Broome County Health Department - Trans Fat Usage Survey
 

1. Trans Fat Usage Survey

 
Please complete the brief survey below in its entirety.
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1. Please enter the name of your facility

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2. Please enter your health-department issued permit number

3. Do you use oil, shortening, butter, or margarine as your FRYING FAT? If Yes, which do you use and does it contain more than 0.5grams of trans fat?

 Yes - Trans FatNo - Trans Fat
Oil:
Shortening:
Butter:
Margarine:

4. Do you use oil, shortening, butter, or margarine in BAKING? If Yes, which do you use and does it contain more than 0.5grams of trans fat?

 Yes - Trans FatNo - Trans Fat
Oil:
Shortening:
Butter:
Margarine:

5. Do you use oil, shortening, butter, or margarine for SPREADING on toast or on sandwiches? If Yes, which do you use and does it contain more than 0.5grams of trans fat?

 Yes - Trans FatNo - Trans Fat
Oil:
Shortening:
Butter:
Margarine:

6. Do you use PRE-PACKAGED FOODS in your menu items? If yes, which do you use and does it contain more than 0.5grams of trans fat?

 Yes - Trans FatNo - Trans Fat
Pre-fried potatoes or other vegetables (frech fries, etc.)
Pre-fried meat or fish (chicken nuggets, fish fillet, etc.)
Pre-prepared mixes (pancake, hot chocolate, salad dressing, etc.)
Pre-packaged desserts (parfait with topping, etc.)
Baked goods (pizza dough, hamburger & hot dog buns, bread crumbs)
Pastries (donuts, danish, croissants, cakes, pies, cookies)
Tortillas/taco shells/tortilla or corn chips/popcorn
Other items – please write in below