Survey Questionnaire for Relationship between Eating Habits and School Outcomes of Grade Six Pupils of Arellano University-

Legarda Campus
Directions: Fill out each question with the appropriate answers. Mark with check ( answer. Part I. Demographic Profile of the Respondents Name:(Optional)________________ Age : _____ Gender: ______ Part II. For the table below refer to this guide: Put a check () on the corresponding answer Lagyan ng check () ang iyong sagot Please think carefully about how you usually ate over the last year as you answer the following questions. Isiping mabuti kung anu ang kadalasang kinakain mo sa nakalipas na isang taon. Scale 5 4 3 2 ` 1 Verbal Interpretation Always Often Sometimes Rarely Never Description 7 or more times a week 5-6 times a week 3-4 times a week 1-2 times a week Never ), the choice of

TABLE 1 Food Preference

Always (Palagi) Often (Madalas) Sometimes (Minsan) Rarely (Bihira) Never (Hindi)

1.1 Do you eat 1 cup of vegetables? Kumakain ka ba ng gulay na may dami ng isang tasa? (repolyo, letsugas,talong kalabasa, sitaw, atbp.) 1.2 Do you eat fruits? (2 medium sized fruit) Kumakain ka ba ng prutas?(2 katamtamang laki ng prutas) (saging, mangga, mansanas, santol, ubas, pinya, atis,atbp) 1.3 Do you eat 2-3 servings of meat products? Kumakain ka ba ng 2-3 servings ng karneng baboy o baka? 1.4 Do you eat 2-3 servings of fish? Kumakain ka ba ng 2-3 servings ng isda 1.5 Do you eat 2-3 servings of chicken? Kumakain ka ba 2-3 servings ng manok?

1.6 Do you eat 2-3 cups of rice? Kumakain ka ba ng 2-3 tasa ng kanin? 1.7 Do you eat 2-3 servings of processed foods? Kumakain ka ba ng hotdog, tocino, longganisa atbp.? 1.8 Do you eat 2 servings of junk foods? Kumakain ka ba ng tsitsirya? (Chippy, Piattos, chicharon, Nova, Lays, Pringels atbp.) 1.9 Do you eat 2-3 servings ng bread and pastries? Kumakain ka ba ng 2-3 servings tinapay at pastries? (pandesal, donut, cake, cookies, biskwit, tasty bread, atbp) 1.10 Do you eat 3-5 servings of sweets? Kumakain ka ba ng minatamis tulad ng chocolates,candies honey,lollipop, atbp.?

TABLE 2
Always (Palage) Often (Madalas) Sometimes (Minsan) Rarely (Bihira) Never (Hindi)

Food Preparation 2.1 Is it boiled? Ito ba ay nilalaga tulad ng sinigang, tinola, kaldereta, paksiw atbp.? 2.2 Is it grilled? Ito ba ay inihaw tulad ng inihaw na isda, chicken bbq,pork bbq,liempo atbp. ? 2.3 Is it fried? Ito ba ay pinirito tulad ng pritong isda,fried chicken, hotdog, bacon, pork chop atbp.? 2.4 Is it steamed? Ito ba ay pinasingawan tulad siomai, steamed fish, siopao atbp.? TABLE 3 Meal Intake 3.1 Do you eat your breakfast? Nag-aalmusal ka ba? 3.2 Do you eat snacks in the morning? Nagmemeryenda ka ba sa umaga? 3.3 Do you eat your lunch? Nag tatanghalian ka ba? 3.4 Do you eat snacks in the afternoon? Nagmemeryenda ka ba sa hapon? 3.5 Do you eat your dinner? Naghahapunan ka ba?

Always (Palage)

Often
(Madalas)

Sometimes (Minsan)

Rarely (Bihira)

Never (Hindi)

3.6 Do you eat midnight snacks? Kumakain ka ba ng midnight snacks? 3.7 Do you bring packed lunch in school? Nagdadala ka ba ng sariling baon na pagkain? Number of meals per day Less than 3 3

More than 6

TABLE 4 How often do you drink the following beverages? Beverages Juice Coffee and Tea Soft drinks Milk Chocolate Drink Every meal Thrice a day Twice a day Once a day Never

How many glasses of water do you drink in a day? Less than 8 glasses 8-10 glasses More than 10 glasses

Part 3: School Outcomes Scale 5 4 3 2 1 School Outcomes

Verbal Interpretation Always Often Sometimes Rarely Never

Always (Palagi) Often (Madalas)

Description 7 or more participation 5-6 3-4 1-2 Never

Sometimes (Minsan) Rarely (Bihira) Never (Hindi)

4.1 Do you join school activities? Sumali ka ba sa mga school activities tulad ng? (nutrition month,academiclympics, buwan ng wika, science week, English week, quiz bees, HELE week, spelling bee, field day/demonstration, UN day.) 4.2 Do you participate and join school organization and clubs? Sumasali ka ba sa mga organisasyon at mga clubs? Class officer, math club, science club, English Club,Arts Club, Music Club, Filipino Club etc.