FFVP CFD Pilot - Individual

Evaluation of the Canned, Frozen, or Dried Fruits and Vegetables Pilot Project in the FFVP
OMB Control No: 0584-XXXX
Appendix E4b. Foods Eaten at School Today (FEST) Diary Recall
Expiration date: XX/XX/XXXX

FOODS Eaten
in School
Today*
Your Name:
Please bring your
completed form
with you to our
meeting today at:
time

room

#

*We’re having a fruit and vegetable FEST(ival)!
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number
for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 20 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.

Directions
Write down everything you eat and
drink in school today in this booklet.
You already did breakfast if you ate it in
school this morning. Keep going up to
the time we meet later today.
Each time you eat or drink, write
the time.
Write one food or drink on a line.
Give brand names if you know them.
Describe the fruits and vegetables
that you ate. If you know it, are they
fresh, canned, dried, or frozen? Are
they sliced, diced, mashed or whole?
Write down any snacks, candy, or
drinks, too.

Date

Month

Day of the Week

Boy
Age

Day
 
Monday
 
Tuesday
 
Wednesday
 
Thursday
 
Friday

Girl
Years

Name of School

Teacher’s Name

Grade

Year

:

:

School
Home
Somewhere else

:

School
Home
Somewhere else

School
Home
Somewhere else

School
Home
Somewhere else

School
Home
Somewhere else

Did you get this from
school or was it
from home or
somewhere else?

:

Food and Drink
(Write type, brand, description)

What?

School
Home
Somewhere else

:

:

Time
(Write in Time)

When?

Write 1 food per line. Do not write in shade areas.

Foods Eaten in School Today*

:

:

School
Home
Somewhere else

:

School
Home
Somewhere else

School
Home
Somewhere else

School
Home
Somewhere else

School
Home
Somewhere else

Did you get this from
school or was it
from home or
somewhere else?

:

Food and Drink
(Write type, brand, description)

What?

School
Home
Somewhere else

:

:

Time
(Write in Time)

When?

Write 1 food per line. Do not write in shade areas.

Foods Eaten in School Today*

FOODS Eaten
in School
Today*