About This Database
You are browsing a database of standardized
questionnaires that ask about respondents' walking and bicycling habits. The
Applied Research Program maintains this database, but, except where noted, did
not create and does not maintain the questionnaires themselves. For more
information about a specific questionnaire, please contact its author(s). When
possible, we cite the source of each questionnaire near the top of the page.
EPIC-Norfolk Physical Activity Questionnaire
http://www.srl.cam.ac.uk/epic/questionnaires/epaq2/epaq2.pdf
Section A HOME ACTIVITIES
Getting About--Apart from going to work
Which form of transportation to you use most often apart from your journey to and from work?
Please tick (check) one box ONLY per line.
| Distance of journeys |
Usual mode of transport |
| Car |
Walk |
Public transport |
Cycle |
| Less than 1 mile |
|
|
|
|
| 1-5 mile(s) |
|
|
|
|
| More than 5 miles |
|
|
|
|
Section B ACTIVITY AT WORK
Please answer this section only if you have been in paid employment at any time during the last 12 months or you have done regular, organized voluntary work.
ACTIVITY LEVELS AT YOUR WORK
Now we would like you to take the total number of hours you worked per week in each job and divide them up according to your activity level.
Please complete EACH line.
| |
Job 1 |
Job 2 |
| No |
Yes |
Hours per week |
No |
Yes |
Hours per week |
| Walking at work -- carrying nothing heavier than a briefcase e.g. moving
about a shop |
|
|
|
|
|
|
| Walking -- carrying something heavy |
|
|
|
|
|
|
TRAVEL TO AND FROM WORK
JOB 1
Please complete EVERY line
Roughly how many miles was it from home to Job 1 ______
How many times a week did you travel from home to Job 1 _____
Please tick (check) one box ONLY per line
| How did you normally travel to Job 1 |
Always |
Usually |
Occasionally |
Never or rarely |
| By bicycle |
|
|
|
|
| Walking |
|
|
|
|
JOB 2
Please complete EVERY line
Roughly how many miles was it from home to Job 2 ______
How many times a week did you travel from home to Job 2_____
Please tick (check) one box ONLY per line
| How did you normally travel to Job 2 |
Always |
Usually |
Occasionally |
Never or rarely |
| By bicycle |
|
|
|
|
| Walking |
|
|
|
|
Section C RECREATION
The following questions ask about how you spent your leisure time.
Please indicate how often you did each activity on average over the last 12 months.
For activities that are seasonal, e.g. cricket or moving the lawn, please put the average frequency during the season when you did the activity.
Please indicate the average length of time that you spent doing the activity on each occasion.
EXAMPLE:
If you went walking for pleasure for 40 minutes once a week you would complete the table below as follows:
|
Number of times you did the activity
in the last 12 months |
Average time
per episode |
| None |
Less than once a month |
Once a month |
2-3 times a month |
Once a week |
2-3 times a week |
4-5 times a week |
Every day |
Hours |
Mins |
Walking for pleasure |
|
|
|
|
X |
|
|
|
|
40 |
|
Number of times you did the activity
in the last 12 months |
Average time
per episode |
| None |
Less than once a month |
Once a month |
2-3 times a month |
Once a week |
2-3 times a week |
4-5 times a week |
Every day |
Hours |
Mins |
Walking for pleasure -- You should not include walking as a means of transportation as this was included in Sections A
and B |
|
|
|
|
|
|
|
|
|
|
Racing or rough terrain cycling |
|
|
|
|
|
|
|
|
|
|
Cycling for pleasure -- you should not include cycling as a means of transportation |
|
|
|
|
|
|
|
|
|
|
|
