Minnesota Participant Questionnaire

S tudy ID

Form Approved

OMB No. 0923-XXXX

Exp. Date xx/xx/20xx

Attachment 5e (MN 10.2 )

STUDY PARTICIPANT QUESTIONNAIRE

INTRODUCTION SCRIPT:

Did everything go okay with the Nurse?

Did you get something to eat or drink?

The way we’ll do the interview is …. I’ll ask questions about who you are and your usual, day-to-day activities…things like your age, places you have lived, foods you eat, jobs, and few others. We ask the same questions of everyone in the study.

The questionnaire has several parts (show outline of Topics in Hand Card Booklet) and it may take anywhere from about 15 minutes to about an hour to go through everything. Tell me know if you need a break or if I am going too fast at any time.

I want to remind you about a few things, before we start:

First, you don’t have to answer any question if you don’t want to…just say “I don’t want to answer” and we’ll skip that question;

Second, if you are not completely sure about an answer, do the best you can. If a question doesn’t make sense, let me know and I’ll repeat it or give more instruction. But if you really can’t remember or don’t know… just say “I don’t know”

Finally, please do the best you can, because your answers are very important. They will help us learn how people have been exposed to chemicals in the environment.

Date of Interview:___________________________ Interviewer Name:__________________________

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-XXXX).

Note to Interviewer: The text in italics are instructions or supporting information. Do not read aloud.

A. BACKGROUND

Script: The first part of the questionnaire is about your background. It will help us compare your answers to others’.

1. What is your age? If less than 18, STOP INTERVIEW as Ineligible

Years

[ ] DK

[ ] Refused

2. Indicate whether the person is a male or female. If unsure, be sure to ask his/her sex.

[ ] Male

[ ] Female

3. Tell me what tribes you are affiliated with. Name as many as apply.

Check Band or Write In Name of Other.

[ ] Fond du Lac Band (if marked, go to Q 3A)

[ ] Grand Portage Band

[ ] Bois Forte Band (Nett Lake)

[ ] Leech Lake Band

[ ] Mille Lacs Band

[ ] White Earth Band

[ ] Other, specify ______________________________

[ ] Other, specify ______________________________

[ ] Other, specify ______________________________

[ ] Other, specify ______________________________

[ ] DK

[ ] Refused

3A. (if affiliated with Fond du Lac) Are you an enrolled member of the Fond du Lac Band?

[ ] Yes

[ ] No

[ ] DK

[ ] Refused

B. RESIDENTIAL HISTORY

Script: Next, I’ll ask where you have lived.

1. How long have you lived at your current address?

_____ years and _____ months

If ENTIRE LIFE, enter age in years

If less than 1 year, enter 0 years and number of months reported.

If full years reported, enter number of years and 0 months.

[ ] DK

[ ] Refused

2. How long have you lived in the area pictured on this map…? SHOW NORTHEAST MINNESOTA MAP

_____ years and _____ months

If ENTIRE LIFE, enter age in years

If less than 1 year, enter 0 years and number of months reported. STOP INTERVIEW as Ineligible

If full years reported, enter number of years and 0 months.

[ ] DK

[ ] Refused

3. Have you ever lived on the Fond du Lac Reservation?

[ ] Yes (if marked, go to Q 3A)

[ ] No

[ ] DK

[ ] Refused

3A. (if YES) Over your entire lifetime, how long have you lived on the Fond du Lac Reservation?

_____ years and _____ months

If ENTIRE LIFE, enter age in years

If less than 1 year, enter 0 years and number of months reported.

If full years reported, enter number of years and 0 months.

[ ] DK

[ ] Refused

C. current home

SCRIPT: I'd like to ask about your current home.

1. In the past 5 years, was new carpet installed in your home?

[ ] Yes

[ ] No

[ ] DK

[ ] Refused

2. In the past 5 years, was any carpet or furniture in your home treated with a stain-resistant product?

[ ] Yes

[ ] No

[ ] DK

[ ] Refused

3. Does the water used for drinking and cooking in your home come from a public water supply, a private well, or something else? (mark all that apply)

