Republic of the Philippines

BATANGAS STATE UNIVERSITY

Lipa City Campus, Marawoy, Lipa City, Philippines
www.batstate-u.edu.ph Occupational Status:
___Student
COLLEGE OF ENGINEERING AND COMPUTING ___Employed
SCIENCES ___ Self-Employed

This survey will help the researchers gather facts and Monthly Allowance/ Income:
information that will suggest the feasibility of distribution of ___Below P1,000
healthy meal boxes in Fitness Centers ___P1,001-5000
Rest assured that whatever information you will provide ___P5,001-10,000
us will be confidential and will be used for fulfillment of our ___P10,001-20,000
requirements as BS Industrial Engineering Student. ___P20,001-30,000
___Above P30,001

CONSUMER’S SURVEY QUESTIONNAIRE II. Product Prospect

Direction: Please put a check mark ()on the space provided 1. What are your Fitness and Nutrition goals?
that corresponds to your answer. (Check all that apply)
I. Respondents Profile
Name(Optional):_________________________ __Weight Loss
Height(in): ____ Weight(kg): ____ __Muscle strength
Sex: ___Female __Muscle Endurance
___Male __Cardiovascular Endurance
__Muscle Toning
Age: __Speed Strength
__15-19 yrs. Old __40-44 yrs. Old
__20-24 yrs. Old __45-49 yrs. Old 2. How long have you been enrolled in this gym?
__25-29 yrs. Old __50-54 yrs. Old __less than 3 months
__30-34 yrs. Old __55-59 yrs. Old __3-6 months
__35-39 yrs. Old __60 yrs. Old and above __ 1 year
__more than a year
 7. For those who answer “NO” in question #4, what is
3. How many times a week you trained in a gym? your reason why you have no dietary program?
__Everyday
__Twice a week __No time to prepare
__Thrice a week __No budget for healthy meal
__Not Interested
__Four times a week
__Five time a week 8. For those who answer “NO” in question #4, and have
NO TIME TO PREPARE a healthy meal in question
4. Do you follow a dietary meal program? #7, if a healthy meal will be available in the market, are
__Yes __No you willing to avail the service?

5. If “YES”, Who provided your healthy meal? __Yes __No

__Myself
__Trainer 9. How much would you pay for a healthy meal?
__Buy from the supplier
__P100-150 __P201-250
6. What meal plan would you have preferred for a
__P151-200 __P251-300
day? (Check all that apply)
10. How many times will you avail this meal plan?
__Breakfast
__ Lunch __Everyday
__ Dinner __Twice a week
__Snack __Thrice a week
__Four times a week
__Five time a week
11. What healthy meal would prefer to order? (Check all that apply)
Example list of RESISTANCE TRAINING (Muscle strength, Muscle Endurance, Cardiovascular Endurance,
Muscle Toning, Speed Strength) healthy meal available:
Breakfast:
__Tapsilog and Apple
__Egg Muffin & Oatmeal Lunch:
__Adobo Fried rice with poached egg __ Sinigang Na Bangus & Banana
__ Corned Beef - Eggdesal __ Honey Chicken Teriyaki & Sauteed Vegetables
__ Cheesy Ham Sausage Sandwich, Fresh Milk __ Garlic Butter Shrimp & Vegetable Salad with
__ Tocilog Honeymustard Dressing
__ Tinapa with Salted Egg and Tomato __ Fish Fillet with Tausi, Fruit Cocktail
__Fried Bangus Belly, Monggo with Dilis, Banana
Snack: __ Chicken Stir-Fry, Polvoron
__Taho __ Bistek Tagalog, Steamed Vegetables, Watermelon
__Halo-Halo
__Tuna Sandwich Dinner:
__Mais Con Yelo __ Chicken Curry, Pineapple-Orange Juice
__Whole Wheat Strawberry Sandwich __ Fried Galunggong, Bulanglang
__Banana-Pineapple Smoothie __ Creamy Malunggay Pesto - Chicken Pasta,
__Baked Kamote Fries with Caramel Sauce Dalanghita Juice
__Cassava Cake __ Chopsuey, Melon Juice
__Bibingka & Ube Haleya __ Misua Soup with Meatballs, Apple
__Calamares __ Nilagang Baka
__ Green Mango Smoothie __ Pork Strips, Carrot-Singkamas with Vinegar
__Banana Fritters with Condensed Milk Dressing, Ripe Mango
__Peanut Butter and Jelly Sandwich, Fresh Cow’s
Milk
__ Honey-Glazed Apple
 Example list of WEIGHT LOSS healthy meal available:
Breakfast: Lunch:
__ Ground Beef Omelet and Pandesal __ Beef Salpicao with Mushrooms, Apple
__ Vegetable-Bacon Frittata, Apple __ Braised Pork in Sweet Soy Sauce with Side Corn,
__ Ham Sausage and Mashed Potato Carrots and Green Peas, Pineapple
__ Fruit Oatmeal __ Tofu and Bangus Teriyaki, Brown Rice, Banana
__ Whole Wheat-Tuna Salad Sandwich, Apple __ Cheesy Chicken and Broccoli with Brown Rice
__ Eggplant Omelet with Ground Beef, Onions, __ Pork and Veggie Stir-Fry
Tomato, And Green Mango, Fried Rice __ Fried Dalagang Bukid, Sauteed Squash and String
__ Pancakes with Strawberry Jam, Skimmed Milk Beans, Polvoron
Snacks: __ Orange-Chicken with Steamed Veggies
__ Peanut Butter-Banana Toast Dinner:
__ Pan De Ube __Seafood and Vegetable Pasta, Toasted Bread
__ Turon __ Pineapple Chicken Salad
__ Fresh Guyabano Shake, Cassava Cake __ Roasted Tilapia with Cucumber-Tomato Salsa
__ Boiled Corn On the Cob __ Fresh Spring Roll, Watermelon
__ Mongo Bread __ Sesame Beef Lettuce Wraps, Sweet Potato Wedges
__ Hopia Munggo __ Chicken Macaroni Soup, Toasted Bread
__ Mango and Nata De Coco, Lady Fingers __ Pancit Canton Guisado, Monay
__ Taho
__ Bibingka, Buko Juice
__ Baked Tofu with Tomato
__ Mango – Papaya Fruit Salad
__ Avocado Smoothie
12. Do you prefer: 13. How would you like to pay?
__Delivery at your location __Credit Card
__Picking up in the store __Cash/Cash On Delivery
14. Which ordering methods do you prefer?
__Phone Call/ Text Message
__Internet Message