Healthy Dining Application |Northern Berkshire Community Coalition

Northern Berkshire Community Coalition

Organizing and supporting the Northern Berkshire community for over 34 years!

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Healthy Dining Application

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Business Name: Enter Business Name

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Email: Enter Email

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Phone: Enter Phone

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Business Address: Enter Address

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City: Enter City

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Business Owner's Name: Enter Name

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Has no unresolved health code violations

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Maintains an appropriate food health license

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Enforces no-smoking laws within the establishment

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Follows guidelines for food allergen regulations

Required

Enforces alcohol serving laws, training staff as appropriate

Required

Offers at least two choices of fruits and/or vegetables (other than potatoes)

Required

Allows substitution of salad or other vegetables for fried potatoes (e.g. French fries) at no extra cost

Required

Clearly designates low-fat, low-calorie, lower sodium, and trans fat free menu items when offered

Required

Offers 1% or skim milk when milk is offered as a beverage

Required

Offers some dishes in a smaller portion size (e.g., half portion sizes) for a reduced price OR offers a half-meal-to-go option

Required

Attempt to serve seasonal items and to purchase locally (optional)

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Will remove salt shakers, providing them by request only (optional)

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Image Verification:

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I certify that:*As the owner/manager of the above establishment(s), I certify that, as evidenced by my local health department records, this facility:

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61 Main Street, Suite 218 | North Adams. MA 01247 | Tel: (413) 663-7588 | Fax: (413) 663-9877