[ ] Public Water Supply

[ ] Private Well

[ ] Something Else

[ ] DK

[ ] Refused

4. What do you use to heat your home most? SHOW HEATING FUEL CARD (Select one)

[ ] Natural gas

[ ] Propane

[ ] Fuel oil

[ ] Kerosene

[ ] Wood-burning stove/fireplace

[ ] Outdoor wood boiler

[ ] Pellet stove

[ ] Electricity

[ ] Something Else

[ ] DK

[ ] Refused

5. What do you use to cook with most? SHOW COOKING FUEL CARD (Select one)

[ ] Natural gas

[ ] Propane

[ ] Wood fire/wood-burning stove

[ ] Electricity

[ ] Something Else

[ ] DK

[ ] Refused

D. EDUCATION AND OCCUPATION

1. What is the highest grade, level of school, or degree you completed? SHOW EDUCATION LEVEL CARD. (Select one)

[ ] 8th Grade or less [ ] Associate Degree

[ ] 9th to 12^th Grade, No Diploma [ ] Bachelor’s Degree

[ ] High School Graduate or GED [ ] Postgraduate, Professional or Doctoral Degree

[ ] Some College, No Diploma

2. Which best describes your job status in the past 12 months? SHOW JOB STATUS CARD. (Select one).

If status changed in past 12 months, enter current category.

[ ] Employed, and not a student (if checked, go to Q 2A)

[ ] A Student, and employed (if checked, go to Q 2A)

[ ] A Student, and not employed

[ ] Out of work for more than 1 year

[ ] Out of work for less than 1 year (if checked, go to Q 2A)

[ ] A Homemaker

[ ] Retired for over 1 year

[ ] Unable to Work

[ ] DK

[ ] Refused

SCRIPT: I'd like to know what type of work you’ve done and the kind of business or organization where you worked in the past 12 months.

2A.  Currently, what is your job or job title and the kind of business or organization where you work?  

Job 1 Title:___________________________   [  ] DK      [   ] Refused

(Optional) What are you usual activities or duties: _______________________________________________________

Job 1 Business or Industry:___________________________  [  ] DK      [   ] Refused

(Optional) What does (did) the company or organization do or make: ________________________________________

Prompt: If you had more than one job in the past 12 months, tell me about each.

Job 2 Title:___________________________   [  ] DK      [   ] Refused

(Optional) What are you usual activities or duties: _______________________________________________________

Job 2 Business or Industry:___________________________  [  ] DK      [   ] Refused

(Optional) What does (did) the company or organization do or make: ________________________________________

Job 3 Title:___________________________   [  ] DK      [   ] Refused

(Optional) What are you usual activities or duties: _______________________________________________________

Job 3 Business or Industry:___________________________  [  ] DK      [   ] Refused

(Optional) What does (did) the company or organization do or make: ________________________________________

Job 4 Title:___________________________   [  ] DK      [   ] Refused

(Optional) What are you usual activities or duties: _______________________________________________________

Job 4 Business or Industry:___________________________  [  ] DK      [   ] Refused

(Optional) What does (did) the company or organization do or make: ________________________________________

E. FOOD

SCRIPT: We are very interested in knowing about the food you eat. Food has many health benefits, but can also contain chemicals from the environment. I’ll ask about different kinds of food and where you get them.

For most of these questions, we want to get an estimate of how many times you ate each item in the past 12 months. Prompt: You can tell me the number of times you ate it per week, number of times per month or number of times in the past year – whatever is easiest to remember.

We’ll start with questions about fish. First, a few general questions about fish that you eat.

1. Has the total amount of fish you eat changed in the past 5 years? SHOW CHANGE IN FISH AMOUNT CARD

[ ] Eat less

[ ] Same or about the same (has not changed)

[ ] Eat more

[ ] Don’t eat fish (if checked, go to wild birds or animalS)

[ ] DK

[ ] Refused

2. Compared to this model of a half-pound serving of fish, would you say that a typical meal of fish that you eat is usually ….? SHOW SERVING MODEL

[ ] Less (smaller than the example)

[ ] Same or about the same

[ ] More (larger than the example)

[ ] DK

[ ] Refused

3. Have you eaten fish or shellfish in the past week?

[ ] Yes

[ ] No (if checked, go to CAUGHT Fish)

[ ] DK

[ ] Refused

3A. (If YES to Q 3) When was the last time you ate fish or shellfish? 

[  ]  Today/same day

[  ]  Yesterday/1 day ago

[  ]  Day before yesterday/2 days ago

[  ]  3 days ago

[  ]  4-7 days ago

[ ] DK

[ ] Refused

F. CAUGHT FISH

SCRIPT: To begin the questions about fish, let’s talk only about fish that were caught by you or someone you know.

