Person Completing Assessment ___________________________________ Title _________________________________________________
School _____________________________________ City ______________________________________ Date ______________________
Instructions: Use the guidelines for scoring found on page 7, along with your knowledge or observations of the elementary school to assess the school environment and policy.
For each statement, place an X in the one box that best represents current school environment and policy. You may wish to add comments clarifying your selection.
School Environment
See page 7 for scoring guidelines All Elements in Place
Most Elements in Place
Some Elements in Place
Few Elements in Place
No Elements in Place
N/A Comments
Nutrition
1.
Foods and beverages with limited nutritional value are not marketed in the cafeteria.
2.
School store offers consistent messaging for healthy items.
3.
There is easy access to water in the cafeteria as well as easy access to water throughout the building.
4.
Fruits and vegetables are placed in prominent easy-to-reach positions.
5.
Adequate time for students to enjoy eating healthy foods with friends, scheduled as near the middle of the school day as possible. Students have 10-20 minutes after seated to eat breakfast/lunch.
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School Environment
See page 7 for scoring guidelines
Nutrition
6.
Scheduled recess for elementary grades before lunch so that children will come to lunch less distracted and ready to eat.
7.
Nutrition education is offered in the school dining room as well as in the classroom, with coordination between the food service staff and teachers.
8.
Students receive consistent nutrition messages throughout the school, classroom, cafeteria, home, community and media.
9.
Schools are Team Nutrition
Schools and they conduct nutrition education activities and promotions that involve parents, students and the community.
All Elements in Place
Most Elements in Place
Some Elements in Place
Few Elements in Place
No Elements in Place
N/A Comments
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School Environment
See page 7 for scoring guidelines
Physical Activity
10.
At a minimum, students have 60 minutes of physical activity on most, preferably all, days of the week.
11.
Students are given opportunities for physical activity during the school day through daily recess periods provided to children in all grades, elective physical education (PE) classes, walking programs, and the integration of physical activity into the academic curriculum.
12.
Students have opportunities for physical activity through a range of after-school programs, including intramural and interscholastic athletics, and physical activity clubs.
13.
Schools work with the community to create an environment that is safe and supportive of students’ physically active commute to and from school. (Example: a Safe
Routes to School Program is established. http://www.saferoutesinfo.org/ )
(national site) or http://www.nh.gov/dot/org/proj ectdevelopment/planning/srts/in dex.htm
(New Hampshire site)
14.
The school is a mixed use facility for physical activity.
All Elements in Place
Most Elements in Place
Some Elements in Place
Few Elements in Place
No Elements in Place
N/A Comments
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Policy
See page 7 for scoring guidelines
In School
1.
Students in grades pre-k-12 receive nutrition education that is interactive and teaches the skills they need to adopt healthy eating behaviors.
2.
Staff that provide nutrition education have appropriate training.
3.
State and district health education curriculum standards and guidelines include both nutrition and physical education.
4.
Nutrition is integrated into the health education curricula or core curriculum (e.g., math, science, language arts).
5.
Procedures for educating and training school staff on nutrition policies including their responsibilities are in place.
6.
If vending machines are available for children and staff, they are compliant with the Healthy Kids
Act.
7.
Competitive foods are compliant with the Healthy Kids Act.
8.
Fundraising efforts do not involve sales of foods high in sugar, fat, and sodium.
9.
Healthy options are available at every event i.e. classroom parties, school celebrations.
Policy
Enforcement
/Evaluation
Policy
Implementation
Policy
Formulation and
Adoption
Problem
Identification
Not Identified as Problem
N/A
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Comments

Policy
See page 7 for scoring guidelines
In School
10.
Clean, safe, enjoyable meal environment for students providing enough space and serving areas to ensure student access to school meals with a minimum wait.
11.
Elimination of the use of food as a reward or punishment by all teachers and administrative staff.
(e.g. providing candy or fast food coupons for behavior/ performance)
12.
The school uses already established events to reinforce nutrition messages by providing healthy options. (e.g. parent/ teacher conferences, school plays, and parties)
13.
Elimination of the restriction of recess or other physical activity as a form of discipline, or cancellation of recess or other physical activity time for instructional make-up time.
14.
Physical education activities are designed so that all able students participate all the time. (Example:
Games do not require long periods of time where a child sits out.)
Policy
Enforcement
/Evaluation
Policy
Implementation
Policy
Formulation and
Adoption
Problem
Identification
Not Identified as Problem
N/A Comments
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Policy
See page 7 for scoring guidelines
Collaboration with Home
15.
Parents, teachers, school administrators, students, food service professionals, and community members are involved in the development of the Local Wellness Policy (LWP) and serve as role models in practicing healthy eating and being physically active, both in school and at home. (e.g. Parent
Advisory Committee exists for nutrition and physical activity)
16.
