GDAKC Self-Audit Assessment

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GDAKC Certification - Step 2: Self-Audit Assessment

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Page 1

The goal of this survey is to inform potential Green Dining Alliance members what will be asked and discussed during a certification audit. We provide you with this tool to increase transparency during the process and allow you to self-assess. Responses to all questions are optional, but we recommend being as thorough as possible. You can save and return to the form as many times as necessary before submission; this is especially helpful if specific people within your establishment can provide answers within the different categories.

Once you submit your responses, our coordinator will contact you to schedule your audit.

Contact Information

Restaurant Name:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Primary Contact Information:

First Name:

Last Name:

Email:

Phone Number:

What is your job title / connection to this establishment:

Secondary Contact (optional):

First Name:

Last Name:

Phone Number:

Email:

What is your job title / connection to this establishment:

GDAKC Audit Categories and Core Concepts

Your GDAKC certification audit is broken down into seven categories. Each category contributes to the total score, but some are more impactful than others because there are more points available. The following represents the weight of each category and how each contributes to your final score. Your final report will reflect a sub-score for each category.

recycling & waste reduction: 30%
sourcing & procurement: 37%
water conservation: 8%
energy conservation & efficiency: 16%
chemicals: 5%
awareness & education: 4%
innovation (bonus points): up to 18%

If you commit to the Core Concepts of GDAKC and score within the following ranges, you will receive a certified star rating, which will be published on Bridging The Gap's website and celebrated/promoted in its newsletter as well as on social media:

100-170 points: 2 star
171-220 points: 3 star
221-270 points: 4 star
271+ points: 5 star

If you can check off all of the following boxes, you are ready to begin your self-audit. These are the Core Concepts of GDAKC, and are required for certification:

We have banned the use of Styrofoam in our establishment.We have implemented or are currently working to phase in single-stream or separated recycling (glass, aluminum, cardboard, plastic, paper). We have implemented or are phasing in energy-efficient lighting and fixtures.We are prepared to set waste reduction and diversion goals in an effort to improve our operations.

Please share any additional details in regards to your establishment's existing or potential commitment to the Core Concepts:

Waste Management

Landfill Hauler:

Dumpster size, quantity & frequency:

Recycling Hauler:

Dumpster size, quantity & frequency:

Waste Oil Hauler:

Dumpster size, quantity & frequency:

Compost Hauler:

Dumpster size, quantity & frequency:

Regarding waste collection:

We rent our space, and we pay the waste collection bills for the business.We own our building, so we pay the waste collection bills for the business.We rent our space, and waste collection is included with our rent.

Page 2

Part I: Recycling & Waste Reduction

We currently recycle the following (check all that apply):

glasscardboardpaperaluminummetalfluorescent and CFL light bulbs +4 pointstoner and ink jet cartridges from POS terminals and office equipment +3 pointsbatteries +4 pointselectronics (monitors, printers, blenders, can openers, etc.) +4 pointsrehab materials (paint, carpet, drywall, etc.) +bonusother; please explain (you may qualify for bonus points during your in-person audit):

Regarding our disposables (check all that apply):

we use to-go boxes that are compostable. +3 pointswe use to-go boxes that are made from post-consumer materials. +2 pointswe use to-go boxes that are made with recyclable plastic. +1 pointsome are made of compostable materials and/or recycled paper. +2 pointssome are made of paper (no recycled content) and/or aluminum (no recycled content). +1 pointno drink straws are used in our restaurant, or we have a straw-reduction plan in place. +4 pointsonly compostable straws are used. +4 pointsno plastic bags are used for takeout or leftovers. +2 pointswe ask if items, including beverages, are "for here or to go". +3 pointsother; please explain (you may qualify for bonus points during your in-person audit):

Regarding food waste (check all that apply):

we compost all kitchen food waste. +4 pointswe compost all consumer food waste. +4 pointswe keep a food waste log. +2 pointsour food waste log is laminated. +1 pointwe weigh/measure portions (i.e. french fries and meat). +2 pointsour circular plate sizes are 10" or less. +1 pointother; please explain (you may qualify for bonus points during your in-person audit):

e.g. we offer 1/2-sized portions; we remove inedible garnishes from plates; etc.

