Montana School District Wellness Policy Report (district level)

In order to meet the requirements of the USDA’s School Wellness Policy, a school must:

Assign a school wellness designee to manage school wellness policy implementation,
Demonstrate the steps they are taking to implement and evaluate the five areas of the school wellness policy ,
Maintain ongoing communication with key stakeholders and the public, and
Report to the school board and the public on an annual basis.

This survey will serve as a baseline report for your district level school wellness policy.

Completing this report will enable you to generate a yearly report that can be shared with key stakeholders, the public and the Office of Public Instruction. We suggest that you review the entire document to become familiar with the information requested in each section. Once you start entering data, you can save and update this file as often as needed. You must press the SAVE button prior to closing the document each time. It will be helpful to use the same computer while completing this report. Once you’ve completed this report to your satisfaction, press the SAVE Button and then the SUBMIT button. Once submitted, we will be able to send the report back to you in Adobe PDF format for your future use.

Thank you for your commitment to school wellness and creating a healthy school environment. Please contact Katie Bark, Montana Team Nutrition, Montana State University if you need further clarification: kbark@mt.gov or (406) 994-5641

Select the School Year:

Please provide the following:

Date of Completion:
Name of person completing form:
E-mail address for the person completing the form:
School District Wellness Coordinator Name:
E-mail Address:
Telephone Number:

County and School District

Select County First:

District:

I have another district to add.

	Yes
	No

County and School District

Select County First:

District:

School Wellness Policy Review and Reporting to the Public:

Please provide the following information

Date that this policy was adopted or last reviewed by the local school board members:
Most recent date that the board members received a progress report on the policy’s implementation plan:
Most recent date that the parent association(s) received a progress report on the policy’s implementation plan:

Attach a copy of the report or meeting minutes:

Choose File

The school wellness assessment report is posted on the district website.

Yes	No	Please provide the website link for the report:

Stakeholder Input for the School Wellness Policy:

A School Wellness or Health Committee is recommended to ensure that key school and community stakeholders provide input to the development, implementation, and assessment of the wellness policy. This committee may be a standalone council or be a sub-committee of an existing committee (i.e. through the Montana Behavioral Initiative School Team or Graduation Matters Council).

Please include a list of the positions (or roles) and their names that serve on the committee (*recommended members).

School Administrator*:
School Food Service*:
Health Enhancement Teacher*:
Family Consumer Science Teacher:
School Nurse/Health Professional*:
Parent*:
School Board Member:
Community Representative*:
Student:
Other:

Please provide the following information:

Name of Chairperson:
Phone:
E-mail:
How often does the committee meet during the school year?

Do students and family members have opportunities to provide both suggestions and feedback about the school meals program? Please select one.

	Neither students nor family members have these opportunities.
	Either students or family members have opportunities, but not both.
	Yes, both students and family members have opportunities to provide either suggestions for school meals OR feedback on the meal program.
	Yes, both students and family members have opportunities to provide suggestions AND feedback.

Does your health education curriculum address all of these essential topics on healthy eating? After reviewing the following list of healthy eating topics and using the following (3-0) scale, please list the number that reflects your response.

The relationship between healthy eating and personal health and disease prevention.
Food guidance from MyPlate
Reading and using food labels
Eating a variety of foods every day
Balancing food intake and physical activity
Eating more fruits, vegetables and whole grain products
Choosing foods that are low in fat, saturated fat, and cholesterol and do not contain transfat
Choosing foods and beverages with little added sugars
Eating more calcium-rich foods
Preparing healthy meals and snacks
Risks of unhealthy weight control practices
Accepting body size differences
Food safety
Importance of water consumption
Importance of eating breakfast
Making healthy choices when eating at restaurants
Social influences on healthy eating, including media, family, peers, and culture
How to find valid information or services related to nutrition and dietary behavior
How to take steps to achieve the personal goal to eat healthfully
Resisting peer pressure related to unhealthy eating behavior
Influencing, supporting, or advocating for others’ healthy dietary behavior

	3 = Yes, addresses all of these topics
	2 = Addresses most of these topics
	1 = Addresses some of these topics
	0 = Addresses one or none of these topics, or there is no health education curriculum