1. In the past 12 months, have you eaten fish that was caught by you or someone you know?

[ ] Yes

[ ] No (if checked, go to BOUGHT Fish)

[ ] DK

[ ] Refused

SCRIPT: To make it easier for you to remember what you ate over the past year, I will ask about these fish by going through different ways fish might be caught and each season.  The Fond du Lac Band and their Natural Resources staff are also interested in how much fish people are eating and how they get their fish. We’ll start with netting and then go on to other ways fish are caught.

2. (If YES to Q 1) In the past 12 months, did you eat any fish caught by netting?

[ ] Yes

[ ] No (if checked, go to Q 3 NETTED FISH)

[ ] DK

[ ] Refused

2A. (if YES to Q 2) What kinds of fish did you eat in the past 12 months that were netted? SHOW CAUGHT FISH CARD. Prompt: You may choose from this list of fish if it helps you remember. Please tell me which.

Walleye [ ] Y [ ] N [ ] DK

Northern pike [ ] Y [ ] N [ ] DK

Perch [ ] Y [ ] N [ ] DK

Bass (smallmouth, largemouth, rock) [ ] Y [ ] N [ ] DK

Panfish (bluegill, sunfish, crappie, etc.) [ ] Y [ ] N [ ] DK

Whitefish [ ] Y [ ] N [ ] DK

Catfish [ ] Y [ ] N [ ] DK

Bullhead [ ] Y [ ] N [ ] DK

Stream Trout (brook, rainbow) [ ] Y [ ] N [ ] DK

Lake trout [ ] Y [ ] N [ ] DK

Eelpout [ ] Y [ ] N [ ] DK

Suckers [ ] Y [ ] N [ ] DK

Smelt [ ] Y [ ] N [ ] DK

Lake herring (cisco) [ ] Y [ ] N [ ] DK

Salmon [ ] Y [ ] N [ ] DK

Other, specify _____________________________

Other, specify _____________________________

Other, specify _____________________________

[ ] DK

[ ] Refused

For each species eaten in the past 12 months that was netted, complete a NETTED [SPECIES] Table.

NETTED Walleye
Did you eat any Walleye caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Walleye come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Northern Pike
Did you eat any Northern Pike caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Northern Pike come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Perch
Did you eat any Perch caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Perch come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Bass
Did you eat any Bass caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Bass come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Panfish
Did you eat any Panfish caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Panfish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Whitefish
Did you eat any Whitefish caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Whitefish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Catfish
Did you eat any Catfish caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Catfish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Bullhead
Did you eat any Bullheads caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Bullheads come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Stream Trout
Did you eat any Stream Trout caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Stream Trout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Lake Trout
Did you eat any Lake Trout caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Lake Trout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Eelpout
Did you eat any Eelpout caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Eelpout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Suckers
Did you eat any Suckers caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Suckers come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Smelt
Did you eat any Smelt caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Smelt come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Herring
Did you eat any Herring caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Herring come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED Salmon
Did you eat any Salmon caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Salmon come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED other, specify ______________________________
Did you eat any [Species] caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED other, specify ______________________________
Did you eat any [Species] caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

NETTED other, specify ______________________________
Did you eat any [Species] caught by netting last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

3. (If No Other NETTED [SPECIES]) In the past 12 months, did you eat any fish caught by SPEARING?

[ ] Yes

[ ] No (if checked, go to Q 4 ANGLED FISH)

[ ] DK

[ ] Refused

3A. (If YES to Q 3) What kinds of fish did you eat in the past 12 months that were SPEARED? SHOW CAUGHT FISH CARD. You may choose from this list of fish if it helps you remember. Please tell me which.

Walleye [ ] Y [ ] N [ ] DK

Northern pike [ ] Y [ ] N [ ] DK

Perch [ ] Y [ ] N [ ] DK

Bass (smallmouth, largemouth, rock) [ ] Y [ ] N [ ] DK

Panfish (bluegill, sunfish, crappie, etc.) [ ] Y [ ] N [ ] DK

Whitefish [ ] Y [ ] N [ ] DK

Catfish [ ] Y [ ] N [ ] DK

Bullhead [ ] Y [ ] N [ ] DK

Stream Trout (brook, rainbow) [ ] Y [ ] N [ ] DK

Lake trout [ ] Y [ ] N [ ] DK

Eelpout [ ] Y [ ] N [ ] DK

Suckers [ ] Y [ ] N [ ] DK

Smelt [ ] Y [ ] N [ ] DK

Lake herring (cisco) [ ] Y [ ] N [ ] DK

Salmon [ ] Y [ ] N [ ] DK

Other, specify _____________________________

Other, specify _____________________________

Other, specify _____________________________

[ ] DK

[ ] Refused

For each species eaten in the last 12 months that was speared, complete a SPEARED [SPECIES] Table.

