Healthy Dining New Bedford Restaurant Application

View Healthy Dining New Bedford Restaurants
Healthy Dining New Bedford Restaurant Application

Establishment Information
Establishment Name*
Street Address*
Location must be in New Bedford, MA
Zip Code*
- Mailing address is different from above
Establishment Mailing Address
Street Address Address Line 2 City State ZIP Code
Establishment Telephone Number
Owner’s Name
First Last
E-mail Address for Person in Charge (PIC) of Daily Operations*
Style of Establishment
Number of seats
Restaurant Menu

As a condition of participation, please upload copies of your restaurant’s current food menus for adults and children
Menu File (.pdf or .png or .jpg or .doc or .docx only)
Accepted file types: jpg, png, pdf, doc, docx.
ADULT Menu Features (check all that apply)

Must meet at least 4 of the guidelines below
- Substitution of salad or vegetables for fried vegetables (ie: French Fries or Onion Rings);
- At least three sides or choices of fruits and/or non-fried-vegetables (other than potatoes);
- Clearly indicated Vegetarian, Vegan, or Gluten-Free items;
- Clearly indicated items with “No Added Salt/Sugar” or “Reduced Salt/Sugar”;
- Some dishes in half or children’s size portions;
- Menu utilizes local, hand-made and/or organic ingredients;
- Salt Shaker removed from table, offered if requested;
- Offers a weekly Healthy Dining special;
- No use of Trans Fats;
- The “half meal to-go” option in which a customer eats only half and takes the remaining portion home;
- At least one whole grain item;
- At least one item that contains Lower-Sodium meats, toppings, soups, etc.;
- Water is default for meal combos;
- Other Healthy Dining Options
Other Healthy Dining Options
CHILDRENS Options (check all that apply)

Must meet at least 3 of the above options
- 1% milk, skim milk or water as the default beverage;
- Substitution of salad or vegetables for fried vegetables (ie: French Fries or Onion Rings);
- At least two sides or choices of fruits and/or non-fried vegetables (other than potatoes);
- At least one whole grain item;
- At least three baked or grilled entrée items;
- Substitution of adult entrée items in children’s size for children’s entrée items;
- Offers a weekly Healthy Dining special;
- Other Healthy Dining Options
Other Healthy Dining Options
Terms & Agreement*
As the owner/manager of the above restaurant, I certify that, as evidenced by New Bedford Health Department records, this establishment:

1. Has a valid Food Establishment Permit issued by the New Bedford Health Department;
2. Has no unresolved sanitary health code violations;
3. Complies with “Smoke-Free Workplace Law”
4. Follow guidelines for food allergen regulations
5. Enforce alcohol serving laws, training staff as appropriate
- I understand and agree to the above terms
- I understand that if any of the above conditions change, the Healthy Dining New Bedford designation will be forfeited

Please enter your name and date to complete the application*

Name	Date

View Healthy Dining New Bedford Restaurants
Healthy Dining New Bedford Restaurant Application

Establishment Information

Restaurant Menu

As a condition of participation, please upload copies of your restaurant’s current food menus for adults and children

Must meet at least 4 of the guidelines below

Must meet at least 3 of the above options