SPORTS SCREENERS CHECKLIST

Name _____________________________________

  1. Name of film/video/TV program:

    __________________________________________________

    TV channel ____________ Time of program ____________

    Name of producer __________________________________________

  2. How would you characterize the film, video or television program?

    Circle one: Drama Comedy Thriller/Science Fiction Other

    If you circled Other, how would you describe it?

    __________________________________________________________

  3. Did you see any sports or physical activity in the film, video or TV program?

    Circle one: YES NO

    If YES, what sports or physical activities were shown, approximately how many times were they were shown, and who performed the activity (child, adult, male, female, etc)?

    What Sports or Physical Activity? How many times? Who did it?



    ________________________________ _______________ _______________



    ________________________________ _______________ _______________



    ________________________________ _______________ _______________



    ________________________________ _______________ _______________



    ________________________________ _______________ _______________



    ________________________________ _______________ _______________



    ________________________________ _______________ _______________



    ________________________________ _______________ _______________

    Total number: ______

  4. Do you think the film, video or tv program encouraged youth to participate in physical activity or sports?

    Circle one: YES NO

    If YES, how?

    ____________________________________________________________

    ____________________________________________________________

    ____________________________________________________________

  5. What grade would you give the movie, video or TV program for depicting physical activity or sports participation?

    Circle one: A = Excellent B = Good C = Average D = Fair F = Poor