Healthy Lifestyle Survey
Name: Position:
How Healthy You Really Are!
Questionnaire
1. How do you go to work? _a. Walk _b. Drive
2. Do you eat muesli* for breakfast? (*a mixture of uncooked grains, dried fruit, and nuts, eaten with milk) _a. Yes _b. No, never
3. Do you eat sweets between meals? _a. No _b. Yes
4. How often do you play sport? _a. at least once a week _b. gave up
5. Did your waist size increase? _a. No, it’s the same _b. Yes
6. What do you do in the evening? _a. Housework _b. Sit and watch TV
7. How often do you drink (alcohol)? _a. Moderate _b. A lot at weekends
8. How often do you eat chocolates? _a. occasionally few _b. Often
9. How often do you eat chips? _a. Never _b. more than once in a week
10. How do you go to the upper floor of the Department Store? _a. Walk _b. take the lift
11. How often do you eat fish? _a. At least once a week _b. Never
12. How often do you do exercises? _a. Whenever I get a chance _b. Never
13. Do you eat pudding? _a. No _b. Yes
14. Do you go to the countryside often? _a. Yes, a lot. _b. No
15. How do you relax? _a. Read a book _b. Go to the pub
Comment: _________________________________________________________________________________________________________________________________________________________________________________
Result:
14-15 a’s: Congratulations! You’re as fit as a fiddle.
10-13 a’s: You’re in pretty good shape. Keep it up!
6-9 a’s: You could be in better condition. Perhaps you need to go on a diet or join gym.
0-5 a’s: Oh dear! You’d better go to the doctor for a check-up before it’s too late!
How Healthy You Really Are!
Questionnaire
1. How do you go to work? _a. Walk _b. Drive
2. Do you eat muesli* for breakfast? (*a mixture of uncooked grains, dried fruit, and nuts, eaten with milk) _a. Yes _b. No, never
3. Do you eat sweets between meals? _a. No _b. Yes
4. How often do you play sport? _a. at least once a week _b. gave up
5. Did your waist size increase? _a. No, it’s the same _b. Yes
6. What do you do in the evening? _a. Housework _b. Sit and watch TV
7. How often do you drink (alcohol)? _a. Moderate _b. A lot at weekends
8. How often do you eat chocolates? _a. occasionally few _b. Often
9. How often do you eat chips? _a. Never _b. more than once in a week
10. How do you go to the upper floor of the Department Store? _a. Walk _b. take the lift
11. How often do you eat fish? _a. At least once a week _b. Never
12. How often do you do exercises? _a. Whenever I get a chance _b. Never
13. Do you eat pudding? _a. No _b. Yes
14. Do you go to the countryside often? _a. Yes, a lot. _b. No
15. How do you relax? _a. Read a book _b. Go to the pub
Comment: _________________________________________________________________________________________________________________________________________________________________________________
Result:
14-15 a’s: Congratulations! You’re as fit as a fiddle.
10-13 a’s: You’re in pretty good shape. Keep it up!
6-9 a’s: You could be in better condition. Perhaps you need to go on a diet or join gym.
0-5 a’s: Oh dear! You’d better go to the doctor for a check-up before it’s too late!