A survey tool developed to help care providers quickly assess diet and physical activity of individuals.
Listed in the SNAP-Ed Evaluation Framework Interpretive Guide.
Used to measure Indicator R3: Whole Grains

Specific questions from the Interpretive Guide- In an average week, how often do you:
- eat less than 2 servings of whole grain products or high-fiber starches a day? (Serving = 1 slice of 100 percent whole grain bread; 1 cup whole grain cereal like Shredded Wheat, Wheaties, Grape Nuts, high fiber cereals, oatmeal, 3–4 whole grain crackers, ½ cup brown rice or whole wheat pasta, boiled or baked potatoes, yucca, yams, or plantain. [R3a1,2] Responses: Usually/often; sometimes; rarely/never
- Eat regular potato chips, nacho chips, corn chips, crackers, regular popcorn, nuts instead of pretzels, low-fat chips or low-fat crackers, air-popped popcorn? [R3b1,2] Responses: Usually/often; sometimes; rarely/never
- Eat sweets like cake, cookies, pastries, donuts, muffins, chocolate, and candies more than 2 times per day. [R3b1,2] Responses: Usually/often; sometimes; rarely/never