Please Complete This Form and When You Are Ready for Your Assessment, Contact Us on 01905

Application form

Please complete this form and when you are ready for your assessment, contact us on 01905 822799 or at

Payment is by cash or cheque. Please give this to the officer who comes to do your assessment visit. Cheques should be made payable to Bromsgrove District Council. A receipt will be given or emailed to you.

Name of establishment:

Address:

Name of contact person:

Telephone number: Email:

Website:

Type of establishment e.g. Café, restaurant, care home:

Independent business or group?

Average number of meals served daily/weekly:

Approximate % of customers asking for healthier options:

Opening days and hours:

Please write down how you meet each of the criteria on the right hand side. The officer will also request a copy of your menu during the assessment visit.

Local food(GOLD level only) How you meet the criteria

Do you use local food?

Notes:

Minimum of Five Menu items-please list them

‘Local food’ is food from suppliers in the county of Worcestershire

and the adjoining counties.

Hate Waste

Do you have a flexible menu that allows you to use up food?

Healthier food and drink

Do you offer at least threehealthier meal choices on your menu?

Do you offer healthier choices of drinks?

Fantastic fruit and vegetables

Do you sellfresh fruit or include it in your snacks and meals?

Do you include salad and vegetables within your meals?

Fats and salts

Do you use lower fat cooking methods wherever possible?

Do you allow customers to add their ownspreads

/salad dressings/cream etc.?

Do you minimise the use of salt in your cooking wherever possible?

Food for all tastes and allergy awareness

Do you offer smaller portion sizes?

Do you offer healthier main mealsfor children?

Can you provide accurate information to customers about any allergens in your food?

Promotion and Customer Commitment

Do you and your staffpromote your healthier choices?

Do you listen to your customers and make changes from their feedback?

Would you like to receive a mystery customer visit? (An optional part of the process)

Are you interested in having some recipes analysed?

Are you interested in attending a training course on nutrition?

Please read the terms and conditions (next page) and if in agreement, sign and date below:

Name Signature

Date

Office use

Officer / Date-
Verified by / Date-

Terms and Conditions of the Food Award

Payment is by cash or cheque. Cheques should be made out to Bromsgrove District Council. Please give this to the officer who does your assessment visit. A receipt will be given.

You will be sent the guidance document once Worcestershire Regulatory Services has received payment for your membership fee.

You can only apply for the award if your business has achieved and maintains level 4 or 5 of the Food Hygiene Rating Scheme.

If one or more of the following occurs, your premises will no longer be part of the award scheme. Fees will not be reimbursed.

a)If following an inspection or complaint, your business is no longer a level 4 or 5 under the Food Hygiene Rating Scheme

b)If your business is no longer meeting the food award criteria

c)If the ownership of the business changes

In the above situations, the certificate, sticker and logo will no longer be applicable and must not be used.

The assessment is based on the information provided by you on the self-assessment questionnaire and what is seen by the assessor during their visit.

If during the assessment visit your business is not meeting all the criteria, you are entitled to up to Two hours support and guidance, followed by a re-assessment. Any additional hours support required will be charged at our hourly rate.

The logo, window sticker and certificate must only be used by your business and no other businesses and will remain the property of Worcestershire Regulatory Services.

You should display the certificate in a prominent place within your business and actively promote your healthier options.

A mystery customer visit cannot be carried out in premises which are not open to the public such as workplace canteens or children’s nurseries.

During the course of your membership we may ask you and your customers for basic information on buying and eating habits and feedback on the award scheme.

The membership fee is reviewed on an annual basis.

By becoming a member of the scheme you agree to us contacting you by telephone, email, post and newsletters to keep you updated about the scheme.