Food and Nutrition: Choices for Health Evaluation

Program Planning and Reporting
Evaluation

Food and Nutrition: Choices for Health Evaluation Form

Dear Extension Participant:
Thank you for participating in a Food and Nutrition: Choices for Health program. We need periodic feedback in order to assess the benefit of programs to Iowans. We would appreciate your response to the statements below. Thank you.

Directions:
For each statement, please circle the number in the "Before" column that comes close to describing how you acted before the Extension program. Then circle the number in the "After" column that describes your action after the program.

1 - Almost Never 2 - Sometimes 3 - Often 4 - Almost Always

Before Program		After Program
	Food Safety and Quality
1 2 3 4	I used a meat thermometer to check that meat and poultry are cooked thoroughly.	1 2 3 4
1 2 3 4	I washed my hands before food preparation.	1 2 3 4
1 2 3 4	I washed my hands, utensils and cutting board after handling raw meat, fish and poultry.	1 2 3 4
1 2 3 4	I checked the temperature in the refrigerator and freezer.	1 2 3 4
1 2 3 4	I thawed meat and poultry in refrigerator or microwave.	1 2 3 4
1 2 3 4	I refrigerated food in shallow containers for quick cooling.	1 2 3 4
1 2 3 4	I avoided using raw or lightly cooked eggs.	1 2 3 4
1 2 3 4	I heated leftovers thoroughly.	1 2 3 4
1 2 3 4	I had my gauge pressure canner tested.	1 2 3 4
1 2 3 4	I used current (after 1988) USDA recommended food preservation instructions.	1 2 3 4

	Nutrition and Physical Activity
1 2 3 4	I follow MyPyramid recommendations.	1 2 3 4
1 2 3 4	I try to maintain a healthy weight.	1 2 3 4
1 2 3 4	I am physically active for at least 30 minutes per day, on most days of week.	1 2 3 4
1 2 3 4	I eat 4 1/2 cups of fruits and vegetables on a daily basis.	1 2 3 4
1 2 3 4	I eat a variety of fruits and vegetables daily.	1 2 3 4
1 2 3 4	Half of the grains (cereal, breads and pastas) I eat are whole grain.	1 2 3 4
1 2 3 4	I choose/prepare foods that are lean or low-fat.	1 2 3 4
1 2 3 4	I choose/prepare foods with less added sugar and other sweeteners.	1 2 3 4
1 2 3 4	I choose/prepare foods with little sodium (salt).	1 2 3 4
1 2 3 4	I limit my alcoholic beverage consumption.	1 2 3 4
1 2 3 4	I use the nutrition facts panel on the food label to choose foods.	1 2 3 4
1 2 3 4	I consume 3 cups of fat-free or low-fat (1%) milk or equivalent amount of yogurt or cheese daily.	1 2 3 4

Your age:	____
Your gender:	____ Female ____ Male
Your ethnicity:	____ Hispanic or Latino ____ Not Hispanic or Latino
Your race:	____ American Indian or Alaskan Native ____ Asian ____ Black or African American ____ Native Hawaiian or Other Pacific Islander ____ White
Place of residence:	____ Farm ____ Town under 1,000 ____ Town between 1,000-5,000 ____ Town over 5,000

Comments/questions:
Kristin Taylor
Last update: 9/18/06