Youth Risk Behavior Survey Template Page 4
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1616.
During the past 30 days, on how
20.
During the past 12 months, how
many days did you carry a gun on
many times were you in a physical
fight?
school property?
A.
0 times
A.
0 days
B.
1 time
B.
1 day
C.
2 or 3 days
C.
2 or 3 times
D.
4 or 5 days
D.
4 or 5 times
E.
6 or more days
E.
6 or 7 times
F.
8 or 9 times
G.
10 or 11 times
17.
During the past 30 days, on how
many days did you not go to school
H.
12 or more times
because you felt you would be unsafe
21.
During the past 12 months, how
at school or on your way to or from
many times were you in a physical
school?
A.
0 days
fight on school property?
B.
1 day
A.
0 times
B.
1 time
C.
2 or 3 days
C.
2 or 3 times
D.
4 or 5 days
E.
6 or more days
D.
4 or 5 times
E.
6 or 7 times
18.
How often do you feel safe and
F.
8 or 9 times
G.
10 or 11 times
secure at school?
H.
12 or more times
A.
Never
B.
Rarely
C.
Sometimes
22.
During the past 12 months, did your
D.
Most of the time
boyfriend or girlfriend ever hit, slap,
or physically hurt you on purpose?
E.
Always
A.
Yes
19.
During the past 12 months, how
B.
No
many times has someone threatened
or injured you with a weapon such as
23.
Have you ever been physically forced
to have sexual intercourse when you
a gun, knife, or club on school
did not want to?
property?
A.
Yes
A.
0 times
B.
No
B.
1 time
C.
2 or 3 times
D.
4 or 5 times
E.
6 or 7 times
F.
8 or 9 times
G.
10 or 11 times
H.
12 or more times
-4-
2009 YRBS
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