6700-016 Moms and Caregivers Mini Quiz

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MomsWG_MiniQuiz

OMB: 2030-0051

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2	-	Moms	and	Caregivers	Mini	Quiz	(Multiple	Languages)
OMB	Control	Number:	2030-0051
This	collection	of	information	is	approved	by	OMB	under	the	Paperwork	Reduction	Act,	44	U.S.C.	3501	et	seq.
(OMB	Control	No.	2030-0051).	Responses	to	this	collection	of	information	are	voluntary	(40	CFR).	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.	The	public	reporting	and	recordkeeping	burden	for	this	collection	of
information	is	estimated	to	be	15-30	minutes	per	response.	Send	comments	on	the	Agency’s	need	for	this
information,	the	accuracy	of	the	provided	burden	estimates	and	any	suggested	methods	for	minimizing	respondent
burden	to	the	Regulatory	Support	Division	Director,	U.S.	Environmental	Protection	Agency	(2821T),	1200
Pennsylvania	Ave.,	NW,	Washington,	D.C.	20460.	Include	the	OMB	control	number	in	any	correspondence.	Do	not
send	the	completed	form	to	this	address.

1.	Which	language	would	you	prefer	to	take	this	survey	in?
?	
¿en	qué	idioma	prefiere	tomar	esta	encuesta?	
Bạn	muốn	hoàn	thành	bảng	khảo	sát	của	mình	bằng	ngôn	ngữ	nào?	Hãy	chọn	ngôn	ngữ	mình
muốn.		
English
	/	Khmer
Español	/	Spanish
Tiếng	Việt	/	Vietnamese

Form	Number:		6700-016

2	-	Moms	and	Caregivers	Mini	Quiz	(Multiple	Languages)
Moms	and	Caregivers	Workshop	Knowledge	Quiz	(English)
OMB	Control	Number:	2030-0051
*	2.	Participant	ID:	

*	3.	Which	team	are	you	with?	
	

GAL	Team

	

Khmer	Team

Vietnamese	Team

LARC	Team

4.	We	can	tell	with	our	eyes	if	a	fish	is	contaminated	with	toxic	chemicals.	

	
True
False

5.	Eating	a	variety	of	seafood	from	different	places	can	help	minimize	your	exposure	to	toxic

chemicals.																																																																																				
True
False

	

6.	Because	I'm	an	adult,	it	is	safe	for	me	to	eat	crab,	mussels,	and	clams	from	the	Duwamish

River.																																																													
True
False

7.	Why	is	the	salmon	the	only	seafood	from	the	Duwamish	River	safe	to	eat?	Please	choose
one	answer.	

Because	the	color	of	the	meat	is	different	from	other	fish			

Because	salmon	spend	a	short	time	in	the	Duwamish	River			

Because	salmon	is	bigger	than	other	fish	caught	in	the	Duwamish	River					

8.	Which	group	can	be	harmed	the	most	by	the	toxic	chemicals	in	the	seafood	from	the
Duwamish	River?	

Pregnant/nursing	women	and	young	children				

Elderly	adults				

People	who	are	no	longer	having	children				

People	who	only	eat	seafood	from	supermarkets				

*	9.	Please	enter	today's	date?	

Today's	date:

Date

MM/DD/YYYY

Form	Number:		6700-016

	

2	-	Moms	and	Caregivers	Mini	Quiz	(Multiple	Languages)
Moms	and	Caregivers	Workshop	Knowledge	Quiz	-	Khmer
OMB	Control	Number:	2030-0051
*	10.	
Participant	ID:	

*	11.	

?

Which	team	are	you	with?	
	

GAL	Team

12.	

	

Khmer	Team

Vietnamese	Team

	

We	can	tell	with	our	eyes	if	a	fish	is	contaminated	with	toxic	chemicals.

							

	
True

False

13.	
Eating	a	variety	of	seafood	from	different	places	can	help	minimize	your	exposure	to	toxic
chemicals.

																																																																					
True

False

	

14.	

	
	

	

	

	

			

Because	I'm	an	adult,	it	is	safe	form	me	to	eat	crab,	mussels,	and	clams	from	the	Duwamish
River.	

																																										

	

True

False

15.	
?	(
)
Why	is	the	salmon	the	only	seafood	from	the	Duwamish	River	safe	to	eat?	Please	choose	one
answer.	

				
Because	the	color	of	the	meat	is	different	from	other	fish				

					
Because	salmon	spend	a	short	time	in	the	Duwamish	River				

			
Because	salmon	is	bigger	than	other	fish	caught	in	the	Duwamish	River					

16.	
?
Which	group	can	be	harmed	the	most	by	the	toxic	chemicals	in	the	seafood	from	the
Duwamish	River?	

/
Pregnant/nursing	women	and	young	children	

				
Elderly	adults

				
People	who	are	no	longer	having	children

			
People	who	only	eat	seafood	from	supermarkets	

			

*	17.	
Today's	date:	

		 	

	/	Date

Date

MM/DD/YYYY

Form	Number:		6700-016

	

2	-	Moms	and	Caregivers	Mini	Quiz	(Multiple	Languages)
Moms	and	Caregivers	Workshop	Knowledge	Quiz	-	Spanish
OMB	Control	Number:	2030-0051
*	18.	#	ID	del	participante:
Participant	ID:	

*	19.	En	que	equipo	estas?
Which	team	are	you	with?	
	

GAL	Team

	

Khmer	Team

Vietnamese	Team

20.	Con	solo	verlo	nos	podemos	dar	cuenta	si	un	pescado	está	contaminado	con	sustancias
químicas	tóxicas.	
We	can	tell	with	our	eyes	if	a	fish	is	contaminated	with	toxic	chemicals.

