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Description
Southwest Chicago Food Store Audit Instrument Illinois Prevention Research Center Observer Name (1): Observer Name (2): Date (mm/dd/yyyy): Start Time: End Time: Circle One: AM PM Circle One: AM PM Store Name: Address: Store Operating Hours: Weekdays _______________AM to _________________PM Weekends _______________AM to _________________PM Contact Shannon Zenk, PhD (szenk@uic.edu) for more information about this instrument, including instructions for use. Funded by the NCI Cancer Education and Career Development Program ( 5 R25T CA57699-12). 1AVAILABILITY: FRUITS & VEGETABLES Does the store sell fresh fruit or vegetables? _____ Yes _____ No e sell canned fruit or vegetables? _____ Yes ____e sell frozen fruit of vegetables? _____ Yes _____ NoITEM FRESH CANNED FROZENITEM FRESH CANNED FROZENApple Kidney beans D Apricot Kiw rracacha Kohlrabi Artichoke Leeks Asparagus Lemon Avocado Lentils Banana Lettuce (chard) Batata (iceberg) Beet (green leaf) Bitter melon (red Black beans D Lettuce (romaine) Blackberries (spinach) Black-eye peas Lima beans DBlueberries Lime Bok choy Malanga (Yautia) Borage ...
Informations
| Publié par | Armyo |
| Nombre de lectures | 28 |
| Langue | English |
Extrait
1
Southwest Chicago Food Store Audit Instrument
Illinois Prevention Research Center
Contact Shannon Zenk, PhD (
szenk@uic.edu
) for more information about this instrument,
including instructions for use.
Funded by the NCI Cancer Education and Career Development Program ( 5 R25T CA57699-12).
Observer Name (1):
Observer Name (2):
Date (mm/dd/yyyy):
Start Time:
Circle One: AM
PM
End Time:
Circle One: AM
PM
Store Name:
Address:
Store Operating Hours:
Weekdays
_______________AM
to
_________________PM
Weekends
_______________AM
to
_________________PM
2
AVAILABILITY: FRUITS & VEGETABLES
Does the store sell
fresh
fruit or vegetables?
_____ Yes
_____ No
Does the store sell
canned
fruit or vegetables?
_____ Yes
_____ No
Does the store sell
frozen
fruit of vegetables?
_____ Yes
_____ No
ITEM
FRESH
CANNED
FROZEN
ITEM
FRESH
CANNED
FROZEN
Apple
Kidney beans
D
A
p
r
i
c
o
t
K
i
w
i
Arracacha
Kohlrabi
Artichoke
Leeks
Asparagus
Lemon
Avocado
Lentils
Banana
Lettuce (chard)
Batata
Lettuce (iceberg)
Beet
Lettuce (green leaf)
Bitter melon
Lettuce (red leaf)
Black beans
D
Lettuce (romaine)
Blackberries
Lettuce (spinach)
Black-eye peas
D
Lima beans
D
Blueberries
Lime
Bok choy
Malanga (Yautia)
B
o
r
a
g
e
M
a
n
g
o
Broccoli
Maya coba beans
D
Brussel sprouts
Mushroom
Cabbage (green)
Nappa
Cabbage (red)
Navy beans
D
Cantaloupe
Nectarine
Carrot
Okra
Cassava (Yucca)
Onion
C
a
u
l
i
f
l
o
w
e
r
O
r
a
n
g
e
C
e
l
e
r
y
P
a
p
a
y
a
Cherimoya
Passion fruit
Cherries
Peach
Coconut
Pear
C
o
r
n
P
e
a
s
Cucumber
Pepino melon
Eggplant
Pepper (chile)
Endive
Pepper (green bell)
Fava beans
Pepper (red bell)
Fennel
Pepper (yellow bell)
Garbanzo beans
D
Pepper (jalepeno)
Ginger
Pepper (poblano)
Grapes (green)
Pepper (serrano)
Grapes (red)
Pepper (chipotle)
Grapefruit
Persimmon
Green beans
D
Pigeon peas
Green onion
Pineapple
Greens (collard)
Pinto beans
D
Greens (kale)
Plantain
Greens (mustard)
Plum
Greens (turnip)
Potato
Guava
Potato (sweet)
Honeydew (melon)
Prickly pear (Cactus)
Jicama
Pumpkin
3
AVAILABILITY: FRUITS & VEGETABLES
ITEM
FRESH
CANNED
FROZEN
ITEM
FRESH
CANNED
FROZEN
Quince
Verdolaga
Radish
Watercress
Raspberries
Watermelon
Red beans
D
Other
Rhubarb
Other
Rutabaga
Other
Shallots
Other
Snow peas
Other
Sprouts (alfalfa, bean)
Other
Strawberries
Other
Squash (acorn)
Other
Squash (buttercup)
Other
Squash (butternut)
Other
Squash (chayote)
Other
Squash (spaghetti)
Other
Squash (yellow)
Other
Squash (zucchini)
Other
Starfruit
Other
Tangerine
Other
Taro root (eddo, kalo)
Other
Tomatillo
Other
Tomato
Other
Turnip
Other
PRICE: FRESH FRUITS & VEGETABLES
ITEM
UNIT/WEIGHT
(Circle One)
PRICE
(LOWEST COST)
ON SALE?
