State and Local Parks Nutrition Environment Survey SMALL CONCESSION VENUE
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1 SMALL CONCESSION VENUE Small Concession Type: O Snack shop O Gift store O Visitors center O Cart (ex: hot dog or popcorn cart) O Specialty shop (ex: ice cream, coffee) O Combination. Please specify O Other: Rater Initials: Park Name: Concession Name: Concession ID: - Site Visit: Date: / / Month Day Year Start Time: : O AM O PM End Time: : O AM O PM Comments: 1
2 1) Data Sources (check all that apply): 2) Hours of operation: O site visit O menu O internet Weekday O open O closed Weekend O open O closed Opening time*: Closing time*: Opening time*: : O AM O PM : O AM O PM *If the small concession opens/closes multiple times per day, please list Closing time*: : O AM O PM : O AM O PM O Open 24 hours (If open 24 hours, leave Hours of Operations section blank) O Hours not listed 3) Access: O car O foot only 4) Seating available? O yes O no first opening time and last closing time (see protocol for details) Number of tables = Comments 2
3 Promotion Pg. 3 Select One Comments 1) a. Is nutrition information for items available? O yes O no b. Are healthy items identified on menu or brochure with icons or labels? O yes O no c. Do signs/table tents/displays highlight healthy menu or shop options? O yes O no d. Do signs/table tents/displays promote healthy eating? O yes O no e. Do signs/table tents/displays promote unhealthy eating? O yes O no f. Do signs/table tents/displays promote overeating (all-you-can-eat, super-size, O yes O no jumbo, grande, supreme, king size, feast descriptors on menu or signage)? g. Do signs/table tents/displays promote water consumption? O yes O no h. Do signs/table tents/displays promote free refills on sugar-sweetened beverages? O yes O no Do signs/table tents/displays promote free refills on diet (artificially sweetened) beverages? O yes O no i. Do signs/table tents/displays promote local/regional/or state grown/produced items? O yes O no j. Do signs/table tents/displays promote sustainable farming practices or sustainably produced items? O yes O no k. Do signs/table tents/displays promote organic items? O yes O no l. Do menus identify local/regional/or state grown/produced items with icons or labels? O yes O no m. Do menus identify sustainably farmed/produced items with icons or labels? O yes O no n. Do menus identify organic items with icons or labels? O yes O no o. Other? O yes O no
4 Beverage Review 2) Plain drinking water available (free or for sale)? O yes O no a. What sources of free water are available? O As part of fountain drink station O Water cooler (e.g. Igloo thermos) O Filtration device (e.g. small spigot) O Water pitcher O Water fountain O Other (specify: ) O None b. Is there a fee associated with free water (e.g. charge for cup or ice)? O yes O no O NA c. Are sources of free water operational at time of scan/survey? O yes O no O NA d. How many brands of bottled plain water are available? O 0 O 1-2 O 3-4 O 5 e. Are reusable water bottles available for sale/rental? O yes O no Comments: f. Price of bottled water (20 oz bottle, if possible)? Brand Price $. Bottle size oz/ml g. Price of a reusable water bottle (smallest size available)? Brand Price $. Bottle size oz/ml 3) Healthy or low calorie beverage available? O yes O no a. Diet soda O yes O no Price $. Bottle/Cup size oz/ml b. Unsweetened tea O yes O no c. Artificially-sweetened flavored waters ( 10cal/8 oz) O yes O no d. Low-calorie sports drink ( 10cal/8 oz) O yes O no e. Low-calorie energy drink ( 10cal/8 oz) O yes O no f. 100% fruit juice O yes O no Price $. Bottle/Cup size oz/ml g. 1% Low-fat or non-fat/skim (cow), unflavored O yes O no h. Dairy alternative milk (soy, almond, rice), unflavored O yes O no i. Coffee O yes O no j. Other: O yes O no Pg. 4
