APPENDIX Survey instrument Part I: For each statement below, please rate how confident you are that you could perform the following food safety practices. Can't do at all Can do a little Can do some Can do mostly Can do for sure 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1. Correctly use a thermometer to determine if food is cooked to a safe temperature 2. Clean and sanitize food contact surfaces before and after preparing food 3. Wash my hands with soap and water for 20 seconds before I begin to prepare food 4. Constantly prepare food in a sanitary manner, even when I am busy with other tasks 5. Perform proper food handling practices to prevent crosscontamination 6. Wash my hands before putting on or changing gloves 7. Wash my hands when food preparation tasks are interrupted or changed 8. Wash my hands after using the restroom, coughing, sneezing, smoking, or touching body parts 9. Use the thermometer to ensure proper food holding temperature 1 2 3 4 5 1 2 3 4 5 10. Use the thermometer at the completion of reheating food to 165°F 1 2 3 4 5 Part II: Please indicate your level of agreement with each of the following statements by circling the corresponding number. 11. I closely monitor my handwashing practices during my shift 12. I always evaluate my own handling practices of food and work surfaces 13. I monitor my thermometer use practices to ensure food safety 14. I evaluate my handwashing practices to ensure I follow the proper steps 15. I wash my hands with a goal to ensure food safety 16. I monitor my own handling practices of food and work surfaces 17. I always set a goal to ensure food safety when handling food and work surfaces 18. I evaluate myself when I use a food thermometer 19. I have a goal to ensure food has reached a safe temperature for service and consumption 20. Facilities are adequately equipped to follow safe food handling practices 21. Sufficient financial resources are provided to support hygiene and food safety 22. I get sufficient time to work in a hygienic and safe food way 23. Procedures and instructions concerning food safety are provided to me Strongly disagree Disagree Undecided Agree Strongly agree 1 2 3 4 5 1 2 3 4 5 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 Appendix continues on next page 310 Food Protection Trends September/October