The Builders Project Pre-Evaluation Form_KIDSCREEN (Lutheran Community Care Services) FY22 Contact ID * Activity 1 Administrative Question Which is your school? LCCS1 LCCS2 Would you like to proceed with this survey? Yes No What is your date of birth [DD/MM/YY]? Which is your class? What is your class register number? Overall Well-Being How would you rate your quality of life? Very poor Poor Neither poor nor good Good Very good Why did you rate your quality of life as answered in the question above? In general, how would you say your health is? Poor Fair Good Very good Excellent Have you felt fit and well? Not at all Slightly Moderately Very Extremely Have you felt physically active (e.g., running, climbing, biking)? Not at all Slightly Moderately Very Extremely Have you been able to run well? Not at all Slightly Moderately Very Extremely Have you felt full of energy? Never Seldom Quite often Very often Always Has your life been enjoyable (e.g., been feeling positive emotions like happiness or joy)? Not at all Slightly Moderately Very Extremely Have you been in a good mood? Never Seldom Quite often Very often Always Have you had fun? Never Seldom Quite often Very often Always Have you felt sad? Never Seldom Quite often Very often Always Have you felt so bad that you didn’t want to do anything? Never Seldom Quite often Very often Always Have you felt lonely? Never Seldom Quite often Very often Always Have you been happy the way you are? Never Seldom Quite often Very often Always Have you had enough time for yourself? Never Seldom Quite often Very often Always Have you been able to do the things that you want to do in your free time? Never Seldom Quite often Very often Always Have your parent(s)/caregiver(s)/those you look up to as parent(s) had enough time for you? Never Seldom Quite often Very often Always Have your caregiver(s)/parent(s)/those you look up to as parent(s) treated you fairly? Never Seldom Quite often Very often Always Have you been able to talk to your parent(s)/caregiver(s)/those you look up to as parent(s) when you wanted to? Never Seldom Quite often Very often Always Have you got along well with your siblings? If you do not have siblings, please indicate “Not applicable”. Never Seldom Quite often Very often Always Not applicable Have you had enough money to do the same things as your friends? Never Seldom Quite often Very often Always Have you had enough money for your expenses? (e.g., have enough money to buy what you need) Never Seldom Quite often Very often Always Have you spent time with your friends? Never Seldom Quite often Very often Always Have you had fun with your friends? Never Seldom Quite often Very often Always Have you and your friends helped each other? Never Seldom Quite often Very often Always Have you been able to rely on your friends? (e.g., you can count on your friends) Never Seldom Quite often Very often Always Have you been happy at school? Not at all Slightly Moderately Very Extremely Have you got on well at school? (e.g., you can handle the day-today activities at school) Not at all Slightly Moderately Very Extremely Have you been able to pay attention? Never Seldom Quite often Very often Always Have you got along well with your teachers? Never Seldom Quite often Very often Always Have you been afraid of other girls and boys? Never Seldom Quite often Very often Always Have other girls and boys made fun of you? Never Seldom Quite often Very often Always Have other girls and boys bullied you? Never Seldom Quite often Very often Always When faced with a new situation, how confident are you with your ability to handle problems when they arise? Not very confident Neither Fairly confident Very confident To what extent do you clearly communicate (verbally and/or nonverbally) your emotions to people so that they know exactly how you feel? Not at all A little Moderately Mostly Completely To what extent do you listen to others and offer them support? Not at all A little Moderately Mostly Completely How well can you control your feelings? Not at all A little Moderately Mostly Completely To what extent do you have the skills and/or knowledge to do what you want to do? Not at all A little Moderately Mostly Completely How safe do you feel in your daily life? Not at all A little A moderately amount Very much Extremely How satisfied are you with the conditions of your living place? Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied How satisfied are you with your access to health and social services? Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied To what extent do you believe you are able to achieve most of the goals that you set for yourself? Not at all A little Moderately Mostly Completely To what extent do you believe you can make a difference in the community, such as by volunteering, donating, raising awareness about a cause, engaging in small acts of kindness etc.? Not at all A little Moderately Mostly Completely Closing Question Are you currently being supported by other social service programmes outside of Lutheran Community Care Services? Yes No Do you have any comments for us? Submit