Apples
Per pound
Per item
Yes
Preferred
No
Avocado
Per pound
Per item
Yes
Preferred
No
Bananas
Per pound
Per item
Yes
Preferred
No
Broccoli
Per pound
Per item
Yes
Preferred
No
Collard greens
Per pound
Per item
Yes
Preferred
No
Iceberg lettuce (head)
Per pound
Per item
Yes
Preferred
No
4
PRICE: FRESH FRUITS & VEGETABLES
ITEM
UNIT/WEIGHT
(Circle One)
PRICE
(LOWEST COST)
ON SALE?
Mangos
Per pound
Per item
Yes
Preferred
No
Oranges
Per pound
Per item
Yes
Preferred
No
Papaya
Per pound
Per item
Yes
Preferred
No
Peppers—
green bell
Per pound
Per item
Yes
Preferred
No
Plantain
Per pound
Per item
Yes
Preferred
No
Potatoes -- sweet
Per pound
Per item
Yes
Preferred
No
Tomatoes
Per pound
Per item
Yes
Preferred
No
QUALITY: FRESH FRUITS & VEGETABLES
ITEM
RATING
COMMENTS
ITEM
RATING
COMMENTS
Apples
(individual)
1
3
2
4
Iceberg lettuce
(head)
1
3
2
4
Bananas
(individual)
1
3
2
4
Mangos
(individual)
1
3
2
4
Broccoli
(bunch)
1
3
2
4
Peppers --green bell
(individual)
1
3
2
4
Collard greens
(bunch)
1
3
2
4
Tomatoes
(individual)
1
3
2
4
5
AVAILABILITY: DRY GOODS
Any dry goods
Yes
No
White bread
Yes
No
100% whole wheat bread
Yes
No
Multigrain bread
Yes
No
Flour tortillas
Yes
No
Corn tortillas
Yes
No
White rice
Yes
No
Brown rice, long grain
Yes
No
White pasta
Yes
No
100% whole wheat pasta
Yes
No
Frosted flakes (any brand)
Yes
No
Corn flakes
Yes
No
Cream of wheat
Yes
No
Grits
Yes
No
Oatmeal
Yes
No
Regular potato chips
Yes
No
Baked potato chips
Yes
No
PRICE: DRY GOODS
ITEM
UNIT/WEIGHT
PRICE
(LOWEST COST)
ON SALE?
White bread
Per loaf (20 oz)
Yes
Preferred
No
100% whole wheat
bread
Per loaf (20 oz)
Yes
Preferred
No
White rice
Per 2 lb bag
or box
Yes
Preferred
No
Brown rice, long grain
Per 2 lb bag
or box
Yes
Preferred
No
White pasta
Per 1 lb box
Yes
Preferred
No
100% whole wheat
pasta
Per 1 lb box
Yes
Preferred
No
6
PRICE: DRY GOODS
Flour tortilla
Pack of 1 dozen
Yes
Preferred
No
Corn tortilla
Pack of 1 dozen
Yes
Preferred
No
Frosted flakes
20 oz box
Yes
Preferred
No
Corn flakes
18 oz box
Yes
Preferred
No
Kidney beans
1 lb bag
Yes
Preferred
No
Black beans
1 lb bag
Yes
Preferred
No
AVAILABILITY: CANNED OR BOTTLED GOODS
Any canned or bottled goods
Yes
No
Any bottled/shelved 100% fruit or vegetable juice
Yes
No
*Remember to check for canned fruits and vegetables (pages 2-3).
PRICE: CANNED OR BOTTLED GOODS
Kidney beans
15 oz
Yes
Preferred
No
Black beans
15 oz
Yes
Preferred
No
7
PRICE: FRESH MEATS
ITEM
UNIT/WEIGHT
PRICE
(LOWEST COST)
ON SALE?
Split chicken breast
with skin
Per pound
Yes
Preferred
No
Boneless, skinless
chicken breast
Per pound
Yes
Preferred
No
Regular ground beef
Per pound
Yes
Preferred
No
Extra lean ground
beef (95-100% lean,
0-5% fat)
Per pound
Yes
Preferred
No
Ground turkey
Per pound
Yes
Preferred
No
Extra lean ground
turkey (95-100% lean,
0-5% fat)
Per pound
Yes
Preferred
No
Items adapted from Community Health Council, Inc.
