Background: Although the connection between health behaviors and Health Education is well established, elementary Health Education (EHE) readiness and delivery has been challenging to assess. Purpose: This research was intended to develop and test a valid and reliable instrument to assess school district readiness for and delivery of EHE. The transtheoretical model was the foundation for creating the Elementary Health Education District Assessment Tool (EHE-DAT). Methods: Development occurred in 3 phases: review, pilot study, and case study. Validity was established through quantitative and qualitative jury review, a focus group, and administrator interview. For reliability, the EHE-DAT was piloted in a local school district (n = 31) and case study of a second district (n = 161). Results: The EHE-DAT was found to be reliable and valid. All scales and subscales were determined to have high levels of internal consistency (coefficient a = 0.739 to 0.927). Discussion: States and professional organizations could apply the EHE-DAT on a wider scale. The EHE-DAT is customizable for states or grade levels where EHE requirements vary from Alabama. Translation to Health Education Practice: The EHE-DAT has implications for EHE practice and accountability. By determining school district engagement in readiness behaviors and practices, it provides a starting point for bridging the gap between state standards and EHE delivery.