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Measure Complete

By Joseph Wilson,2014-08-09 10:22
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Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    SouthWest Baltimore Food Access Study

    Cover Sheet

    Rater ID: | |

    O Grocery Store 10

    O Supermarket 20

    O Convenience Store 30

    O Liquor Store 40 Hours of Operation

     Monday Friday ____ : ____ to ____ : ____

     Store ID: | - - | - | | | Saturday ____ : ____ to ____ : ____ Sunday ____ : ____ to ____ : ____ Date: ____/____/____ Month Day Year GIS Start Time: _____ : _____ Latitude: _______ Longitude: _______ O AM O PM MISC. End Time: _____ : _____ O AM WIC Accepted? ? Yes ? No O PM Food Stamps Accepted? ? Yes ? No Number of cash registers: ____|____ Refusal ? Yes ? No

Comments: ____________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

     | Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    Measure #1: MILK

    Rater ID: | Store ID: | - - | - | | | Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

A. Reference Brand

    1. Store brand (preferred) O yes O no

    2. Alternate Brand Name _______________________________________________________

    Comments: _____________________________________________________________

     _____________________________________________________________

B. Availability Comments:

    1. a. Is soy milk available? O Yes O No ____________________________

    b. Is low-fat (skim or 1%) available? O Yes O No ____________________________

     c. If not, is 2% available? O Yes O No ____________________________

    2. Shelf Space: (measure only if soy OR low fat milk is available; “shelf space” = # of facings)

     Type Pint Quart Half gallon Gallon

    a. Skim & 1% ___|___ ___|___ ___|___ ___|___

    b. 2% ___|___ ___|___ ___|___ ___|___

    c. Whole ___|___ ___|___ ___|___ ___|___

    d. Soy Milk 64 oz ___|___

C. Pricing: Milk items should be same brand (Store or Alternate) Comments:

     1. Whole milk, quart $ ____._______ ________________________________________

     2. Whole milk, half-gallon $ ____._______ ________________________________________

     3. Whole milk, one gallon $ ____._______ ________________________________________

     3. Lowest-fat milk, quart $ ____._______ ________________________________________

     3. Lowest-fat milk, half-gallon $ ____._______ ________________________________________

     4 Lowest-fat milk, one gallon $ ____._______ ________________________________________

     5. Soy milk, 64 oz. $ ____._______ ________________________________________

     | Measure Complete

    Nutrition Environment Measures Survey (NEMS)

    Measure #2: FRUITS

Rater ID: | Store ID: | - - | - | | |

    Date: ____/____/____

     Month Day Year O Grocery Store O Supermarket O Convenience Store O Liquor Store

Availability and Price

1. Total Varieties O None O 1-10 O 11-25 O 26-50 O >50

     Available Price Unit Quality Comments

    Produce Item Yes No # pc lb A UA

    2. Bananas O O $ ____._______ ___O O O O _________________________

     __________________________

    3. Apples O Red delicious O O $ ____._______ ___O O O O _________________________

     O ___________ __________________________ 4. Oranges O Navel O O $ ____._______ ___O O O O _________________________

     O ___________ ___________________________ 5. Grapes O Red Seedless O O $ ____._______ ___O O O O _________________________

     O ___________ ___________________________ 6. Cantaloupe O O $ ____._______ ___O O O