Fish Consumption Survey (page 1/4)

If you have any questions, please call Lauren Dey of the Environmental Services Program at 231-242-1572, e-mail ldey@ltbbodawa-nsn.gov, or use the contact form on our website to contact us. If you would prefer to take the survey in person, please contact us as well to set up an interview.

Basic Information

1Are you completing this survey for:

2Please fill in the following information about the respondent:

Gender
Age (yrs)
Height feet    inches
Weight (lbs.)
24 Hour Recall

3Please recall everything you ate or drank yesterday.

Please recall everything you ate or drank yesterday, from the time you woke up until you went to sleep. Record the total number of ounces for each food and beverage item in the chart. Food dishes do not need to be separated out by ingredients. List the total serving size of entire dish. NOTE: “You” refers to the person to whom the postcard was addressed.

Time Where Prepared Food/Beverage Name Amount (oz.)
Home Restaurant
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Please be sure to check your answers before continuing.