St Davids CIW Primary

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* 1. How old are you?

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* 2. Are you a ...

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* 3. What things make you feel good at the moment? Tick as many as you like

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* 4. What things do you worry about? You can tick as many as you want to.

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* 5. How much do you agree or disagree with these statements?

  strongly disagree disagree neither agree or disagree agree Strongly agree
I have fun things to do in my days
I often feel bored
When I do something, I try my hardest
I know that there are things that I am good at
I am proud of the things I can do
I enjoy learning new things
I feel like I have a choice in what I am learning just now
Generally, I feel cheerful and I am in a good mood

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* 6. How much do you agree or disagree with these statements?

  Strongly disagree Disagree Neither agree or disagree agree Strongly agree
I think I make healthy choices in my life
If I have a question about my health I know who to speak to
Most of the time I have plenty of energy
I think I get enough exercise
I worry about my own health
I worry about the health of people in my family

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* 7. How much do you agree or disagree with these statements?

  Strongly disagree Disagree Neither agree or disagree Agree Strongly agree
I feel free to express my ideas and opinions
I feel like my rights are respected by others
If I want to, I can be creative
When I am online I feel safe
I can look for and get information that I need
I often feel lonely
There are lots of things I worry about in my life
Even if I am having a difficult time, I feel I will be okay

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* 8. How much do you agree or disagree with these statements?

  Strongly disagree Disagree Neither agree or disagree Agree Strongly agree
I enjoy being with my family
My family gets along well together
I feel safe at home
I have someone to talk to in my family when I have a worry
I have someone to talk to outside my family when I have a worry
When I want to be alone I can have privacy
I am happy with the friends I have
I feel supported by my friends
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