Regarding our sewer system (check all that apply):

we clean our grease trap regularly. +2 pointswe do not use a garbage disposal in our sinks. +2 pointswe separate and recycle our grease. +2 pointswe produce NO grease (no fried items). +2 pointsother; please explain (you may qualify for bonus points during your in-person audit):

Regarding water service to guests (check all that apply):

we only use tap water. +4 pointswe only offer ice upon request. +4 pointswe only offer water upon request. +4 pointswe only refill water at the table upon request. +4 pointsother; please explain (you may qualify for bonus points during your in-person audit):

e.g. we offer Boxed Water instead of bottled water, etc.

We reduce packaging and material waste by (check all that apply):

buying food in bulk (e.g. large sacks of onions, rice, cheese wheels, etc.). +3 pointsbuying condiments in bulk. +3 pointsonly using refillable condiments (no individual packets). +1 pointother; please explain (you may qualify for bonus points during your in-person audit):

e.g. reusing pickle buckets for storage, etc.

Regarding our service-ware and linens (check all that apply):

we use washable flatware. +3 pointswe use ramekins and portion cups instead of disposable cups. +3 pointswe use plates and glassware. +2 pointswe use cloth napkins. +2 pointswe wash our linens in-house (without bleach). +1 pointwe provide reusable dishware to staff for use in employee break rooms, offices, etc. (non-disposable cups/plates/flatware). +4 pointsother; please explain (you may qualify for bonus points during your in-person audit):

Regarding beverages (check all that apply):

we ONLY dispense soda from a fountain. +3 pointswe dispense some soda from a fountain. +1 pointwe ONLY dispense beer from a tap. +3 pointswe dispense some beer from a tap. +1 pointwe ONLY dispense wine from a tap. +3 pointswe dispense some wine from a tap. +1pointother; please explain (you may qualify for bonus points during your in-person audit):

Regarding our office practices (check all that apply):

we use electronic employment forms and files. +3 pointswe pay bills online. +2 pointswe offer direct deposit to our employees. +3 pointswe print double-sided documents. +1 pointwe use Energy Star computers, printers and monitors. +1 pointwe use reusable lists and templates (sections, side work, etc.). +3 pointswe offer the use of scrap paper for staff tasks and taking orders. +1 pointwe purchase office/copy paper that is either: 100% recycled or is FSC-certified with at least 30% post-consumer waste recycled content. +3 pointsother; please explain (you may qualify for bonus points during your in-person audit):

Roughly how many reams of office paper do you purchase annually?

Regarding our restrooms (check all that apply):

we reduce soap container waste by using refillable or bulk soap dispensers. +3 pointswe only offer hand dryers (no paper towels). +2 pointswe use Energy Star hand dryers. +2 pointswe use Dyson Airblade, Excel Xcelerator, or an equivalent type of hand dryer. +2 pointswe use post-consumer paper towels. +1 pointwe use post-consumer toilet paper. +1 pointother; please explain (you may qualify for bonus points during your in-person audit):

Regarding our menus (choose the response which best describes your practices):

we do not print our menus (QR code, digital). +3 pointswe print our menus on recycled paper, and they are protected from spills. +2 pointswe protect our menus from spills. +1 pointother; please explain (you may qualify for bonus points during your in-person audit):

Page 3

Part II: Sourcing & Procurement

We have defined local to help you determine what category your goods fall into:

Regional: 300 miles or less
Local: 150 miles or less
Backyard: 50 miles or less

In the following questions, "local" or "locally" refer to all three categories. You may qualify for bonus points during your in-person audit.

Fruits & Vegetables

Do you source your fruits and vegetables from local farmers? You may qualify for bonus points during your in-person audit.

Are your fruits and vegetables organic? (e.g. USDA Certified Organic and/or Certified Naturally Grown and/or known organic)

Dairy

Do you source your dairy products locally? See above for definitions. You may qualify for bonus points during your in-person audit.

