School Name
Years of Teaching
Age of School
Sick Leave days Taken
Clean Physical Environment
Condition of Equipment
Often too Warm
Often too Cold
Adequate Ventialtion
At least one Window
Clean Restrooms
Clean Cafeteria
Chemical Fumes
Classroom Noise
Traffic Noise
Acoustical tile on walls
Carpeted floors
Students lethargic or sleepy
Students show no interest
Students sick
Students abscent
Student behavior hinders teaching objectives
Student behavior in my classsroom
Student behavior in school
Student behavior causes substantial stress
Student motivation
Student behavior affects teacher enthusiasm
Feel sick or lethargic at school
Considered career change
Frustrated with behavior of my students