IMPLEMENTATION PLAN Name of Outlet(s): Outlet Location(s): Health Authority: STEP 1: SUBMIT CONTACT FORM Complete the Informed Dining Contact Form available at www.InformedDining.ca STEP 2: SUBMIT IMPLEMENTATION PLAN Complete this form and email to: InformedDining@gov.bc.ca. Ministry of Health staff will contact you within 5 business days to set-up a time to review your implementation form. STEP 3: STATUS OF RECIPES Recipes are standardized? Nutrient analysis is complete? Yes Yes No No Partial STEP 4: IDENTIFY METHOD OF MEETING LOGO AND DIRECTIONAL STATEMENT REQUIREMENTS See page 3 of the Health Care Participation Guide TYPE OF MENU Printed Menu METHOD Menu Board (includes white boards and sandwich boards) No Printed Menu or Menu Board Combination STEP 5: IDENTIFY METHOD OF PROVIDING NUTRITION INFORMATION TO CONSUMERS See page 5 of the Health Care Participation Guide for available formats and location options Format nutrition display (3 ringed stand) nutrition menu (folder or booklet) brochure or pamphlet poster Location at the ordering counter on a stand in the ordering line upon entry to the establishment in another location approved 1 AVAILABLE PROGRAM SUPPORTS Please complete: Menu Board Danglers (colour variation available in both formats) Style and Colour: Quantity: Blue Horizontal (17 x6) Grey Horizontal (17 x6) Blue Vertical (9 x12) Grey Vertical (9 x12) Square Directional Clings (4.5 x 4.5) Style and Colour: Quantity: Blue Grey Informed Dining Logo Graphic Please provide the Informed Dining Logo Graphic 2 Nutrition Display 3-Ring Stand (holds page protectors for 8.5 x 11 sheets) Quantity: Nutrition Menu Folders Type: Quantity: 2 Pages (holds 4x8.5 x 11 sheets) 4 Pages (holds 8x8.5 x11 sheets) Nutrition Menu Graphic Templates Type of File: Adobe InDesign—Portrait (vertical) MS Publisher—Portrait (vertical) Adobe InDesign—Landscape (horizontal) MS Publisher—Landscape (horizontal) 3 Window Decals (1 per entry way) Colour: Quantity: Blue Grey Table Tent Cards Quantity: 4 Informed Dining Staff Training Poster (minimum or 1 per outlet) Quantity: Large—11x17 Small—8.5x14 5