This document provides a survey to record the types and amounts of out-of-date food products found in one's home, and to rate how often different food categories are thrown away. The survey asks one to note expired dairy, fruit/vegetables, bread/cereal/rice, meat/fish, and sweets/candy in their house. It then asks them to rate how often they waste each category from 1 (never) to 4 (often). The results found dairy and fruit/vegetables were wasted most at 37% and 32% respectively.