Content and implementation of
LWP is available to parents, students and others in the community. An effective system is established for receiving regular feedback from the aforementioned.
17.
One or more school officials ensure that the school complies with the LWP.
18.
The school periodically measures and makes available to the public an assessment of the implementation of the LWP and describes the progress in attaining goals of LWP.
Policy
Enforcement
/Evaluation
Policy
Implementation
Policy
Formulation and
Adoption
Problem
Identification
Not Identified as Problem
N/A Comments
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School Environment
Physical, social, or economic settings designed to influence people’s practices and behaviors.
All elements in place All elements are in place in the environment. For example (see item #4), fruits and vegetables are always prominent and easy-to-reach.
Most elements in place
Some elements in place
Most elements are in place in the environment. For example (see item #4), fruits and vegetables are prominent and plans are underway to make them always easy-to-reach.
Some elements are in place in the environment. For example (see item #4), fruits and vegetables are prominent, but not consistently easy-to-reach.
Few elements in place
No elements in place
Few elements are in place in the environment. For example (see item #4), fruits and vegetables are prominent, but not ever easy-to-reach.
No elements are in place in the environment. For example (see item #4), fruits and vegetables are not prominent or easy-toreach.
This type of environmental change is not appropriate for this school. N/A
Policy
Laws, regulations, rules, protocols, and procedures, designed to guide or influence behavior. Policies can be either legislative or organizational in nature.
Policies often mandate environmental changes and increase the likelihood that they will become more permanent (institutionalized or sustainable).
Policy enforcement and evaluation
This stage involves determining to what extent the policy has been enforced, and what occurred as a result of the policy.
Based on the evaluation results, adjustments can be made to the current policy to ensure effectiveness. For example (see item #11), the policy prohibiting use of food as punishment/reward was in place last year, and a comment period was held.
Policy implementation
Policy formulation and adoption
Problem identification/
Gaining agenda status
The policy was revamped, and is now implemented with revisions that address both teachers and administrative staff.
This occurs within organizations directed to carry out adopted policies. Implementation begins once a policy has been formulated and adopted, and administrators have made a decision about how to deploy necessary resources (human and financial) to actualize the policy. For example (see item #11), the policy to prohibit use of food as punishment/reward was established and passed last year by the school board, communicated to all students, staff, and parents, and implemented this year. The end of this year will be the review and comment period of the policy.
This stage involves analyzing policy goals and solutions, the development or creation of alternative recommendations to resolve or address the identified public problem, and final selection of a policy. For example (see item #11), the school board developed and approved the policy, but it has not yet been implemented. It will be implemented in the next school year.
This stage involves getting a problem onto the radar screen of the authoritative body that must deal with the issue. This is usually done when the issue or problem is categorized as a social or public problem. For example (see item #11), the school board discusses prohibiting use of food as a punishment/award after complaints are filed by parents and students; policy implications and issues are being considered.
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Policy
Laws, regulations, rules, protocols, and procedures, designed to guide or influence behavior. Policies can be either legislative or organizational in nature.
Policies often mandate environmental changes and increase the likelihood that they will become more permanent (institutionalized or sustainable).
Not identifies as a problem This stage represents the time when the issue has not yet been identified as a concern or a problem. For example (see item
#11), the school board has never discussed a policy prohibiting use of food as punishment/reward, complaints have never been filed, and issues have not been raised by parents or school officials.
N/A This type of policy is not applicable for this school.
1.
Environment: Physical, social, or economic settings designed to influence people’s practices and behaviors.
Examples of alterations or changes to the environment include:
Physical: Structural changes or the presence of programs or services, including the presence of healthy food choices in schools, improvements in the built environment to promote walking (e.g., walking paths), and the presence of comprehensive school health education curricula in schools.
Social: A positive change in attitudes or behavior about policies that promote health or an increase in supportive attitudes regarding a health practice, including an increase in favorable attitudes community decision makers have about the importance of school wellness policies or an increase in nonacceptance of sugar sweetened beverage offerings at school functions.
Economic: The presence of financial disincentives or incentives to encourage a desired behavior, including paying higher prices for sugar sweetened beverages to decrease their use.
2.
Policy: Laws, regulations, rules, protocols, and procedures, designed to guide or influence behavior. Policies can be either legislative or organizational in nature. Policies often mandate environmental changes and increase the likelihood that they will become more permanent (institutionalized or sustainable). Examples of legislative policies include taxes on less healthy foods, provision of county or city public land for multi-use paths or farmers’ markets, regulations governing the National School Lunch Program. Examples of organizational policies include schools requiring healthy food options for all students, a district ban on the sale of less than healthy foods throughout the school day.