	
Verdadero
True
Falso
False

21.	Comer	una	variedad	de	mariscos	de	diferentes	lugares	puede	ayudar	a	minimizar	su
exposición	a	sustancias	químicas	tóxicas.
Eating	a	variety	of	seafood	from	different	places	can	help	minimize	your	exposure	to	toxic
chemicals.																																								

																																																																													
Verdadero
True
Falso
False

	

22.	Como	soy	adulto,	puedo	comer	cangrejos,	mejillones	y	almejas	del	río	Duwamish	sin
peligro
Because	I'm	an	adult,	it	is	safe	form	me	to	eat	crab,	mussels,	and	clams	from	the	Duwamish
River.	

																																																					

	

Verdadero
True
Falso
False

23.	¿Por	qué	el	salmón	es	el	único	marisco	del	río	Duwamish	seguro	para	comer?	(Elija	todas
las	que	aplican)
Why	is	the	salmon	the	only	seafood	from	the	Duwamish	River	safe	to	eat?	(Please	choose	one
answer.)	

Porque	el	color	de	la	carne	es	diferente	al	de	otros	peces		
Because	the	color	of	the	meat	is	different	from	other	fish	

Porque	el	salmón	pasa	poco	tiempo	en	el	Río	Duwamish				
Because	salmon	spend	a	short	time	in	the	Duwamish	River

Porque	el	salmón	es	más	grande	que	otros	peces	capturados	en	el	río						
Because	salmon	is	bigger	than	other	fish	caught	in	the	Duwamish	River

24.	¿Qué	grupo	puede	resultar	más	perjudicado	por	las	sustancias	químicas	toxicas	en	los
mariscos	del	río	Duwamish?
Which	group	can	be	harmed	the	most	by	the	toxic	chemicals	in	the	seafood	from	the
Duwamish	River?	

Mujeres	embarazadas/lactantes	y	niños	pequeños		
Pregnant/nursing	women	and	young	children			

Adultos	mayores					
Elderly	adults

Personas	que	ya	no	están	teniendo	hijos					
People	who	are	no	longer	having	children

Personas	que	comen	mariscos	de	los	supermercados			
People	who	only	eat	seafood	from	supermarkets	

*	25.	Today's	date
Fecha	

Fecha	/	Date

Date

MM/DD/YYYY

Form	Number:		6700-016

	

2	-	Moms	and	Caregivers	Mini	Quiz	(Multiple	Languages)
Moms	and	Caregivers	Workshop	Knowledge	Quiz	-	Vietnamese
OMB	Control	Number:	2030-0051
*	26.	số	ID	của	quý	vị
PARTICIPANT	ID	#	

*	27.	Bạn	đang	ở	với	đội	nào?
Which	team	are	you	with?	
	

GAL	Team

	

Khmer	Team

Vietnamese	Team

28.	Bằng	mắt	thường	chúng	ta	có	thể	biết	được	cá	có	bị	nhiễm	hóa	chất	độc	hại	hay	không.
We	can	tell	with	our	eyes	if	a	fish	is	contaminated	with	toxic	chemicals.

	
Đúng
True
Sai
False

29.	Ăn	nhiều	loại	hải	sản	từ	những	nơi	khác	nhau	có	thể	giúp	giảm	thiểu	việc	quý	vị	tiếp	xúc
với	các	hóa	chất	độc	hại.
Eating	a	variety	of	seafood	from	different	places	can	help	minimize	your	exposure	to	toxic
chemicals.																																								

																																																																													
Đúng	
True
Sai
False

	

30.	Vì	tôi	là	người	lớn	nên	tôi	có	thể	an	toàn	ăn	cua,	sò	và	ốc	hến	ở	sông	Duwamish
Because	I'm	an	adult,	it	is	safe	form	me	to	eat	crab,	mussels,	and	clams	from	the	Duwamish
River.	

																																																					

	

Đúng
True
Sai
False

31.	Tại	sao	cá	hồi	là	hải	sản	duy	nhất	ở	sông	Duwamish	là	an	toàn	để	ăn?	(kiểm	tra	tất	cả	các
câu	phù	hợp)
Why	is	the	salmon	the	only	seafood	from	the	Duwamish	River	safe	to	eat?	(Please	choose	one
answer.)	

Vì	màu	sắc	của	thịt	khác	với	các	loại	cá	khác	
Because	the	color	of	the	meat	is	different	from	other	fish	

Vì	cá	hồi	sống	một	thời	gian	ngắn	ở	sông	Duwamish			
Because	salmon	spend	a	short	time	in	the	Duwamish	River

Vì	cá	hồi	lớn	hơn	các	loại	cá	khác	được	đánh	bắt	ở	sông					
Because	salmon	is	bigger	than	other	fish	caught	in	the	Duwamish	River

32.	Nhóm	nào	có	thể	bị	tác	hại	nhiều	nhất	bởi	chất	độc	hóa	học	trong	hải	sản	từ	sông
Duwamish?
Which	group	can	be	harmed	the	most	by	the	toxic	chemicals	in	the	seafood	from	the
Duwamish	River?	

Phụ	nữ	có	thai	/	cho	con	bú	&	trẻ	nhỏ		
Pregnant/nursing	women	and	young	children

Người	lớn	tuổi			
Elderly	adults

Những	người	không	còn	con	cái		
People	who	are	no	longer	having	children

Những	người	ăn	hải	sản	từ	siêu	thị		
People	who	only	eat	seafood	from	supermarkets	

*	33.	Ngày	hôm	nay	
Today's	date	

Ngày	/	Date

Date

MM/DD/YYYY

Form	Number:		6700-016

	


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