SPEARED Walleye
Did you eat any Walleye caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Walleye come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Northern Pike
Did you eat any Northern Pike caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Northern Pike come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Perch
Did you eat any Perch caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Perch come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Bass
Did you eat any Bass caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Bass come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Panfish
Did you eat any Panfish caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Panfish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Whitefish
Did you eat any Whitefish caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Whitefish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Catfish
Did you eat any Catfish caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Catfish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Bullhead
Did you eat any Bullheads caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Bullheads come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Stream Trout
Did you eat any Stream Trout caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	. _ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Stream Trout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Lake Trout
Did you eat any Lake Trout caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Lake Trout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Eelpout
Did you eat any Eelpout caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Eelpout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Suckers
Did you eat any Suckers caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Suckers come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Smelt
Did you eat any Smelt caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Smelt come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Herring
Did you eat any Herring caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Herring come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED Salmon
Did you eat any Salmon caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Salmon come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED other, specify ______________________________
Did you eat any [Species] caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED other, specify ______________________________
Did you eat any [Species] caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

SPEARED other, specify ______________________________
Did you eat any [Species] caught by spearing last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

4. (If No Other SPEARED [SPECIES]) In the past 12 months, did you eat any fish caught by angling/ hook and line /rod and reel?

[ ] Yes

[ ] No (if checked, go to CAUGHT FISH SUMMARY)

[ ] DK

[ ] Refused

4A. (If YES to Q 4) What kinds of fish did you eat in the past 12 months that were caught by angling/ hook and line /rod and reel? (POINT OUT STATE CAUGHT FISH CARD AGAIN) Prompt: You may choose from this list of fish if it helps you remember. Please tell me which.

Walleye [ ] Y [ ] N [ ] DK

Northern pike [ ] Y [ ] N [ ] DK

Perch [ ] Y [ ] N [ ] DK

Bass (smallmouth, largemouth, rock) [ ] Y [ ] N [ ] DK

Panfish (bluegill, sunfish, crappie, etc.) [ ] Y [ ] N [ ] DK

Whitefish [ ] Y [ ] N [ ] DK

Catfish [ ] Y [ ] N [ ] DK

Bullhead [ ] Y [ ] N [ ] DK

Stream Trout (brook, rainbow) [ ] Y [ ] N [ ] DK

Lake trout [ ] Y [ ] N [ ] DK

Eelpout [ ] Y [ ] N [ ] DK

Suckers [ ] Y [ ] N [ ] DK

Smelt [ ] Y [ ] N [ ] DK

Lake herring (cisco) [ ] Y [ ] N [ ] DK

Salmon [ ] Y [ ] N [ ] DK

Other, specify _____________________________

Other, specify _____________________________

Other, specify _____________________________

[ ] DK

[ ] Refused

For each species eaten in the last 12 months that was caught by angling/hook and line/rod and reel, complete an ANGLED [SPECIES] Table.

ANGLED Walleye
Did you eat any Walleye caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Walleye come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Northern Pike
Did you eat any Northern Pike caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Northern Pike come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Perch
Did you eat any Perch caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Perch come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Bass
Did you eat any Bass caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Bass come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Panfish
Did you eat any Panfish caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Panfish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Whitefish
Did you eat any whitefish caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Whitefish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Catfish
Did you eat any Catfish caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Catfish come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Bullhead
Did you eat any Bullheads caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Bullheads come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Stream Trout
Did you eat any Stream Trout caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Stream Trout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Lake Trout
Did you eat any Lake Trout caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Lake Trout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Eelpout
Did you eat any Eelpout caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Eelpout come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Suckers
Did you eat any Suckers caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Suckers come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Smelt
Did you eat any Smelt caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Smelt come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Herring
Did you eat any Herring caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Herring come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED Salmon
Did you eat any Salmon caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those Salmon come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED other, specify ______________________________
Did you eat any [Species] caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED other, specify ______________________________
Did you eat any [Species] caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

ANGLED other, specify ______________________________
Did you eat any [Species] caught by angling last [SEASON]?	How many times? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember.
SPRING [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Spring [ ] DK [ ] Refused
SUMMER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Summer [ ] DK [ ] Refused
FALL [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Fall [ ] DK [ ] Refused
WINTER [ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] last Winter [ ] DK [ ] Refused
Where did those [Species] come from? SHOW MAP OF FISHING LOCATIONS. Mark all that apply. [ ] Mille Lacs [ ] FDL waters [ ] SLR above FDL dam [ ] SLR below FDL dam [ ] Superior [ ] Any other [ ] DK / Unknown [ ] Refused

CAUGHT FISH SUMMARY

Script: Now I’d like to ask you about how these fish you ate were prepared and cooked.

