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) 31-40

c) 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)
b)
c)
d)

Yes
Half & half
Can Improve
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)
Breakfast

Quantity
1

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
..

1. What you have for your Breakfast today?

(you may more than one)
( in the box that provided)

>5

2. What you have for your lunch today?

(you may more than one)
( in the box that provided)
Lunch

Quantity
(Pieces,Cup,Nos)
1

a) Plain Rice / Noodles / western

(Cut if not necessary)
Chicken

b) Curry

Meat
Fish / Seafood
Chicken

c) Soup
-(Asam Pedas, Singgang,sup , tom
yam, steam)
d) Fried

Meat
Fish/Seafoods
Chicken
Meat
Fish/Seafoods
Chicken

e) Grilled

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)

>5

( in the box that provided)

Lunch

Quantity
(Pieces,Cup,Nos)
1

a) Plain Rice / Noodles / western

(Cut if not necessary)
Chicken

b) Curry

Meat
Fish / Seafood
Chicken

c) Soup
-(Asam Pedas, Singgang,sup , tom
yam, steam)
d) Fried

Meat
Fish/Seafoods
Chicken
Meat
Fish/Seafoods
Chicken

e) Grilled

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

>5