Contact:
Dept. of 4-H Youth Development
Cooperative Extension Service
Box 7606 NC State University
Raleigh, NC 27695-7606
Check what you really do!
1. I wash my hands before I eat-
___All the time
___Sometimes
___Never
2. I look at the labels on food to see what is in them-
___All the time
___Sometimes
___Never
3. I get to help plan the meals at home-
___All the time
___Sometimes
___Never
4. I drink this many soft drinks most days-
___1 can/bottle
___2 cans/bottles
___3 cans/bottles
___None
5. I like to eat (check all that apply) for snacks-
___Cereal
___Bread
___Popcorn
___Apples
___Oranges
___Bananas
___Peaches
___Carrots
___Broccoli
___Celery
___Milk
___Cheese
___Ice cream
___Yogurt
___Peanut butter
___Peanuts
___Eggs
___Cookies
___Cake
___Donuts
___Potato chips
___French fries
6. My favorite snack is
7. Before I go to bed at night I like to eat
Evaluation Tools Page
ENTRY DATE:: January 1999