| FOOD POLICY |
| 1. Is there a headquarters or local policy to include healthy food and beverage options (as an example: at least 25% of the full menu, minus alcohol) at the venue? Ask the manager this question. |
| ◯ Yes ◯ No |
| 2. Is there a policy to identify healthier options on menu boards/menus? Ask the manager this question. |
| ◯ Yes ◯ No |
| FOOD AVAILABILITY |
| 3. How many healthier a la carte main meal options (meat or vegetarian), including salads, are available? |
| Count each option separately, except low fat deli meats counts as 1 option. |
| Healthier main meal options include: skinless chicken/turkey breast, low-fat deli meat (chicken, turkey, ham), veggie/turkey burgers, fish/seafood, pork top loin, beef top round steak or roast, items that is not prepared by breading or frying, and is not covered in sauce or salad dressing |
| Healthier items are described as: baked, grilled, sautéed, stir fried, steamed |
| ◯ 0 ◯ 1–2 ◯ 3–4 ◯ ≥5 |
| 4. Are healthier options listed first for their category on the menu board or menu? |
| Example: Healthier side items (such as fresh fruit) is listed first in the “side” section |
| ◯ Yes ◯ No |
| 5. How many different healthier side options are available? Side is defined as a single serving of a food that may accompany a meal or entree or eaten on its own. |
| Healthier side options include: prepared side salad (not from a salad bar), fruit without added sugar/syrup, baked/steamed vegetables, legume (beans) without added fat, brown/wild rice, quinoa, couscous, barley, and or whole grain pasta. |
| Healthier items are described as: baked, grilled, sautéed, stir fried, steamed |
| ◯ 0 ◯ 1–2 ◯ 3–4 ◯ ≥5 |
| 6. How many vegetable variety options are available for salad options? |
| Can be fresh, chopped/diced vegetables or fruit, or canned beans |
| ◯ 1–4 ◯ 5–8 ◯ 9–12 ◯ ≥13 ◯N/A—no salads |
| 7. How are high fat sauces, condiments, and/or salad dressing served? |
| High fat sauces, condiments, salad dressing include cream-based, cheese-based, butter-based, or mayonnaise-based sauces. |
| Do not include ketchup, mustard, avocado |
| ◯ Placed automatically on the dish ◯ Served on the side automatically |
| ◯ Served on the side by request ◯ N/A—No condiments available |
| 8. How many whole grain bread/tortilla wrap options are available? |
| Whole grain options include: wheat, oats, barley, rye |
| ◯ 0 ◯ 1 ◯ 2 ◯ ≥3 |
| 9. How many healthier grab-and-go snack options are available? |
| Healthier Grab-n-Go option can include: |
| Granola/protein bars with low-sugar or no sugar added (<200 kcals) |
| Plain nuts/seeds and/or dried fruit/nut trail mixes without added sugar, candy, or chocolate (<200 kcals) |
| Dried fruit without added sugar (<200 kcals) and/or canned/packaged fruit in its own juice or water |
| Baked pre-packaged snacks (chips, pretzels) (<200 kcals) |
| Hummus, hard-boiled eggs, fresh veggies, whole fruit, etc. |
| ◯ 0 ◯ 1–3 ◯ 4–7 ◯ 7–10 ◯ ≥11 ◯ N/A—no grab & go available |
| 10. How many different healthy beverage options are available? |
| Healthy beverages are defined as: |
| Beverages with ≤25 calories per 8 oz service (exclude fruit juice and milk) |
| Water, including flavored, carbonated, and seltzer water |
| 100% juice—fruit or vegetable juice with no added sugar |
| Fat free or 1% milk (both flavored or unflavored) |
| Fortified soy, almond, or rice milk with <12 g sugar per serving |
| ◯ 0 ◯ 1–5 ◯ 6–10 ◯ 11–15 ◯ ≥16 |
| BEHAVIORAL DESIGN |
| 11. Are healthier items promoted outside the entrance (on the door, windows, or freestanding signs) so that you see the health messaging before you walk into the establishment? |
| ◯ Yes ◯ No |
| 12. Inside the establishment, are there table tents, posters, or signs on the wall that promote healthier options? |
| ◯ Yes ◯ No |
| 13. Are there healthier options (fresh fruit, baked chips, packaged plain nuts or seeds, trail mix) available at the point of service? |
| ◯ Yes ◯ No ◯ N/A—sit-down restaurant |
| 14. Are healthier beverages positioned at eye-level in the beverage cooler? |
| ◯ Yes ◯ No ◯ N/A—no beverage cooler |
| 15. Are healthier menu options identified (as “healthier” or with a logo) on menu boards or menus? |
| ◯ Yes ◯ No |
| 16. With meal, can you substitute the less healthy default (e.g., fries or chips) for a healthier option (e.g., side salad or fruit) at no cost? NA = No combo meals |
| ◯ Yes ◯ No ◯ N/A |
| 17. Is health messaging/promotion of healthier substitutions emphasized and highly visible at the point of service? (e.g., highlighted on the menu, menu board, and/or sign by point of sale) |
| ◯ Yes ◯ No |
| 18. Is the calorie information clearly visible (next to menu items) to customers? |
| ◯ Yes ◯ No |
| 19. Is additional nutrition information (more than calories) available upon request by the customer? |
| Either on the website, in a handout, or booklet/binder |
| ◯ Yes ◯ No |
| 20. Are the “healthier” items advertised as specials of the day or “chef’s specials”? |
| ◯ Yes ◯ No |