AVAILABILITY: FRESH MEATS
Any fresh meat
Yes
No
Split chicken breast with skin
Yes
No
Boneless, skinless chicken breast
Yes
No
Regular ground beef
Yes
No
Lean ground beef (85-94% lean, 6-15% fat)
Yes
No
Extra lean ground beef (95-100% lean, 0-5% fat)
Yes
No
Ground turkey
Yes
No
Lean ground turkey (90-94% lean, 6-10%)
Yes
No
Extra lean ground turkey (95-100% lean, 0-5% fat)
Yes
No
Pork
Yes
No
“Lean” pork
Yes
No
Fresh fish
Yes
How many types?
__________
No
8
*Remember to check for frozen fruits and vegetables (pages 2-3).
PRICE: FROZEN FOODS
100% orange juice
12 oz
Yes
Preferred
No
AVAILABILITY: REFRIGERATED FOODS
Any refrigerated dairy
Yes
No
Whole milk
Yes
No
2% milk
Yes
No
1% milk
Yes
No
Fat free milk (skim)
Yes
No
Regular yogurt
Yes
No
Nonfat/fat free yogurt
Yes
No
Regular cheese -- any variety or form
Yes
No
Reduced fat/2% cheese -- any variety or form
Yes
No
Fat free cheese -- any variety or form
Yes
No
Regular/whole milk cream cheese
Yes
No
Reduced fat cream cheese
Yes
No
Fat free cream cheese
Yes
No
Regular/whole milk cottage cheese
Yes
No
Fat free cottage cheese
Yes
No
Soy milk
Yes
No
Tofu
Yes
No
Any fresh 100% fruit or vegetable juice
Yes
Yes
Fresh 100% orange juice
Yes
No
Items adapted from Community Health Council, Inc.
AVAILABILITY: FROZEN FOODS
JUICE -- FROZEN
Any frozen 100% fruit or vegetable juice
Yes
No
Frozen 100% orange juice
Yes
No
9
PRICE: REFRIGERATED FOODS
ITEM
UNIT/WEIGHT
PRICE
(LOWEST COST)
ON SALE?
Whole milk
Per gallon
Yes
Preferred
No
Whole milk
Per half gallon
Yes
Preferred
No
Fat free milk (skim)
Per gallon
Yes
Preferred
No
Fat free milk (skim)
Per half gallon
Yes
Preferred
No
Regular yogurt
6 oz
Yes
Preferred
No
Fat free yogurt
6 oz
Yes
Preferred
No
Regular cheese,
cheddar
8 oz brick
Yes
Preferred
No
Reduced fat
cheese/2%, cheddar
8 oz brick
Yes
Preferred
No
Fat free cheese
8 oz brick
Yes
Preferred
No
100% orange juice
64 oz
Yes
Preferred
No
10
ADDITIONAL OBSERVATIONS
1. How many operational cash registers does the store have?
______________ registers
2. Does the store have bullet-proof glass at the check-out
counter?
Yes
No
3. Does the store have a turnstile at the check-out counter?
Yes
No
4.
Are there any non-English words used to label foods?
Yes
No
5.
Does the store have signage in languages other than English?
Yes
No
6.
Are there any window ads for tobacco products in the front of
the store?
Yes
No
7.
Are there any window ads for alcoholic beverages in the front
of the store?
Yes
No
8.
Do the check-out lanes carry candy or gum?
Yes
No
9.
Are any of these health promotion signs in the store?
5-A-Day (fruits and vegetables)
Nutritional information
Food guide pyramid
Healthy recipes
10.
Is a liquor sign the main sign for the store?
Yes
No
11. Store cleanliness?
Very clean
Somewhat clean
Somewhat dirty
Very dirty
12. Does the store have any of the following:
(check all that apply)
Fresh meat and poultry section
Deli section
Fresh produce section
Bakery
Pharmacy
13. What is the primary good for sale?
(select one)
Meat
Fruits & vegetables
Baked goods (bakery)
Medications (drug store or pharmacy)
Liquor
Deli
No primary good
Other: __________________________________
14. Is there a gas station?
Yes
No
15. How would you categorize this store?
Chain grocery store
Independent grocery store
Bakery
Drug store or pharmacy
Deli
Supercenter
Convenience store (without a gas station)
Convenience store with gas station
Fruit & vegetable market
Meat market
Limited assortment store
Wholesale club
Other: __________________________________
16. Does the store accept any of the
following?
LINK cards
WIC (Women, Infants & Children) coupons
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