Move More Survey


This survey is designed to measure your levels of physical activity in the last week to determine whether or not you might benefit from support to increase your weekly physical activity participation.

Thank you for taking the time to complete this survey. This should take no longer than two minutes.

There are 12 questions in this survey.

Personal Information

Name:

Please state your gender.

 

What is your Age?

What is your staff/student number?
Please provide a contact email address.
Please provide a contact telephone number.

Providing this information is optional. You will still receive the same support on the programme should you not wish to disclose this information.

Do you consider yourself to have a disability?

 

Providing this information is optional. You will still received the same support on the programme should you not wish to disclose this information.

Please choose ONE ethnic group that best describes you.

Physical Activity Levels

In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be a part of your job.

Please type your answer from one of the numbers below:

0   1   2   3   4   5   6   7

Are you interested in becoming more active?
Would you like to be supported in becoming more active?

Privacy Notice

The information that you supply on this ‘Move More Derby’ questionnaire will be held and processed in line with the Data Protection Act 1998 and GDPR.

We use this information to contact you, gain a better understanding of your activity levels.

We share this data with the ‘Move More Team’ Fluid Ideas, who create and monitor the customer management relationship system and Sport England (data provided in aggregated anonymous form).

We may contact you for participation or consultation purposes during this project.

We will retain this data for up to two years, covering the duration of your participation in this physical activity intervention scheme (Maximum 12 month scheme).

I give explicit consent for my details to be used in this manner.