Are your dairy products hormone- and steroid-free?

Are your dairy products organic? (e.g. USDA Certified Organic and/or Certified Naturally Grown and/or known organic)

Does your dairy come from grass-fed/pasture-raised livestock?

Poultry

Do you source your poultry locally? See above for definitions. You may qualify for bonus points during your in-person audit.

Are your poultry products hormone- and steroid-free?

Are your poultry products organic? (e.g. USDA Certified Organic and/or Certified Naturally Grown and/or known organic)

Is your poultry pasture-raised? (This does not include "cage-free or "free range.")

Eggs

Do you source your eggs locally? See above for definitions. You may qualify for bonus points during your in-person audit.

Are your eggs produced hormone- and steroid-free?

Are your eggs organic? (e.g. USDA Certified Organic and/or Certified Naturally Grown and/or known organic)

Do your eggs come from pasture-raised chickens? (This does not include "cage-free" or "free range.")

Red Meat (beef, pork, lamb, etc.)

Do you source your meats locally? See above for definitions. You may qualify for bonus points during your in-person audit.

Is all of your meat hormone- and steroid-free?

Are your meat products organic? (e.g. USDA Certified Organic and/or Certified Naturally Grown and/or known organic)

Does your meat come from grass-fed/pasture-raised livestock?

Grains, Dry Goods & Baked Goods

Do you source your grains, rice, beans, or other dry ingredients locally? See above for definitions. You may qualify for bonus points during your in-person audit.

Are your grains, rice, beans, or other dry ingredients produced with organic materials? (e.g. USDA Certified Organic and/or Certified Naturally Grown and/or known organic)

Do you source your baked goods locally? See above for definitions. You may qualify for bonus points during your in-person audit.

Do you produce baked goods on-site for the restaurant?

Are your baked goods produced with organic materials? (e.g. USDA Certified Organic and/or Certified Naturally Grown and/or known organic)

Do you purchase unbleached grains and baked goods?

Seafood

Do you source any seafood locally or regionally? See above for definitions. You may qualify for bonus points during your in-person audit.

Is all of your seafood sustainably harvested? (NOT endangered or unsustainably harvested seafood as per the Monterey Bay Aquarium Seafood Watch AVOID list, or Blue Ocean Institute's guide to Ocean-Friendly Seafood)

Beverages (beer, wine, liquor, soda)

Do you source your beverages from local producers, and/or make any of your beverages/beverage components in-house? See above for definitions. You may qualify for bonus points during your in-person audit.

Are your beverages made with organic materials? (e.g. USDA Certified Organic and/or Certified Naturally Grown and/or known organic)

"Luxury Items" (coffee, tea, chocolate)

Do you source your coffee from local roasters? See above for definitions. You may qualify for bonus points during your in-person audit.

Does your coffee, tea, or chocolate (if applicable) meet any certifications, such as (but not limited to) Fair Trade, Rainforest Alliance, Shade Grown, USDA Organic?

Page 4

Part III: Water Conservation

Check all that apply to your kitchen and prep areas:

We use a high-temperature (low-flow) dishwashing machine (Energy Star). +4 pointsWe have aerators on all faucets in the kitchen. +4 pointsWe only thaw frozen items in the walk-in and NEVER use running water in the sink. +4 pointsWe strictly enforce water conservation efforts in the kitchen - no sinks are ever left running. +4 pointsWe maintain our grease trap and dumpster to keep waste from entering the sewer lines and stormwater drains. +2 pointsWe have a record of our last grease trap cleaning posted. +2 pointsWe have water tested for heavy metals and/or chemicals. +1 pointWe have a water filter. +1 pointother (Additional points (+3) may be awarded during your in-person audit for responsible use of a three-sink system.)

Check all that apply to your restrooms:

We use 1.6-gallon / 6L-per-flush toilets and 1.0-gallon urinals. +3 pointsWe use dual-flush toilets. +4 pointsWe have automatic faucets. +2 pointsWe have aerators on all faucets. +4 points

Page 5

Part IV: Energy Conservation & Efficiency

We use the following for energy-efficient lighting (check all that apply):

we have conducted a lighting audit +5 pointsdimmer switches +2 pointsmotion detectors for spaces that aren't continually occupied (offices, banquet rooms, restrooms, etc.) +3 pointsnatural lighting to reduce amount of bulb usage during the day +2 pointscandles on tables to reduce need for overhead lighting (rechargeable LED or wax) +1 pointCFLs in all applicable light fixtures +1 pointLEDs are currently being phased in +2 pointsLEDs in all applicable fixtures +6 pointsbi-level switches allowing us to adjust lighting for groups of fixtures +2 pointsdaylight sensors on our outdoor lighting to reduce unnecessary use +2 pointsLED exit sign +2 pointsLED lighting in walk-in +1 pointother (Additional points may be awarded during your in-person audit.)

We use the following for heating and cooling conservation (check all that apply):

we have replaced our gas water heater with an electric heat pump water heater, or we have obtained a quote for future replacement (please provide this information to your coordinator) +5 pointswe have insulated and weatherized our building envelope (roof +2 points, windows and doors +2 points), ductwork +2 points).utilization of separate thermostats for the kitchen and dining room +4 pointsprogrammable thermostats to regulate temperatures during non-peak hours +4 pointsawnings over windows and doors to assist with HVAC efficiency +1 pointceiling fans to supplement our HVAC system +3 pointsthermal windows +2 pointsthermal doors +2 pointshigh-efficiency air conditioning units (SEER >13 or EER >11) +4 pointshigh-efficiency furnace +4 pointsregular maintenance of air intake vents, making sure they are open and clean +1 pointregular maintenance and cleanings of refrigeration units (coils & gaskets) +1 pointuse of high-efficiency hoods +2 pointsregular calibration checks of kitchen equipment thermostats +2 pointsinstallation of plastic curtain strips in our walk-ins to hold cool air in when door is open +2 pointsautomatically closing walk-in doors +2 pointsno walk-in cooler or freezer +3 pointsother (Additional points (+3) may be awarded during your in-person audit if you are a conscientious renter and encourage your landlord to make reasonable, applicable improvements.)

We use the following alternative energy practices/systems (check all that apply):

our computers and laptops are set to go into hibernate/sleep mode after 15 minutes of inactivity +1 pointsubsidy program for employees who commute to work using alternative transportation, such as walking, bicycling or public transit +3 pointsconscientious employer bonus (considers employees' safety when scheduling) +2 pointsintegration of hybrid/electric/alternative fuel vehicles into company's fleet +2 pointswe provide company bike(s), electric bike(s), electric vehicle(s), and/or scooter(s) to employees for deliveries or errands. +4 points

Roughly how many miles are driven annually (if applicable)?

Roughly how many trips per week are made using zero-emission alternatives (if applicable)? Roughly how many miles on average per trip (if applicable)?

Our current status on Energy Star products and appliances:

all Energy Star office equipment (printers, computers, monitors) +6 pointsall Energy Star kitchen appliances (ovens, coolers/refrigerators) +6 pointssome Energy Star appliances +3 pointsWe have a plan in place to phase in Energy Star appliances. +1 point

Page 6

Part V: Chemical Use

We use the following cleaning products (brands like Design for the Environment, GreenSeal, etc.) that are biodegradable or aim to reduce chemical pollution (check all that apply):

dishwashing detergents +3 pointsglass cleaner +2 pointsfloor cleaner +3 pointsbathroom cleaner +3 pointsall-purpose cleaner +3 pointspest control that doesn't utilize Atrizine (endocrine disruptor) + 3 pointsdoormats at all entrances to reduce outside particulates +1 pointother; please explain. (You may earn additional points during your in-person audit.)

We use non-toxic chemicals for landscaping, turf management and/or site maintenance when possible.

Yes +3 pointsNoPest management without Atrizine (endocrine disruptor) +1 point

Do you purchase unbleached and/or processed chlorine-free (PCF) paper products (paper towels, napkins, coffee filters, etc.)?

