Audit Instrument

Audit instrument

School ID: ______/ Date of Data Collection: _ _ /_ _ /_ _ _ _
Completed by
Observer:______/ Time of Data observation
Start time:  :  End time: : 

Audit instrument

Forms completed
Form number / Form content / Yes, fully completed / Yes, partly completed / n/a / Comments
(Please indicate why forms are partly completed and/or n/a)
Form 1A / Canteen/shop/kiosk/restaurant interview
Form 1B / Food/drink registration
Form 2A / Vending interview
Form 2B / Food/drink registration
Form 3 / Subscription programs
Form 4 / Commercial Advertising
Form 5 / Bicycle parking
Form 6 / Equipment for recess
Form 7 / Indoor PA facilities
Form 8 / Outdoor PA facilities
Form 9 / Other info outdoor area

Audit instrument

FORM 1A: Canteen/school shop/kiosk/restaurant – Interview
School ID: ______ / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Interview to the canteen/school shop/kiosk/restaurant administrator
One observer fills in this form
Comments
The person who will be interviewed is the:
(For observer to fill in) /

Canteen/school shop/kiosk administrator
Principal (headmaster) /vice principal
Other school staff

/ If “Other”, who:
Who owns the canteen/school shop/kiosk/restaurant?
(You can tick more than one and use comment to explain) /

The school
Parents
Private
Other

/ If “Other”, who:
Are you the main person who is running the canteen/school shop/kiosk/restaurant? /

Yes
No
Partly

/ If “No “and/or “Partly”, indicate who is the main person;
Who decides what is offered in the canteen/school shop/kiosk/restaurant? /

The canteen/school shop/kiosk administrator
The principal (headmaster) /vice principal
The government
Parents
Pupils
Other

/ If “Other”, who:
How many days per week is the canteen/school shop/kiosk/restaurant operated? / ___ days per week
What are its hours of operation? / Open time: _ _: _ _
Close time: _ _: _ _
Does the canteen/restaurant sell/offer any complete mealsto all/a large proportion of the pupils?
(You can tick more than one) /

Yes, for breakfast
Yes, for lunch
Yes, other

Noskip the next 4

( marked with grey colour) / If “Other”, indicate:
How are the meals prepared? /

Cooked in the canteen/school shop/kiosk/restaurant

Professional catering service
Other

/ If “Other”, how:
Who decides what is offered at these complete meals (food and drinks)?
(You can tick more than one) /

School management
The canteen/restaurant manager
The government
Parents
Pupils
Other

/ If “Other”, who:
Is there a weekly/monthly menu available for what foodsare offered? /

/ If “Yes”, please collect a copy of the weekly menu
What is usually offered to drink with the meal?
(You can tick more than one) /

Nothing
Water
Milk
Other

/ If “Other”, what:
What are the main product groups sold (free choice) in the canteen/school shop/kiosk/restaurant?
(You can tick more than one) /

Sandwiches
Hot foods
Drinks
Salt/sweet snacks/cakes
Other

/ If “Other”,explain:
What are the three most sold food products in the canteen/school shop/kiosk/restaurant? /

______
______
______

What are the three most sold drink items in the canteen/school shop/kiosk/restaurant? /

______
______
______

Is there fresh drinking water offered in the canteen/school shop/kiosk/restaurant? /

No
Yes, for free
Yes, for sale

Is it possible for students to stay in the canteen/school shop/kiosk/restaurant before/after breaks? /

/ If “No “or “n/a”, explain why:
Who decides what is offered in the canteen/school shop/kiosk/restaurant? /

The school management
The canteen/school shop/kiosk/restaurant manager
The government
Parents
Pupils
Other

/ If “Other”, who:
Does the school make profit on canteen/school shop/kiosk/restaurant from products’ sales or as rent to the company/person who is running the canteen/school shop? /

/ If “Yes”, how much?
How does the school use that profit? /

Audit instrument

FORM 1B: Canteen/school shop/kiosk/restaurant – food/drink registration
School ID: ______ / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Products Observation Form
Both observers fill in this form
Bread-products (e.g. tuna sandwich, egg sandwich, cheese pie) / gr. /portion / Kcal/portion / Yes / Noof products / Comments
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Drinks(e.g. coca cola, sprite, fanta, fruit juice, water, milk, ice tea, tea, coffee) / ml/Bottle,can,package / Kcal/Bottle,can,package / Noof products / Comments
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Snacks/cakes/candys(e.g. chips, mars, gingerbread) / gr. /portion / Kcal/portion / Noof products / Comments
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Country specific products
Fruits and Vegetables / gr. /portion / Kcal/portion / Noof products / Comments
Country specific products
Country specific products
Other(e.g. salads) / gr. /portion / Kcal/portion / Noof products / Comments
Country specific products
Country specific products
Country specific products
Country specific products
1a. Attach a photograph(s) of the canteen/school shop/kiosk/restaurant, so that is well visible what products are placed on and behind the counter. / 1b. Attach a photograph(s) of the wider area of the school shop/canteen/kiosk/restaurant, so that the facilities/dining area are well visible.
Please write other observations or information regarding the canteen/school shop/kiosk/restaurant here.
FORM 2A: Vending machines - interview
School ID: ______ / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Interview to the canteen/school shop administrator
One observer fills in this form
Comments
The person who will be interviewed is the:
(For observer to fill in) /