3.
Healthy food and beverage options: Healthy foods are fruits, vegetables, whole grains, and related combination products, and nonfat and low-fat dairy that are limited to 200 calories or less per portion as packaged. Healthy beverages are water without flavoring, additives, or carbonation, low-fat and nonfat milk, 100% fruit juice, and caffeine-free drinks. More information can be found at: Dietary Guidelines for Americana, 2010: http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf
http://www.iom.edu/~/media/Files/Report%20Files/2007/Nutrition-Standards-for-Foods-in-Schools-Leading-the-Way-toward-Healthier-
Youth/factsheet.pdf
Less than healthy foods and beverages: As defined by the Institute of Medicine, foods and beverages with a high content of calories, sugar, fat, and sodium and low content of nutrients, including protein, vitamins A and C, niacin, riboflavin, thiamin, calcium, and iron. More information can be found at: http://www.nap.edu/catalog.php?record_id=11015
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Vending, a la carte, and regulated fundraising items (any foods/beverages sold to students between the first bell and the last bell) sold to students during the school day must meet the following requirements:
Foods Table – Final Nutritional Content Standards
Nutrient
Calories
Entrée
< NSLP entrées or < 400 calories
Side
< NSLP sides or < 200 calories
Sodium
Saturated Fat
Trans Fat
Total Fat
< NSLP entrées or < 600 mg/item (< 480 mg/serving in 2014)
< 10% calories (excluding reduced-fat cheese)
< 0.5 gm/serving
< NSLP sides or < 400 mg/serving in 2014)
< 35% calories (excluding nuts, seeds, nut butters, and reduced-fat cheese)
Sugar < 35% calories (excluding fruits and yogurts)
Dietary Fiber/Whole Grain 50% of grains offered must be whole grain (primary ingredient by weight)
4.
Walk or bike to school initiative: Community-based programs (e.g., Safe Routes to School, Walking School Bus) that aim to increase opportunities for daily physical activity by encouraging children to walk or bike to and from school in groups accompanied by adults. Programs advocate for communities to build partnerships with the school, Parent-Teacher Association, local police department, department of public works, civic associations, local politicians, and businesses to create an environment that is supportive of walking and bicycling to school safely. More information can be found at: http://www.saferoutesinfo.org/ (national site) or http://www.nh.gov/dot/org/projectdevelopment/planning/srts/index.htm
(New
Hampshire (NH) site) or http://www.walkingschoolbus.org/ or http://www.nh.gov/dot/org/projectdevelopment/planning/srts/ (NH site)
5.
Mixed land use: The use of safe and well-maintained sidewalks, crosswalks, bicycle paths, trails, parks, recreational facilities, and community designs featuring mixed-use development (e.g., mixing residential and commercial in same area) and a connected grid of streets. More information can be found at: http://www.healthyplaces.org.au/userfiles/file/Mixed%20Land%20Use%20June09.pdf
6.
Food as a reward or punishment: An example of using food as a reward is providing candy or fast-food coupons to students or patrons because they have behaved well or met an academic or fundraising goal. An example of withholding food as punishment is not giving one student or patron a snack or meal that is offered to all others because of his or her inappropriate behavior. More information can be found at: http://www.cdc.gov/HealthyYouth/SHI
7.
Physical activity as a punishment: An example of using physical activity as punishment is making students run laps or do push-ups as a consequence of inappropriate behavior. Withholding physical activity or education as punishment means not allowing students to attend all or part of physical education class as a consequence of inappropriate behavior in another class or failure to complete an assignment in another class. It does not refer to the physical education teachers’ disciplining students during physical education class by having them sit out for a period of time. More information can be found at: http://www.cdc.gov/HealthyYouth/SHI
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8.
Farm to School: Broadly defined as a program that connects school (K-12) and local farms with the objectives of serving healthy meals in school cafeterias, improving student nutrition, providing agriculture, health and nutrition education opportunities, and supporting local and regional farmers.
More information can be found at: http://www.nhfarmtoschool.org/ (NH site)
For more information visit our Healthy Schools NH web site at: http://extension.unh.edu/Healthy-Schools/School-Wellness-Policy-Tools
Adapted from: Iowa Nutrition Network INNSG pilot scan September 2013
The University of New Hampshire Cooperative Extension is an equal opportunity educator and employer. University of New Hampshire, U.S. Department of Agriculture and N.H. counties cooperating. USDA is an equal opportunity provider and employer. The preparation of this document was financed under a contract with the State of New Hampshire, Department of Health and Human Services. This material was funded by USDA’s Supplemental Nutrition Assistance Program – SNAP and USDA’s EFNEP Program. 1/15
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