do you think that your way of eating has an impact on your life ? *

Yes

Maybe

Suggest an idea of balanced diet *

Do you practice a physical activity ? : *

very regularly

usually

sometimes

never

Do you consume alcohol?

Often

Sometimes

Occasionally

Never

Clear selection

Do you use drugs ?

Often

sometimes

occasionally

never

Clear selection

Do you smoke? *

often

sometimes

occasionally

never

If you consume alcohol or/and drugs, why do you do it ? *

to do like friends

to feel good

to be more self-confident

to be accepted in the group

to forget my problems

How many hours do you sleep in a night ? *

more than 8 hours

between 7 and 8 hours

less than 7 hours

Do you think that you are enough informed about... *

yes

food hygiene

risks associated to the use of drugs and alcohol

tobacco dangers

problems associated to the lack of sleep

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