Vending machine administrator
Canteen/school shop/restaurant administrator
Principal (headmaster) /vice principal
Other school staff

/ If “Other”, who:
Who decides what is offered in vending machine(s)? /

The school management
The canteen/shop/kiosk/restaurant manager
The government
Parents
Pupils
Other

/ If “Other”, who:
What are the three most sold food products in the vending machine(s)? /

______
______
______

What are the three most sold drink items in the vending machine(s)? /

______
______
______

How often are the vending machines refilled? / ____per week
____per month
Are there any restrictions on hours of operation/accessibility of vending machines? /

/ If “Yes”, explain:
Are any vending machines owned and operated by the school? /

Does the school/parents/pupils make profit on vending machine(s) from product sales or as rent to the company/person who is running the vending machine(s)? /

/ If “Yes”, how much and who?
How does school use that profit?
Please write other observations or information regarding the vending machine(s) here.
FORM 2B: Vending machines
School ID: ______ / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Both observers fill in this form
Indicate where the vending machine is located (e.g. canteen/school shop, entrance, hallway). / Type of machine (e.g. beverage, snack, mixed) / Is the machine currently on and available to students or is it turned off?

Products Observation Form
Both observers fill in this form
Bread-products (e.g. tuna sandwich, egg sandwich, cheese pie) / gr. /portion / Kcal/portion / Yes / Noof products / Comments
Country specific products
Country specific products
Country specific products
Drinks(e.g. coca cola, sprite, fanta, fruit juice, water, milk, ice tea, tea, coffee) / ml/Bottle,
can,package / Kcal/Bottle,
can,package / Noof products / Comments
Country specific products
Country specific products
Country specific products
Snacks/cakes/candys(e.g. chips, mars, gingerbread) / gr. /portion / Kcal/portion / Noof products / Comments
Country specific products
Country specific products
Other / gr. /portion / Kcal/portion / Noof products / Comments
Country specific products
Country specific products
2a. Attach a photograph(s) of the vending machine(s), so that the products available are well visible. /  2b. Attach overview photograph(s) of the location(s) of the vending machine(s), in which the biggest part of the machine is visible (Location of the machines in the canteen/school shop needs to be visible).

Audit instrument

FORM 3A: Subscription programs
School ID: ______ / Observer: ______ / Begin time: _ _: _ _
End time: _ _: _ _
Both observers fill in this form
Name of program (i.e. School fruit scheme, ”Milk bread”) / Products offered? / Offered by week? / Season offered? / Offered by whom? / Paid by whom? / How administrated in the school? / For how long has the program been in place? / Comments

1 day/week
2 days/week
3 days/week
4 days/week
Everyday

All the year
Spring
Summer
Autumn
Winter

Government
Large/national food company
Small/local food company
Other, explain

By governments
By the school
By parents

Other, explain

By staff paid from school
Parents

Other, explain

Less than a year
1-2 years
3-4 years
5 years or more years

1 day/week
2 days/week
3 days/week
4 days/week
Everyday

All the year
Spring
Summer
Autumn
Winter

Government
Large/national food company
Small/local food company
Other, explain

By governments
By the school
By parents
Other

By staff paid from school
Parents

Other, explain

Less than a year
1-2 years
3-4 years
5 years or more

Audit instrument

 3a. If relevant/possible, attach a photograph of how subscription program 1 is organized / 3b. If relevant/possible, attach a photograph of how subscription program 2 is organized
Please write other observations or information regarding the subscription program(s) here.

Audit instrument

FORM 4: Food and drink commercial advertising
School ID: ______ / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Commercial Advertising Observation form
Both observers fill in this form
Comments
Are there any food or beverage commercial advertisements in the following locations?
(tick applicable options) /

In the canteen/school shop/kiosk/restaurant
On vending machines
In the hallways
In the classroom of 5th and 6th graders
On school grounds, including the outside of school buildings, on playing fields, or other areas of school
Other

Please indicate the types of food/beverages advertised: / Food

No food advertisements
Fruits and vegetables
Bread products (e.g. sandwiches, pies)
Snacks, cakes, candies

Other

Beverages

No beverage advertisements
100% fruit juice
Sweetened drinks (incl. fizzy drinks)
Diet drinks
Milk
Water

Other

/ Food
If “Other”, explain:
Beverages
If “Other”, explain:
 4a. If relevant/possible, attach a photograph of commercial advertisements / 4b. If relevant/possible, attach a photograph of commercial advertisements
Please write other observations or information regarding commercial advertisements.
FORM 5: Bicycle parking area (designated by the school)
School ID: ______ / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Both observers fill in this form
Comments
What is the condition of the bicycle parking?
(tick more than one) / Bad Good
1 2 3 4 5 6 7 / If less than 3 explain:
How is the bicycle parking secured?
(tick more than one) /

