| 1. ID # |
Adult/Homemaker
ID Number (same as |
|
Family ID Number
on the Adult Enrollment Form)
This number is generated by
the computer on NEW
homemakers. The space can be left blank on new homemakers,
until the record has been entered into the computer and
the ID number has been generated. On subsequent records,
the correct ID Number should be placed on the form by the
paraprofessional.
|
2. Date Taken |
Date on which Food Recall is taken. List 2 |
|
digits for month,
2 digits for day of month, and last 2 digits for year, separated
by slashes (MM/DD/YY). January 5, 1994, would
be written as 01/05/94. |
3. HM Name |
Homemaker's Name. Write homemaker's |
|
first
name, middle initial,
and last name. |
4. PP Name |
Paraprofessional's Name. List the first
and |
|
last
name of the EFNEP paraprofessional who works with this homemaker. |
5. Pregnant |
Place an X in the square beside YES or NO |
|
as to whether or
not homemaker IS NOW pregnant. |
6. Nursing |
Nursing a baby (i.e. breastfeeding). Place |
|
an X in square
beside YES or NO as to whether homemaker IS NOW breastfeeding. |
7. Takes Supplements |
Place an X beside YES or NO as to
|
|
whether or not
Nutritional homemaker takes vitamins, minerals, protein
or other nutrients in pill, liquid, or powder form.
If answer is YES,
list type or brand name, frequency and size of dosage, if
this information is available.
|
8. Money Spent on Food
Last Month |
Estimate total dollar value of resources spent on food during
the previous FULL |
|
MONTH. Include CASH
spent at grocery store, plus value of FOOD STAMPS and WIC
VOUCHERS, plus money spent at restaurants, fruit stands,
Farmers' Markets, or other places. |
9. Check Which Food Record |
Show whether this is an "entry"
(first) |
|
record, or an "exit"
(last) record, or OTHER number in between,
by checking the appropriate box.
If it is a record, other than
the entry or exit, list the number of the record in the
blank space. Example: 2, 3, 4, etc.
|
10. What Did Homemaker Eat and Drink |
In taking the 24-Hour Recall, refer to the instructions in
ERS User's Manual, |
|
Appendix
III: "Procedures for Collecting 24-Hour Recalls,"
especially the section entitled "During the food
recall interview."
Begin by explaining to homemaker
why you are asking about
her/his food intake.
Start asking about the foods
and beverages homemaker consumed in the past 2 to 3 hours
just prior to this session. Then, work backward through
the entire previous 24 hour period.
|
Meal Type |
In determining "Meal Type", no
distinction
|
|
is made between
"meal" and "snack."
Use the approximate times below to designate the TYPE of meal/snack;
however, sticking to the exact times is NOT CRITICAL. |
|
GUIDE FOR DESIGNATING MEAL TYPE
1 = Morning
meal/snack = 4:00 a.m. to 9:00 a.m.
(Some may call this breakfast)
2 = Midmorning
meal/snack = 9:00 a.m. to 11:30 a.m.
3 = Noon
meal/snack = 11:30 a.m. to 2:00 p.m.
(Some may call this lunch)
4 = Afternoon
meal/smack = 2:00 p.m. to 5:00 p.m.
5 = Evening
meal/snack = 5:00 p.m. to 8:00 p.m. (Some
may call this dinner or supper)
6 = Late Evening
meal/snack = 8:00 p.m to 4:00 a.m.
|
Food Items and Preparation |
List all foods and beverages consumed by
|
|
homemaker.
Use probes
and props to get as much detail as possible.
(See discussion on probes and props in ERS User's Manual,
Appendix III).
Be sure to list added
fat and sugar, including type of fat (vegetable
oil, margarine, butter, shortening, lard, bacon grease,
and other meat fat).
Also list type of
preparation (baked, broiled, deep fat fried, pan
fried, stewed, stir-fried, raw, etc.)
List main ingredients
in a mixed dish on separate lines, unless that recipe is
included in the EFNEP Foods Data Base. There is no need
to list spices and herbs, but do list fat and sugars, syrups,
or any ingredients that give significant calories.
If you run out of space on
one form, use an additional form.
|
Amount Eaten |
List amount eaten in common household |
|
measurements (cup
= c; tablespoon = TBSP; teaspoons = tsp; ounces = oz; pound
= lb; slice = sl; or Item = whole piece).
Use the items in the Food
Recall Kit (in ERS User's Manual, Appendix III)
to help homemaker tell you how much she/he ate or drank
of an item. Be patient and try to get amount as
nearly accurate as possible!
|
11. To Be Coded by Paraprofessional |
Coding of foods for entry into EFNEP Report System (internal
nutrient analysis) |
|
should be done by
EFNEP paraprofessionals. It
is recommended that the person who took the recall
do coding, as they can
read their own writing and may be able to remember what homemaker
said if an item is unclear. |
Food ID Number |
All of the Food ID Numbers in the EFNEP |
|
Food Dictionary
have 4 or fewer digits. However, there are
5 spaces built into the computer program which means that
5 digits must be
entered during data entry.
To make data entry faster all 5 spaces on the form
should be filled using 0's in front of the number from the
Food Dictionary. Example: Food Dictionary Number 51 should
appear on the form as 00051. |
Amount Code |
Amount of the food item listed in whole |
|
numbers and decimals.
When looking up the food code, be sure to note the serving
unit that is used in measuring that food.
To convert into the appropriate
serving unit, see Conversion Table: Ounce, Teaspoon, Tablespoon,
and Cup in Appendix V.
Fractions of servings should
be converted to decimals.
A "Fraction Conversion Chart" is located in the
ERS User's Manual, Appendix V,
which will help you convert fractions to decimals.
Record the amount in such a
way that all 4 spaces in the
"Amount Code" column are completely filled. Use
zeros (0's) in front
of whole numbers to fill spaces. Example:
Amount Code for 1 1/2 cups is
01.50.
|
12. Number of Lessons Taught Since Last Record |
List number of times homemaker was taught a lesson on food
and nutrition, or |
|
related topic.
List number of lessons in the appropriate blanks according
to whether teaching was done INDIVIDUALLY, or in a GROUP,
or OTHER setting. A lesson usually refers to a complete set
of learning activities related to a major topic in foods and
nutrition, such as one of the food groups, a key nutrient,
food buying or meal planning, etc. One example of a lesson
is "Eating Right, Eating Light" in the ERIB-2 Series.
With some homemakers several contacts or visits may be made
to teach one lesson
OR two or more lessons
may be taught during one group or individual contact. |