Review all caught fish that were eaten in the past 12 months and ask the following three questions for each Species. Record answers in the CAUGHT FISH TABLE under the row for each SPECIES reported so far.

CAUGHT FISH TABLE
What parts of the [SPECIES] did you usually eat? SHOW FISH PARTS EATEN CARD (mark all that apply)	How was the [SPECIES] you ate usually cleaned? ( SHOW FISH CLEANING CARD (mark all that apply)	How was the [SPECIES] you ate usually cooked? SHOW FISH COOKING CARD (mark all that apply)
Walleye
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused	[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Northern pike
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused	[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Perch
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused	[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Bass (smallmouth, largemouth, rock)
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused	[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Panfish (bluegill, sunfish, crappie, etc.)
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Whitefish
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Catfish
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Bullhead
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Stream Trout (brook, rainbow, steelhead)
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Lake trout
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Eelpout
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Suckers
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Continue next page Smelt
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Lake herring (cisco)
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused			[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Salmon
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Other, specify_____________________
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Other, specify_____________________
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] as Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused
Other, specify_____________________
[ ] Fillet [ ] Cheeks [ ] Skin [ ] Eggs [ ] Liver [ ] Other, specify_____________________ [ ] DK [ ] Refused	[ ] Remove skin / puncture skin [ ] Trim fat [ ] Trim belly meat [ ] DK [ ] Refused		[ ] Pan Fry [ ] Deep Fry [ ] Bake/Broil [ ] Boiled/Poached [ ] Stew/Chowder [ ] Smoked [ ] Grilled [ ] Dried [ ] Pickled [ ] Eaten Raw [ ] Other _______________________ [ ] DK [ ] Refused

G. BOUGHT FISH

Script: The next group of questions are about fish bought at a restaurant (including fast food), a store, or a supermarket (this could include commodities).

1. In the past 12 months, have you eaten fish bought from a restaurant, store or supermarket?

[ ] Yes (if checked, go to BOUGHT FISH TABLE)

[ ] No (if checked, go to wild birds or animals)

[ ] DK

[ ] Refused

BOUGHT FISH TABLE
	In the past 12 months, what kinds of fish/species did you eat from a restaurant, store or supermarket? (show BOUGHT FISH LIST)	For each species reported) In the past 12 months, how many times did you eat [SPECIES]? Prompt: You can tell me the number of times per week, month, or year, whichever is easiest to remember. [If NEVER, enter 00 times per year]
Catfish	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Cod	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Halibut	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Lake herring (cisco)	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Lake trout	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Perch	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Pollock	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Salmon (including canned)	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Stream trout (brook, rainbow, steelhead)	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Tilapia	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Tuna (canned or pouch)	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Tuna (not canned)	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Shrimp	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Shellfish (crayfish, crab, lobster, mussels, oysters, clams)	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Swordfish	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Walleye	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Whitefish	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Don’t know species	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Other, specify if known	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Other, specify if known	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused
Other, specify if known	[ ] Yes [ ] No [ ] DK	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused

H. wild birds or animals

Script: The next questions are about wild birds or animals that you or someone else hunted.

1. In the past 12 months, have you eaten any of these wild birds or animals? SHOW WILD BIRDS OR ANIMALS CARD

[ ] Yes (if checked, go to wild birds AND animals Table)

[ ] No (if checked, go to WILD PLANTS)

[ ] DK

[ ] Refused

wild birds AND animals Table
Please tell me which.	During the past 12 months, how often did you eat [BIRDS or ANIMALS]? Prompt: You can tell me the number of times per week or times per month -- whichever is easiest to remember. (if NEVER, enter 00 times per month)	What parts of the [BIRDS or ANIMALS] did you eat? Show PARTS EATEN – BIRDS CARD OR PARTS EATEN – ANIMALS CARD (Mark all that apply)
Waterfowl like ducks, geese or coots
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused
Grouse, pheasants, turkey or other upland game birds
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused
Deer
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused
Moose
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused
Bear
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused
Beaver
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused
Rabbit, squirrel, porcupine or other small animals
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused
Turtle
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused
Other wild animal, Specify__________________________
[ ] Y [ ] N [ ] DK [ ] Refused	_ times per [ ] Week [ ] Month [ ] Year [ ] DK [ ] Refused	[ ] Meat [ ] Skin [ ] Liver [ ] Other, specify:______________________ [ ] DK [ ] Refused

2. Where do you get the wild birds and animals you eat? (check all that apply)

[ ] Hunted by yourself or by someone in your family (if checked, go to Q 2A)

[ ] Store

[ ] Gift

[ ] Other, specify ________________________

2A. (If HUNTED to Q 2) Please show me on this map where you (or your family) usually hunt the wild birds and animals you eat. Show WILD BIRDS and ANIMALS HUNTING Map (check all that apply)

[ ] Fond du Lac Reservation

[ ] 1854 Ceded Territory (not including reservation)

[ ] 1837 Ceded Territory

[ ] Other location in Minnesota

[ ] Other location outside Minnesota

[ ] DK

[ ] Refused

I. WILD PLANTS

Script: The next questions are about food from wild plants. The Fond du Lac Band is particularly interested in the answers to these questions.

1. Do you eat wild rice?

[ ] Yes (if checked, go to Q 1A)

[ ] No (if checked, go to Q 2)

[ ] DK

[ ] Refused

1A. (if YES to Q 1) In the past 12 months, about how many times did you eat wild rice? Prompt: You can tell me the number of times per week, month or year, whichever is easiest to remember.

_ times per [ ] Week [ ] Month [ ] Year

[ ] DK

[ ] Refused

1B. Where do you get the wild rice you eat? (check all that apply)

[ ] Harvested by yourself or by someone in your family (if checked, go to Q 1C)

[ ] Store

[ ] Gift

[ ] Other, specify ________________________

1C. (If HARVESTED to Q 1B) Please show me on this map where you (or your family) harvest wild rice. Show Wild Rice Harvest Map (check all that apply)

[ ] Fond du Lac Reservation

[ ] 1854 Ceded Territory (not including reservation)

[ ] 1837 Ceded Territory

[ ] Other location in Minnesota

[ ] Other location outside Minnesota

[ ] DK

[ ] Refused

2. Do you eat wild fruits or berries (including jams)?

[ ] Yes (if checked, go to Q 2A)

[ ] No (if checked, go to Q 3)

[ ] DK

[ ] Refused

2A. (if YES to Q 2) Where do you get the wild fruit or berries you eat? (check all that apply)

[ ] Picked wild by you or by someone in your family (if checked, go to Q 2B and Q 2C)

[ ] Garden

[ ] Berry Farm

[ ] Store

[ ] Gift

[ ] Other, specify ________________________

[ ] DK

[ ] Refused

2B. (If Picked WILD to Q 2A) What kinds of wild fruits or berries do you or your family pick? Show Wild Fruit and Berry Card (check all that apply)

[ ] Blueberries

[ ] Blackberries

[ ] Raspberries

[ ] Strawberries

[ ] Cranberries

[ ] Choke Cherries

[ ] Other, specify _____________________________________

[ ] Other, specify _____________________________________

[ ] Other, specify _____________________________________

[ ] DK

[ ] Refused

2C. (If Picked WILD to Q 2A) Please show me on this map where you (or your family) pick wild fruit and berries. Show Wild Fruit and Berry Map (check all that apply)

[ ] Fond du Lac Reservation

[ ] 1854 Ceded Territory (not including reservation)

[ ] 1837 Ceded Territory

[ ] Other location in Minnesota

[ ] Other location outside Minnesota

[ ] DK

[ ] Refused

3. Do you eat other edible plants or natural foods such as the items shown here ….? Show Edible Plants Or Natural Foods Card (check all that apply)

[ ] Maple Syrup

[ ] Hazel Nuts

[ ] Wild Asparagus

[ ] Wild Mushrooms

[ ] Fiddle Heads

[ ] Any other traditional foods, specify _______________________________________________

[ ] No (if checked, go to Q 4)

[ ] DK

[ ] Refused

3A. (If ANY REPORTED in Q 3) Where do you get these foods? (check all that apply)

[ ] Harvested or gathered in wild by you or someone in your family (if checked, go to Q 3B)

[ ] Store

[ ] Gift

[ ] Restaurant

[ ] Other, specify ________________________

[ ] DK

[ ] Refused

3B. (If HARVESTED OR GATHERED in Q 3A) Please show me on this map where you (or your family) harvest these foods. Show EDIBLE PLANTS AND NATURAL FOODS Map (check all that apply)