Fully Covered (i.e. roof, shed)
Partly covered(i.e. roof, shed)
Supervised (please indicate below)

Doorkeeper
Camera
Reception
Other_____

Surrounded by a fence (especially for the bicycle parking)

Are there bicycle racks? /

How many bicycles can be placed in the racks?(count 1 bicycle rack, multiply number of racks, count up all the racks with different sizes) / ______
Is the bicycle parking full of bicycles? Number of bikes:.lle fietsensen staan er ...ten)htingsmateriaal in de kantine aanwezig?

More than full100%

Full > 75%  ______
Mean 25 – 75%  ______
Empty < 25%  ______

Please write other observations or information regarding the bicycle parking here:
r 5a. Attach an overview photograph of the bicycle parking
FORM 6: Physical activity equipment (loose) for recess
School ID: ______ / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Both observers fill in this form
How often is the following equipment used by 5th and 6th graders during recess?
**Observer will obtain this info by the headmaster or other school staff /

Every recess
Once a day
A few times per week
Less than once a week
Other

/ If other, specify when and why:
Does the equipment look inviting to play with? / Not inviting Very inviting
at all
1 2 3 4 5 6 7 / If less than 3, explain:
Equipment / Yes / No / Number / Comments
Footballs
Basketballs
Volleyballs
Other balls:
Rackets (i.e. tennis, badminton, squash)
Bandy/hockey sticks
Bats (i.e. baseball)
Skipping ropes
Jump bands (elastics)
Frisbees
Other (i.e. seasonal equipment): ______
 6a. If possible, attach an overview photograph of the room/box for keeping the equipment / 6b. If possible, attach an overview photograph of the type of equipment
Please write other observations or information regarding the equipment or organization of lending it out here:
FORM 7: Indoor sport facilities
School ID: ______ / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Observation Form Indoor Sport Facilities
*Do not include facilities provided outside the school grounds
Both observers fill in this form
Are the indoor facilities open to pupils at other times than during physical education lessons? /

/ Comments:
Facilities / Yes / No / Number of facilities / Size
(m2) / Condition (e.g. new, clean, damaged, poor quality)
Gym
Swimming pool
Weight training facilities
Gender specific changing rooms / n.a?
Shower facilities / n.a?
Other______
Other______
7a. If possible, attach an overview photograph of the indoor gym / 7b. If possible, attach an overview photograph of the equipment for the indoor gym
Please write other observations or information regarding the indoor sport facilities here:
FORM 8: Outdoor sport facilities
School ID: / Observer:______ / Begin time: _ _: _ _
End time: _ _: _ _
Observation Form Outdoor Sport Facilities
Both observers fill in this form
Are there parts of the school grounds designated to specific grade levels? /

/ Comments:
(only observe what is relevant to 5-6th graders)
Facilities / Yes / No / Number of facilities / Size (m2) / Condition (e.g. new, clean, damaged, poor quality)
Football field
Basketball field
Volleyball/badminton/tennis fields with net
Other marked fields for ballgames: ______
Paint/marks for other games / n.a.
Play area with swings, slides etc (for young children)
Tabletennis / n.a.
Track and field (running, jumping, throwing)
Obstacle course/Jungle path
Climbing (walls, trees) / n.a.
Skateboard area
Other:______
Other: ______
Other ______
 8a. Attach an overview photograph of the outdoor sport facilities / 8b. Attach an overview photograph of the outdoor sport facilities
Please write other observations or information regarding the outdoor sport facilities here:
FORM 9: Other information about the school outdoor area
School ID: / Observer: ______ / Begin time: _ _: _ _
End time: _ _: _ _
General observation of the outdoor school area
Both observers fill in this form
Comments
What kinds of surfaces are present?
(tick all that apply) /

Asphalt/paved
Grass
Gravel
Sand
Rocks
Nature/woods
Other

/ If “Other”, explain:
How is the topography?
(tick all that apply) /

Flat (mostly)
Hilly (mostly)
Combination of both
Other

/ If “Other”, explain:
How is the school’s outdoor area separated from the neighbourhood?
(tick all that apply) /

Fence/Hedge
No clear boundaries
Other

/ If “Other”, explain:
Are there other things present?
(tick all that apply) /

Plants/trees
Benches (and tables)
Drinking fountains (outdoor)
Other

/ If “Other”, explain:
General appearance of the outdoor area / Not inviting Very at all inviting
1 2 3 4 5 6 7 / If less than 3, explain:
 9a. If relevant, attach a photograph of a physical activity promoting characteristic of this school / 9b. If relevant, attach a photograph of barriers to physical activity characteristic of this school
Please write other observations or information regarding the outdoor area here: