Unhealthy Healthy □ □ Y □ N Y □ N Gum/Candy Machine Dried or Fresh Fruit □ □ Y □ N Y □ N Candy Unsalted or Low salt Nuts/Seeds □ □ Y □ N Y □ N Non-baked Chips Baked Chips □ □ Y □ N Y □ N Soda Bottled Water □ □ Y □ N Y □ N Alcohol Other □ Y □ N Tobacco □ Y □ N 3) Services Provided by Stores Service Yes/No Comment/Describe □ Accepts SNAP/EBT Y □ N Is there a sign? Inside/Outside Accepts WIC □ Y □ N Is there a sign? Inside/Outside □ Has Kitchen or Deli □ Y N □ Sells Heated Food Y □ N □ Sells Alcohol □ Y N Sells Cigarettes □ Y □ N Presence of Ad/Promotion at Food/Beverage Tobacco Alcohol □ □ □ Y □ N Y □ N Y □ N At Checkout (can be seen/read) □ □ □ □ □ □ Y N Y N Y N Below Checkout level/on Floor □ □ □ Y □ N Y □ N Y □ N Hanging from ceiling □ □ □ □ □ □ Outdoor advertising Y N Y N Y N □ □ □ Y □ N Y □ N Y □ N Window advertising What's advertised (Food/Bev ONLY) Healthy Unhealthy Signage promoting fresh produce visible from: □ □ □ □ □ □ Outside the Store? Y N N/A Inside the Store? Y N N/A □ □ 5) Y N Is a separate section for healthy options? □ □ Y N If yes, is it visible from Front of Store? □ □ 6) Y N Is there a scale available for weighing produce? 7) Please indicate of the following foods are available in the store Section A: Fruits and Vegetables Comments/ Quality of Food (Note if food is Item Available? Price Visible? rotting, damaged, or expired) □ □ Y □ N Y □ N □ □ □ □ Two types of fresh fruit Y N Y N □ □ Y □ N Y □ N Frozen (no sugar added) canned fruit (in 100% juice or □ □ Y □ N Y □ N water, no added sugar) □ □ □ □ Vegetables Y N Y N Two of fresh □ □ Y □ N Y □ N vegetables Canned veggies (no added □ □ Y □ N Y □ N salt)
Unhealthy Healthy Gum/Candy Machine □ Y □ N Dried or Fresh Fruit □ Y □ N Candy □ Y □ N Unsalted or Low salt Nuts/Seeds □ Y □ N Non-baked Chips □ Y □ N Baked Chips □ Y □ N Soda □ Y □ N Bottled Water □ Y □ N Alcohol □ Y □ N Other □ Y □ N Tobacco □ Y □ N □ Y □ N 3) Services Provided by Stores Service Yes/No Comment/Describe Accepts SNAP/EBT □ Y □ N Is there a sign? Inside/Outside Accepts WIC □ Y □ N Is there a sign? Inside/Outside Has Kitchen or Deli □ Y □ N Sells Heated Food □ Y □ N Sells Alcohol □ Y □ N Sells Cigarettes □ Y □ N Presence of Ad/Promotion at Food/Beverage Tobacco Alcohol At Checkout (can be seen/read) □ Y □ N □ Y □ N □ Y □ N Below Checkout level/on Floor □ Y □ N □ Y □ N □ Y □ N Hanging from ceiling □ Y □ N □ Y □ N □ Y □ N Outdoor advertising □ Y □ N □ Y □ N □ Y □ N Window advertising □ Y □ N □ Y □ N □ Y □ N What's advertised (Food/Bev ONLY) Healthy Unhealthy Signage promoting fresh produce visible from: Outside the Store? □ Y □ N □ N/A Inside the Store? □ Y □ N □ N/A 5) Is a separate section for healthy options? □ Y □ N If yes, is it visible from Front of Store? □ Y □ N 6) Is there a scale available for weighing produce? □ Y □ N 7) Please indicate of the following foods are available in the store Section A: Fruits and Vegetables Item Available? Price Visible? Comments/ Quality of Food (Note if food is rotting, damaged, or expired) □ Y □ N □ Y □ N Two types of fresh fruit □ Y □ N □ Y □ N Frozen (no sugar added) □ Y □ N □ Y □ N canned fruit (in 100% juice or water, no added sugar) □ Y □ N □ Y □ N Vegetables □ Y □ N □ Y □ N Two of fresh vegetables □ Y □ N □ Y □ N Canned veggies (no added salt) □ Y □ N □ Y □ N
doc-municipal-strategies-increase-food-access2610.docx