QUESTIONAAIRE

THE EFFECT OF THE STUDENT ULAB 2112 UTMSPACE KOTA BHARU DIET (EATING HABITS) TO THEIR HEALTH

Name (Optional) :

This Questionnaire contains some question about respondent eating habit and health condition.

A. Demographic Information

(Please FILL IN THE BLANK the Appropriate Answer that best fits you)

1. What is your current weight?(..)

2. What is your height? ()

(Please Circle the Appropriate Answer that best fits you)

3. Gender

a) Male

b) Female

4. What is your job?

a) In office

b) Out office (site)

c) Other : __________

5. Year of birth

a) 21-30 b) 31-40c) 41-50

6. Do you have blood pressure problems?

a) Yes

b) No

7. Do you have diabetes?

a) Yes

b) No

8. Do you have any chronic health problems?

a) Yes

b) No

9. What is the most important meal for you in a day

a) Breakfast

b) Lunch

c) Dinner

d) Afternoon Tea

e) All of them

10. Are you satisfied with your exiting eating habits?

a) Very satisfied

b) Satisfied

c) Not satisfied

11. Do you describe your eating habits as healthy

a) Yes

b) Half & half

c) Can Improve

d) No

12. What type of food healthy food do you prefer?

a) Organic

b) Veggie

c) Balanced diet (All ingredients in a balanced way)

13. What will you consider MOST when you purchase healthy food? ( can choose more than 1 option)

a) Accessibility

b) Healthy & balance

c) Diverse Selection

d) Package

e) Price & promotion

f) Taste

g) Eco friendly

14. How do you get Information about healthy food?

a) Newspaper / Magazine

b) Television

c) Internet

d) Fair

e) Poster / leaflet

f) Friend / Relatives

15. Which of the following cuisines do you like most?

a) Chinese cuisine

b) Japanese cuisine

c) Western cuisine

d) Malay cuisine

16. If we are going to offer healthy food service, which way will be the most suitable for you?

a) Delivery (internet based)

b) Sit-in a fast food style

c) Take away

d) Home cooked

17. Do have any routine medical check up

a) Yes

b) No

B. PERSONAL DIETARY ASSESSMENT

(malays Cuisine)

1. What you have for your Breakfast today?

(you may more than one)

( in the box that provided)

Breakfast

Quantity

1

2

3

4

>5

a) Roti Canai

Pieces

b) Nasi Lemak

Cup

c) Nasi Kerabu

Cup

d) Nasi Dagang

Cup

e) Fried rice

Cup

f) Fried Noodles

Cup

g) Breads

Pieces

h) Eggs

nos

i) Cereal

Cup

g) Others

..

2. What you have for your lunch today?

(you may more than one)

( in the box that provided)

Lunch

Quantity

(Pieces,Cup,Nos)

1

2

3

4

>5

a) Plain Rice / Noodles / western

(Cut if not necessary)

b) Curry

Chicken

Meat

Fish / Seafood

c) Soup

-(Asam Pedas, Singgang,sup , tom yam, steam)

Chicken

Meat

Fish/Seafoods

d) Fried

Chicken

Meat

Fish/Seafoods

e) Grilled

Chicken

Meat

Fish/Seafoods

Do you have any vegetable for your side dishes?

a) Yes

b) No

Do you have any other/s side dishes?

a) Yes

b) No

3. What you have for your dinner last night?

(you may more than one)

( in the box that provided)

Lunch

Quantity

(Pieces,Cup,Nos)

1

2

3

4

>5

a) Plain Rice / Noodles / western

(Cut if not necessary)

b) Curry

Chicken

Meat

Fish / Seafood

c) Soup

-(Asam Pedas, Singgang,sup , tom yam, steam)

Chicken

Meat

Fish/Seafoods

d) Fried

Chicken

Meat

Fish/Seafoods

e) Grilled

Chicken

Meat

Fish/Seafoods

Do you have any vegetable for your side dishes?

a) Yes

b) No

Do you have any other/s side dishes?

a) Yes

b) No