COMMUNITY NEEDS ASSESSMENT

(SURVEY)

I. Profile of the respondent.

Name: _______________________________ Age:___________ Sex:_________________
Height:________________Weight:_________________Equivalent:__________________

II. The Proper Questionnaire.

Direction: Read the questions carefully and respond based on your observations and
understanding. Please draw a star next to the space provided. Use a likert or summative
scale.

Scale Verbal Explanation

6 Strongly Agree
5 Agree
4 Slightly Agree
3 Slightly Disagree
2 Disagree
1 Strongly Disagree

SURVEY QUESTIONS 6 5 4 3 2 1
1. I choose to ignore it because I'm not familiar
with the vegetables my parents prepared.
2. I adore eating fast food and meat, which gives
me a ravenous hunger.
3. Due to the appearance and texture of
vegetables, I dislike eating them. My appetite
decreases as a result.
4. In exchange for my good behavior, my parents
reward me with my favorite junk food.
5. During playing, I am prone to being exhausted
and losing energy.