NYC Department of Education
                                                            K-5/6 Observation Scorecard—Pilot Year
Select the appropriate District Borough Number (DBN#) below:

If you were unable to locate your DBN# above please include it in the space below:
DBN#

Please fill out questions to the best of your knowledge in preparation for sharing with your School Wellness Council (SWC). This is a self-assessment tool that can identify strengths/weaknesses in school wellness programs and initiatives. There is no passing grade and all scores are meant to build awareness for recommended potential actions for improving wellness in your school.
Please assign an appropriate score next to each question:

3 = Yes or Always in Place    
2 = Sometimes or Partially in Place      
1 = No or Not in Place           
0 = Not Applicable
A. Physical Education
1. Our students in grades K-6 participate in PE for at least 120 minutes per week.

a. Our students in grades K-3 participate in PE on a daily basis.*

b. Our students in grades 4-6 participate in PE no less than three times per week.*

2. Our PE class is taught by licensed or certified physical educators at all grade levels.

3. Our PE instruction is based on a written and sequential curriculum that is aligned to State/National standards.

4. Our students are engaged in moderate to vigorous physical activity at least 50% of PE class time.

5. Our PE instructional strategies and other practices meet the needs and interests of all students and are appropriately modified or adapted to promote the participation of all students, in particular students with chronic health conditions and/or special needs.

6. Our school conducts annual NYC FITNESSGRAM assessments and uses the results to make both instructional decisions and individualized physical fitness plans for students that include goal setting.

7. Our student/teacher ratio provides a safe environment for quality PE instruction.

8.  Physical Education is not used or withheld as punishment for students in keeping with our school policies and practices.

9. Our school (at least 85% of classroom teachers) use Move-to-Improve in K-5 classrooms to supplement regular PE class.*

B. Fitness and Physical Activity
1. Our school uses at least one additional physical activity curriculum outside of PE class.

2. Our school offers at least 20 minutes of physical activity during daily recess for students, and supervising adults encourage students to be active.

3. Our school provides opportunities for all students to participate in daily physical activity opportunities before and/or after school (e.g., New York Road Runner’s, Mighty Milers).

4. Our school policies and practices support that physical activity is not used or withheld as punishment for students.

5. Our school connects students, families, and staff with physical activity opportunities in our school and/or community.

6. Our school encourages safe active transportation (e.g., walking, biking, riding scooters) to and from school, when appropriate.

C. Health Education
1. Our students in grades K-5 receive health education in planned activities that contribute to their own sense of self-worth, respect for their bodies, and ability to make constructive decisions regarding their social and emotional, as well as physical health.

a. Our students receive health education that is taught weekly by their classroom teacher.

b. Our school uses the recommended HealthTeacher.com online curriculum (or another written, sequential curriculum that is aligned to State and National standards of health education).

c. Puberty education is taught in Grades 4 or 5.

2. All of our students receive the five (grades K- 6) required HIV/AIDS lessons annually using the NYC’s HIV/AIDS Curriculum, 2012 Edition.

3. Health education instructional strategies and other practices meet the diverse needs and interests of all students.

4. Our health education teachers are familiar with school and community resources and can help students learn how to access, evaluate, and manage health and safety resources.

D. Food
1. Our school encourages and has high levels of participation in the free breakfast program, either through traditional line service, breakfast in the classroom, or Grab & Go (especially for middle and high school grades).

2. Our school promotes access to lunch, especially for students qualifying for free or reduced lunch, by promoting and collecting school meal applications and sharing School Food information (e.g., nutrition standards, menus) with parents and students.

3. Our food service manager establishes linkages with teachers, nurses, health educators, and other school staff to connect what is being served in the cafeteria with nutrition and health lessons, or with other information provided to students.

4. Drinking water is accessible throughout the day, free of charge (e.g., working water fountains, water jets, or insulated water coolers.)

5. Our students have at least 20 minutes to eat school meals.

6.Our school has a “no junk food” policy and we work in a variety of ways to enforce it (healthy fundraisers, student campaigns, information for parents, work with local shop owners to provide healthy options around the school).

7. Our school engages in marketing of healthy options using posters, table tents, or creative naming of healthy options.

8. All beverages and competitive foods served to students for school and classroom parties during the regular and extended school day meet the DOE School Food guidelines.

9. Our school provides cooking programs as part of nutrition education and/or enrichment activities for students.

10. Our school has a school garden and/or grows fruits and vegetables at the school.

E. School Environment
1. Our school has established policies and practices supporting a safe, respectful climate that does not tolerate harassment or bullying (e.g., staff designated Respect for All representative.)

2. Our school communicates to students and parents its clear expectations regarding pro-social behavior and respect within the school community (e.g., reaching beyond the Discipline Code with students and families by using progressive discipline strategies*).

3. Our school implements programs and initiatives that promote respect for diversity of all students regardless of race, gender, sexual orientation, etc. (e.g., Respect for All campaigns*, health, and safety messages).

4. Our school has school psychologists, guidance counselors, Substance Abuse Prevention Instruction Specialists (SAPIS), and/or other professionals who address the personal/social growth of our students*.

5. Should it be needed, our school is able to link students to comprehensive mental health resources in the community.

6. Our school has a building response team, emergency plans, and visitor control procedures.

7. Our school has a crisis intervention team, which works closely with the Network’s Crisis Team when a crisis occurs and an intervention plan including tools and information for staff and the school community*.

8. Our school has protocols to support student engagement (e.g., before and after school programs) and address absenteeism.

9. Our school provides resources and information to support student engagement (e.g., services in Schools Initiative, service organizations, internship, clubs, and teams) so that all students see themselves as valued members of the school community.

10. Our school has a green team, energy conservation program, and recycling program in place.

F. Staff Wellness/Community Involvement
1. Our school has an active school wellness council which includes staff, parents, and community members, and it meets at least once a month.

2. Our school offers programs to staff that focus on physical activity/fitness, healthy eating/weight management, and/or other wellness related supports.

3. Staff, students, and parents have the opportunity to participate and provide input to the implementation of wellness programs and activities.

4.  The school effectively communicates its health, wellness, and safety policies and information to students, staff, and parents (e.g., School Wellness Weekly, student run newsletter.)

5. Parents are actively involved in school programs and receive wellness information and opportunities in their preferred language.

6. Our school promotes partnerships with community-based programs and opportunities.

7.  Our school has staff and or systems in place to bring in additional funds (e.g., healthy fundraising ) or leverage resources to support wellness priorities for students, parents, and staff.


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