The Advanced Biology Class composed a two section questionnaire that was distributed to 200 Biology students at Oyster River High School. The first section of the questionnaire was meant to gather general health related information from the student body. The survey, shown below, targeted the areas of exercise, medical problems and treatments, health habits, diet, as well as established the students' schedule which may be used to determine any links between building location and sickness.

Students were also given a short weekly survey, meant to gather data about the students' health for that week. This questionnaire is shown towards the bottom of the page. All students were issued an ID number which linked the answers given on the weekly survey to the health facts gathered in the beginning.

Feel free to submit the forms below which are exact replicas of the paper versions that we use to poll biology classes weekly. While input gathered from this website will not be counted in our experiment it does give us an idea of another data source. 

Questionnaire Section 1 of 2:
ID#:  

Date: Height: Weight:
Gender: M F

Age: 13 14 15 16 17 18 19

My physical activity is best described as the following:
I exercise daily for 20 minutes or more
I exercise at least 5 times a week for 20 minutes or more
I exercise 3-4 times a week for 20 minutes or more
I exercise infrequently or not at all

Do you have any diagnosed medical problems? 
asthma migraines other

Are you on any prescribed medications? (If yes, please list them)

Do you take any steroid-type drugs? (If yes, please list them)

Do you wash your hands after you use the bathroom and before you eat? 
never occasionally usually always

Do you bite your fingernails? No Yes 
Do you smoke tobacco? No Yes 
Does anyone in your family smoke? No Yes 
Do you consume alcoholic beverages? No Yes, about times a month

What liquids do you drink daily? How many cups? (a bottle of soda is about 2˝ cups)

water   0 1 2 3 4 5-6 7-9 10 or more
coffee   0 1 2 3 4 5-6 7-9 10 or more
soda   0 1 2 3 4 5-6 7-9 10 or more
milk   0 1 2 3 4 5-6 7-9 10 or more
tea   0 1 2 3 4 5-6 7-9 10 or more
juice   0 1 2 3 4 5-6 7-9 10 or more

Do you feel high amounts of stress?
I experience very little stress 
I experience some stress
I frequently experience stress
I frequently experience high amounts of stress

How do you get to and from school? car bus on foot or bicycle 
Please list your classes in sequential order. Include where you spend your lunch and free period(s).

Period   Room # Subject

Do you eat a packed lunch or cafeteria food? packed lunch cafeteria

Which if the following might you typically eat for lunch?
yogurt fruit meat pasta bread chips
salad cookies danish candy bar other

How many times a month do you eat fast food?
never 1 2 3 4-5 6-8 9-12 12-16 more often

Do you take vitamins to supplement your diet? No Yes

 

Questionnaire Section 2 of 2:
ID#: Date:

How would you rate your physical health over the past week?
1 (good) 2 3 4 (bad)

Have you experienced any of the following symptoms this week?

headache  sore or irritated throat coughing
frequent sneezing phlegm  congestion runny nose
fever upset stomach vomiting
diarrhea chronic fatigue other
 


Has anyone in your family been sick? How many of them? none 1 2 3-4 5+
(Only if you answered “Yes”) Are/were any of them experiencing the same symptoms that you are experiencing? How many of them? none 1 2 3-4 5+

Have any of your close friends at ORHS been sick? none 1 23-4 5+
(Only if you answered “Yes”) Are/were any of them experiencing the same symptoms that you are experiencing? How many of them? none 1 2 3-4 5+

How many hours of sleep did you get, on average, each day last week?
less than four 4 5 6 7 8 9 10 11 12+

Did you eat breakfast six or more times in the last week? Yes No

How many hours have you spent outdoors in the last week? (Include exercise)
less than one 1 2-3 4-6 7-10 11-15 16-20 21+

Are you currently diagnosed with any diseases? 
laryngitis bronchitis mononucleosis other