The Healthy Snack Box Café -Survey

Please rate your responses by checking one of the numbers that are on a scale of 1-5 (1=low; 3=neutral; 5=high), or by indicating your response as requested. All survey responses are confidential and you may stop at any time.

1.  I use Eating Well with Canada’s Food Guide when planning meals and snacks.

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2.  I try to make small changes in my daily routine to develop healthy eating practices (for example eat fruit in place of muffin for snack or choosing milk and sweetener with coffee in place of cream and sugar).

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3.  I read labels on food items including nutritional value, ingredients list, etc. and interpret them with ease.

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4.  I am able to plan meals ahead of time, on a daily basis, to avoid purchasing ready-to-eat meals or food from fast food restaurants and vendors.

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5.  I choose healthier options when eating out

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6.  I eat breakfast every morning within the first 2 hours upon arising

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7.  I have a morning break with a snack before lunch each work day

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8.  I have a afternoon break with a snack after lunch each work day

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9.  What types of foods would you be most interested to purchase if these healthy options were made available in the workplace? Please circle as many as you like.

Apples / Carrot sticks / Healthy trail mix / Fruit salad cups / Juice packs
Oranges / Celery sticks / Popcorn / Blended fruit mix / Vegetable juice
Bananas / Broccoli / Baked pita chips / Yogurt / Water
Pears / Cucumber / Dried fruit (raisins, dates, cranberries, etc.) / Cheese slices / Milk
Grapes / Peppers (green and red sliced) / Pretzels / Tuna / Nuts (almonds, peanuts, etc.)
Granola bars (variety) / Fruit & vegetable bars / Bagels / Oatmeal / Dried cereal

10.  Please indicate possible reasons why you may find it difficult to eat healthy while at work:

Time

Stress

Inconvenience

Expensive

Unavailability of healthy options

Other: ______

11.  Please select any dietary concerns that may apply to you:

Diabetes □

Celiac Disease □

Allergies □ (please list ______)

Vegetarian □

High blood pressure (restriction of salt intake) □

High Cholesterol (restriction of high cholesterol and saturated fatty acid foods) □

Healthy Weight Maintenance □

Cultural Food Practices □ (______)

Other□:______

12. Would you purchase food at low cost (price to recover purchase cost) that was conveniently provided in safe conditions within your workplace break room/ staff room?

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13.  Do you think that the provision of healthy food products (such as fresh fruit, vegetables, yogurt, etc.) in the workplace break room/ staff room at low cost would improve the nutritional status of workplace employees or enhance their efforts to eat healthier?

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14.  Please provide any additional suggestions:

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Thank you for your participation!