Parent/guardian
signature_____________
Last 4 digits of phone number - ***-***- __ __ __ __
(These numbers as well as your answers will be held in complete
confidentiality, we will just need the number in order to correlate parent and
child media audit data)
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Students'
Media Diary
TIME SPENT with the Media
A) Please read each question carefully and colour in the number of HOURS PER DAY you spend watching TV.
For
example
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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________________________________________________________________________
________________________________________________________________________
1)
How long did you read Books/ Magazines/ Comics?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What books/magazines/comics did you read on Monday at home?
a)
_______________________________________
b)
_______________________________________
c)
_______________________________________
2)
How long did you listen to the Radio/Stereo?
0 1/2 1 1 1/2 2
2 1/2 3
3 1/2 4 4 1/2 5
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i) What radio stations did you listen to on Monday?
a)
_______________________________________
b)
_______________________________________
3) How long did you listen to music on CD player / Walkman / Minidisc?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What is the name of the singers/groups that you listened to on Monday?
a) ______________________________________
b)
______________________________________
c)
_______________________________________
4) How long did you watch TV?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What kinds of TV shows did you watch on Monday?
a)
_______________________________________
b)
_______________________________________
c)
_______________________________________
5) How long did you watch movies on the VCR/DVD?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What movies did you watch on Monday?
a)
______________________________________
b)
______________________________________
c)
______________________________________
6) How long did you spend talking on the Telephone?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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7) How long did you spend talking on a Cell-phone?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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8) How long did you spent using the cell-phone for playing cell-phone games?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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9) How long did you spend playing games on a hand held game machine? (for example a Gameboy)
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What games did you play on your hand held machine on Monday?
a) _______________________________________
b) _______________________________________
c)
_______________________________________
10) How long did you spend playing games on a Video game console? (for example, Game Cube, X-Box, Nintendo, Sega…)
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What games did you play on your video game console on Monday?
a) _______________________________
b)
_______________________________________
c)
_______________________________________
11) How
long did you use the Computer? (for
homework/school assignments)
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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12) How
long did you spend playing games on the computer? (not
Online games)
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What games did you play on the computer on Monday?
a) _______________________________________
b)
_______________________________________
c) _______________________________________
13) How many hours did you spend playing
online games? (using
the Internet for gaming)
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What games did you play online on Monday?
a) _______________________________________
b)
_______________________________________
c)
_______________________________________
14) How many hours did you spend Emailing on Monday?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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15) How long did you spend surfing for fun on the Internet on Monday?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) What websites did you visit on Monday?
a) _______________________________________
b)
_______________________________________
c) _______________________________________
16) How many hours did you spend Chatting online on Monday?
0 1/2 1 1 1/2
2 2 1/2 3 3 1/2 4 4 1/2 5
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i) Who did you chat with online on Monday?
(please
check all of the following that apply to you)
_____ friend
from school.
_____ friend
not from school, but someone you know in person.
_____ someone
you only know online and have never met.
_____ a
relative.