5 Beverage Review (continued) 4) Sugar sweetened beverages available? O yes O no a. Soda O yes O no Price $. Bottle/Cup size oz/ml b. Sweetened tea O yes O no c. Sports drink (>10cal/8 oz) O yes O no d. Flavored water (>10cal/8 oz) O yes O no e. Energy drink (>10cal/8 oz) O yes O no f. Juice-flavored drink (not 100% juice) O yes O no Price $. Bottle/Cup size oz/ml g. Flavored milk (cow) O yes O no h. Flavored dairy alternative milk (soy, almond, rice) O yes O no i. Coffee drink (syrup/sugar added) O yes O no j. Other: O yes O no Menu Review Select One Choices (#) Comments 5) Is there a menu in the small concession? O yes O no 6) Main food items: a. Total # main food items: O yes O no # b. Healthy options: O yes O no # 7) Main salads: a. Total # main salads: O yes O no # b. Healthy salad options: O yes O no # c. Low-fat/fat-free salad dressings: O yes O no # 8) Is 100% whole wheat or whole grain bread available? O yes O no 9) Fruits (without added sugar) O yes O no # 10) Non-fried vegetables (without sauce) O yes O no # 11) French fries O yes O no # Pg. 5
6 Sack/ Boxed Meals 12) Can you purchase a sack/ boxed meal? O yes O no 13) Breakfast: Select One Choices (#) Price Comments a. Total # options: O yes O no # $. b. Healthy options: O yes O no # $. 14) Lunch: a. Total # options: O yes O no # $. b. Healthy options: O yes O no # $. c. Vegetarian options: O yes O no # $. d. Are there any healthy vegetarian options? O yes O no # $. 15) Healthy or Low Fat Snacks: Please indicate the availability of snack options for the following items. If yes, indicate price and size for selected items. (see nutrition criteria reference) *If more than one size available, report on the smallest sized item. Item Available Size Price Number of Comments Yes No Number or Oz/pack per pack Types/ Varieties Green (GO) Items a. Fruit cup in fruit juice O yes O no $. b. Yogurt, Plain (Fat-free or Low-fat) O yes O no $. c. Jerky (low sodium) O yes O no $. d. 100% Real Fruit Strips O yes O no $. e. Popcorn (Fat-free or low-fat) O yes O no $. f. Whole Grain Crackers O yes O no $. Total number of Green (Go) Items: (include items not listed, but similar Green items above) Pg. 6
7 Healthy or Low Fat Snacks (continued) Item Available Size Price Number of Comments Yes No Number or Oz/pack per pack Types/ Varieties Yellow (SLOW) Items g. Yogurt, Flavored (fat-free or low-fat) O yes O no $. h. Trail mix (Plain) O yes O no $. i. Jerky O yes O no $. j. Dried Fruit O yes O no $. k. Nuts or Seeds (Plain or with spices) O yes O no $. l. Pretzel Mix (check nutrition guidelines) O yes O no $. m. Animal crackers O yes O no $. n. Frozen Fruit Bars (100% fruit) O yes O no $. Total number of Yellow (Slow) Items: (include items not listed, but similar to Yellow items above) Red (WHOA) Items o. Fruit cup in heavy syrup O yes O no $. p. Snack Mixes (with cereal, candy, etc) O yes O no $. q. Fruit Flavored Snack O yes O no $. r. Meat Sticks O yes O no $. s. Cookies O yes O no $. t. Snack Cakes O yes O no $. u. Candy Bar O yes O no $. v. Ice Cream O yes O no $. Total number of Red (Whoa) Items: (include items not listed, but similar to Red items above) Pg. 7
8 16. Please indicate the total number of products (from Snack Items ) available for each of the following items: (See nutrition criteria reference) # Food Products GREEN (GO) Items YELLOW (SLOW) Items Pg. 8 RED (WHOA) Items 17. Are baked chips available?* yes no a. If yes, what is the size and price in comparison to regular chips? (circle if ounce or gram; round to nearest whole number; if > 1 size available, report the smallest sized item) Number Size Price of types Other/ Non-nutritive Baked Chips/Pretzels oz/g $. N/A Regular Chips oz/g $. N/A * If more than one size available, report on the smallest sized item. 18. Are granola/energy bars available?* yes no a. If yes, what is the size and price in comparison to candy bars? (circle if ounce or gram; round to nearest whole number; if > 1 size available, report the smallest sized item) Number Size Price of types Granola/Energy Bar (circle one) oz/g $. N/A Candy Bar oz/g $. N/A Pricing Comments 19. Total price of individual items compared to combo meal O more O less O same O NA 20. Healthy main items compared to less healthy ones O more O less O same O NA 21. Healthy ( Green Go ) snack items compared to less healthy O more O less (Yellow Slow or Red Whoa ) snack items. O same O NA Total
9 22. Other? O more O less O same O NA Pg. 9
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