Ukiah Unified School District

CHKS Forms

for more information visit: WestEd | all documents are available in PDF

The California Healthy Kids Survey (CHKS) is a comprehensive youth risk behavior and resilience data collection service available to all California local education agencies (available outside California also). It consists of a modular survey instrument tied to the Centers for Disease Control and Prevention's Youth Risk Behavior Survey and to WestEd's California Student Survey, together with a full-service survey support system. Separate elementary, middle, and high school versions are currently available. Three regional centers serve all 1,049 California local education agencies, providing comprehensive technical assistance on survey administration and use of results. The CHKS employs a set of questionnaire modules that can be configured to meet local needs in collecting student data across a comprehensive range of risk behaviors. Current modules cover

1. alcohol and other drug use,
2. tobacco use,
3. violence and school safety,
4. nutrition and physical health,
5. sexual behavior and attitudes, and
6. youth resilience.

Since 1999, an integrated CHKS statewide representative sample has replaced both the California Student Survey and the Youth Risk Behavior Survey in California.

For 5th Graders:

Elementary Module ENG & SP

For 7th Graders:

The Core module collects demographic background data (age, sex, race/ethnicity) and covers key questions in four priority areas: resilience, alcohol and drug use, tobacco use, and violence and school safety.

ENG | SP

For High School:

ENG | SP

Module H: District After-School Module (DASM)

Elementary:

ENG & SP

Middle School:

ENG | SP

High School:

ENG | SP