[ ] Fond du Lac Reservation

[ ] 1854 Ceded Territory (not including reservation)

[ ] 1837 Ceded Territory

[ ] Other location in Minnesota

[ ] Other location outside Minnesota

[ ] DK

[ ] Refused

4. Do you use wild plants or animal parts -- such as teas, roots, bear grease -- for medicine or good health?

[ ] Yes

[ ] No

[ ] DK

[ ] Refused

4A. (If YES to Q 4) Where do you get these? (check all that apply)

[ ] Harvested or gathered in wild by you or someone in your family (if checked, go to Q 4B)

[ ] Gift

[ ] Other, specify ________________________

[ ] DK

[ ] Refused

4B. (If HARVESTED OR GATHERED in Q 4A) Please show me on this map where you (or your family) gather these. Show WILD PLANTS AND ANIMALS FOR HEALTH Map (check all that apply)

[ ] Fond du Lac Reservation

[ ] 1854 Ceded Territory (not including reservation)

[ ] 1837 Ceded Territory

[ ] Other location in Minnesota

[ ] Other location outside Minnesota

[ ] DK

[ ] Refused

J. Personal Activities

Script: The next questions are about personal activities that are not done as part of a job. The focus is on certain activities that may lead to contact with some of the chemicals we are studying.

1. In the past 12 months, have you done any of these activities? SHOW PERSONAL ACTIVITIES CARD.

[ ] Yes (if marked, go to ACTIVITIES TABLE)

[ ] No (if checked, go to Q 2)

[ ] DK

[ ] Refused

2. In the past 12 months, has someone else living in your household done any of these activities at home? SHOW PERSONAL ACTIVITIES CARD.

[ ] Yes (if marked, go to ACTIVITIES TABLE)

[ ] No (if checked, go to Q 3)

[ ] DK

[ ] Refused

ACTIVITIES TABLE
	Tell me which activities you did.	Tell me which activities someone else in your household did.
Dyeing material	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Electronics assembly	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Gardening or farming	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Glass crafting	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Leather crafting	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Metal work	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Painting and glazing	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Printmaking	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Woodworking	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Smoking meat or fish	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK
Waxing skis	[ ] Yes [ ] No [ ] DK	[ ] Yes [ ] No [ ] DK

3. In the past 12 months, including while you were at work, about how many times did you swim, dive or wade in the St. Louis River between Cloquet and the mouth (Lake Superior)? (if NONE, enter “00” times)

__ times in last 12 months

[ ] DK

[ ] Refused

K. LIFESTYLE

Script: We also want to know about a few lifestyle choices that might increase or decrease the amount of chemicals in your body.

1. Do you take multi-vitamins most days?

[ ] Yes

[ ] No

[ ] DK

[ ] Refused

2. Most days, do you take any dietary supplements that have fish oil or Omega 3 fatty acids?

[ ] Yes

[ ] No

[ ] DK

[ ] Refused

3. Most days, do you take any store-bought herbal supplements?

[ ] Yes

[ ] No

[ ] DK

[ ] Refused

4. Have you smoked at least 100 cigarettes (5 packs) in your lifetime?

[ ] Yes (if checked, go to Q 5)

[ ] No (if checked, go to Q 8)

[ ] DK

[ ] Refused

5. (If YES to Q 69) Do you smoke cigarettes now?

[ ] Yes (current smoker) (if checked, go to Q 7)

[ ] No (former smoker) (if checked, go to Q 6)

[ ] DK

[ ] Refused

6. (If NO to Q 5) How long has it been since you last smoked cigarettes regularly? Prompt: Can answer in months or years whichever is easiest to remember

_____ {months/years} (GO TO Q 8)

[ ] DK

[ ] Refused

7. (If YES to Q 5) How often do you smoke cigarettes? Show SMOKING CARD

[ ] Daily (if checked, go to Q 7A)

[ ] Weekly

[ ] Monthly

[ ] DK

[ ] Refused

7A. (If DAILY to Q 7) How many cigarettes do you smoke per day?

Note: One pack equals 20 cigarettes

[ ] 1-5

[ ] 6-10

[ ] 11-20

[ ] > 20

[ ] DK

[ ] Refused

8. Does anyone smoke cigarettes inside your home?

[ ] Yes (if checked, go to Q 8A)

[ ] No (if checked, go to Q 9)

[ ] DK

[ ] Refused

8A. (if YES to Q 8) How often do people smoke cigarettes in your home? Show SMOKING CARD

[ ] Daily

[ ] Weekly

[ ] Monthly

[ ] DK

[ ] Refused

9. Do people smoke cigarettes indoors where you work?

[ ] Yes

[ ] No

[ ] Doesn’t apply (don’t work indoors with others)

[ ] DK

[ ] Refused

10. In the past 12 months, how many times did you eat fast food, including takeout and delivery …..? Prompt: You can tell me the number of times per week, month or year, whichever is easiest to remember. (if NEVER, enter 00 times per year)

_ times per [ ] Week (if Week selected) How many weeks out of 52? ____

[ ] Month (if Month selected) How many months out of 12? ____

[ ] Year

[ ] DK

[ ] Refused

11. In the past 24 hours, how many times did you eat food from a can? (if NEVER, enter 00 times)

# times per

[ ] DK

[ ] Refused

12. In the past 24 hours, how many times did you have a beverage from a can? (if NEVER, enter 00 times)

# times

[ ] DK

[ ] Refused

13. In the past 24 hours, how many times did you eat any meat that was cooked over a flame or coals…grilling for example? (if NEVER, enter 00 times)

# times

[ ] DK

[ ] Refused

14. How many times do you use any of the personal care products shown in this list in a typical 24-hour day? Please tell me the number of times for each product. SHOW PERSONAL CARE PRODUCTS CARD (go to PERSONAL CARE PRODUCTS TABLE)

PERSONAL CARE PRODUCTS TABLE
Products	Number of times used in 24-hr day
Liquid hand soap	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Liquid cleanser (Body wash, face wash)	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Toothpaste	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Deodorant	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Moisturizer/lotion	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Acne treatment	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Foot spray	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Body spray	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Shaving cream/aftershave	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused
Any cosmetic (for example mascara or lipstick: count each one separately)	[ ] 0  [ ] 1  [ ] 2  [ ] 3 [ ] 4  [ ] 5+ [ ] DK [ ] Refused

L. BIRTHS (FEMALE ONLY)

Script: We want to know if you have had children recently, because giving birth and nursing can change the amount of some chemicals in the body.

1. Have you been pregnant at any time in the past 12 months?

[ ] Yes

[ ] No

[ ] DK

[ ] Refused

2. Have you breastfed at any time in the past 12 months?

[ ] Yes (if checked, go to Q 2A)

[ ] No (if checked, go to INCOME)

[ ] DK

[ ] Refused

2A. (if YES to Q 2) How many months did you breastfeed?

______ months

[ ] DK

[ ] Refused

M. INCOME

Script: These last questions are about income level. This will help us compare results between people and can be used to plan public health programs too.

1. How many family members currently live with you (not including yourself)? We consider your family to include everyone currently living with you who is related by birth, marriage, or adoption.

______ members (confirm, that they did not include themself)

[ ] DK

[ ] Refused

2. Can you tell me your total family income in {LAST CALENDAR YEAR} before taxes? SHOW FAMILY INCOME 1 CARD

[ ] 1) Less than $25,000 (if checked, go to Q 2A)

[ ] 2) $25,000 to less than $35,000

[ ] 3) $35,000 to less than $50,000

[ ] 4) $50,000 to less than $75,000

[ ] 5) $75,000 to less than $100,000

[ ] 6) $100,000or more

[ ] DK

[ ] Refused

2A. (If <$25,000 to Q 2) You just told me that your family incomes was less than $25,000. Which of the following best describes your family's total income in the past year? Was it . . . .? SHOW FAMILY INCOME 2 CARD

[ ] 1) Less than $5,000

[ ] 2) $5,000 to less than $15,000

[ ] 3) $15,000 to less than $25,000

[ ] DK

[ ] Refused

Closing Script:

That is the end of the Interview.

We would like to give you another gift card to thank you for helping with this study. Hand them the gift card and request their signature on the Participation Record.

When your blood and urine have been tested, we’ll send your results directly to you in the mail. You should get the results of blood sugar (A1C) and cholesterol tests a few weeks from today. If any of your results for lead, cadmium or mercury are high we’ll let you know as quickly as possible because there may be things you want to do to protect your health….if that is the case, we’ll also send information you can use to protect yourself. We’ll send most of the results after samples from all the people in the study have been tested – sometime around {time period}.

Do you have any questions about the study or how you will get your results? If you have questions later…. you can contact study staff at the numbers shown in the Consent Brochure and the Consent Form.

If you don’t have any questions, you are free to go.

Offer to show them the way out or direct them if they need transportation.

Appendix 10.2 page 81