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Home - Our services - School Nursing (Knowsley) - Pupil Health Assessment Questionnaire (Year 6) – Knowsley

Pupil Health Assessment Questionnaire (Year 6) – Knowsley

Your answers to the following questions are confidential

Name of School*
Your Name*
Your date of birth*

Day
Month
Year
How do you feel about your life in school?*
Choose from 0 – 10
- 0 – Very negative 🙁
- 1
- 2
- 3
- 4
- 5 😐
- 6
- 7
- 8
- 9
- 10 – very positive 😁
Please use the comment box to add any information about how you are feeling.
How do you feel about your life outside school (your community, clubs, travelling to and from school)?*
Choose from 0 – 10
- 0 – Very negative 🙁
- 1
- 2
- 3
- 4
- 5 😐
- 6
- 7
- 8
- 9
- 10 – very positive 😁
Please use the comment box to add any information about how you are feeling.
How do you feel about your life at home?*
Choose from 0 – 10
- 0 – Very negative 🙁
- 1
- 2
- 3
- 4
- 5 😐
- 6
- 7
- 8
- 9
- 10 – very positive 😁
Please use the comment box to add any information about how you are feeling.
Do you have any worries about your health and wellbeing?
- Yes
- No
Please use the comment box to add any information about how you are feeling.
Can you see the writing on the board from the back of the classroom?
If you struggle to see the writing on the board please ask someone at home to take you to the opticians (it’s free).
- Yes
- No
Comments
This field is for validation purposes and should be left unchanged.

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Page last reviewed: 04/11/2022

In this section

Pupil Health Assessment Questionnaire (Year 6) – Knowsley
Foundation Stage 2 Child Health and Development review (Knowsley)
Health and wellbeing questionnaire for year 9 pupils

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