Food Safety Education Survey

Form Approved

OMB No. 0990-0379

Exp. Date 06/03/2014

Food Safety Education Survey

2014

Please respond to this short survey

1. What is your gender?

   1. Female

   2. Male

2. What is your age?

   1. 18-20 years of age

   2. 21-23 years of age

   3. 24-25 years of age

3. Which of the following best describes your highest completed grade or degree?

   1. Some high school

   2. High school graduate

   3. Some college

   4. Associates degree or certification

   5. Bachelor’s degree

4. Are you learning, or did you learn about food safety in school?

   1. Yes

   2. No

   3. Not sure

5. If yes, was this information you could use at home?

   1. Yes

   2. No

Please tell us more.

6. Which of the following concerns do you have about food safety? Select all that apply

   1. I have food allergies

   2. I need to be careful about food because of my health

   3. I don’t know how to cook

   4. I’m not sure when foods go bad

   5. Healthy eating

   6. What they use to grow food

   7. I’m a vegetarian / vegan

   8. I’ve had food poisoning before and I don’t want it again

   9. I don’t know what “Food Safety” means

   10. Other, please specify ______________________________

7. Tell us three things you know you need to do to make sure your food is safe to eat?

   1. [text box]

   2. [text box]

   3. [text box]

8. If there was a website that gave you information on how to clean, cook and store food to keep you safe from food borne illness, how likely would you be to visit the site?

   1. Very likely

   2. Likely

   3. Not sure

   4. Not very likely

   5. I wouldn’t

Please tell us why or why not?

9. What are ways we could market a FoodSafety.gov so that it gets your attention and becomes a reference site for you and your friends & family?

Thank you for your time and comments.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0379 . The time required to complete this information collection is estimated to average ( hours)(minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer