It would be good to first teach some basic regular verbs, possibly use the Infinitives Worksheet as a guide.
In the survey students choose 5 regular verbs and write them in the infinitive form. They then write whether they do that activity or not next to it, conjugating in the YO form. Then they create questions in the Tú form to ask their classmates. After they have all the spaces filled in, they are to write down the results for you saying who does (or doesn't) do what using the él/ella form and ellos/ellas form. It also includes the Nosotros(as) form of the conjugations. (Note: Although it says -AR verbs in the title, it can easily be changed for ER/IR verbs also)