Roughly how many pounds of paper towels, napkins, coffee filters, etc. do you purchase annually (if applicable)?

Page 7

Part VI: Awareness & Education

We display our environmental policy to the public via social media and/or our website.

Yes +1 pointNo

We include our environmental policy in our employee manual.

Yes +3 pointsNo

New staff members undergo training that specifically incorporates instruction on green restaurant practices and policies.

Yes +2 pointsNo

We regularly educate staff (ongoing training) on waste reduction and diversion goals, and the policies/procedures we have in place to achieve them.

Yes +2 pointsNo

We set up easily accessible waste stations with landfill, compost, and recycle bins together, with clearly marked signage.

Yes +4 pointsNo

We post signage encouraging resource conservation (e.g. reminders to turn off lights, faucets, etc.)

Yes +3 pointsNo

We emphasize local and environmentally-friendly menu options.

Yes +2 pointsNo

We have environmental education displays, information, etc. available for (check all that apply):

employees +2 pointscustomers +3 points

We purchase exclusively from vendors that have an environmental policy/commitment.

Yes +3 pointsNo

We share our environmental policy with vendors and encourage them to offer or continue offering sustainable product options.

Yes +3 pointsNo

We request that vendors and suppliers provide their shipments in non-plastic packaging, and we prioritize vendors with reusable, returnable, or compostable packaging.

Yes +3 pointsNo

Page 8

Part VII: Innovation

Regarding recycling and waste reduction (check all that apply):

we donate excess food. +4 pointswe purchase items that are refurbished or made from recycled materials, and use interior features and decorations that are sustainable. +8 pointswe separate coffee grounds for community donations or use in garden. +3 pointswe utilize food scraps for further use (bread --> croutons, veggie scraps --> stock, etc.). +3 pointswe encourage employees to use reusable bottles. +3 points

Regarding sourcing (check all that apply):

we source food using local resources such as Cultivate KC or The Food Circle.we grow herbs, flowers, fruits or vegetables for use in the restaurant. +4 pointswe promote Meatless Mondays (or a similar environmental awareness program). +4 pointswe source meat that is Certified Humane, Animal Welfare Association-approved (AWA), and/or is produced in support of the Global Animal Partnership (GAP). +3 pointswe refuse to use unhealthy/environmentally unsound products (palm oil, aspartame, etc.). +4 pointswe source needed items from friends, employees, neighbor supply chain). +2 points

Regarding water conservation (check all that apply):

we have a tankless water heater. +2 pointswe use foot pedals on kitchen faucets. +4 pointswe use a low-flow pre-rinse nozzle for dish scraping/pre-cleaning (with a max of 1.28 GPM). +3 pointswe use waterless urinals in bathrooms. +4 pointswe use composting toilets. +4 pointswe utilize some Water Sense-labeled equipment and/or products (EPA certification). +2 pointswe use native plants in landscaping. +2 pointswe use rain gardens in landscaping. +4 pointswe use rain barrels to water the landscape. +3 pointswe use drip irrigation for gardens and landscaping. +2 pointswe have pervious pavement in the parking lot. +4 points

Regarding energy conservation (check all that apply):

we have at least one electric car charging station. +4 pointswe have bike racks. +2 pointswe are accessible via public transit. +2 pointswe have a white-top or reflective roof. +2 pointswe have a rooftop garden. +3 pointswe have a "green" roof, either fully planted or solar. +4 pointswe utilize solar-powered energy production on site. +10 pointswe utilize geothermal energy production on site. +5 pointswe utilize solar thermal energy production on site. +4 pointswe utilize wind turbine energy production on site. +4 pointswe have conducted an energy audit within the last 12 months. +4 pointswe have obtained at least three quotes to install solar panels +1 pointwe take advantage of Evergy and Spire incentives and rebates to replace aging equipment or make building upgrades +3 pointswe install repurposed or recertified parts when applicable to machine maintenance. +2 points

If you utilize solar, geothermal, or wind turbine energy production on site, what is your monthly kWh generation?

Regarding chemicals (check all that apply):

we use low-VOC paint. +1 pointwe use low-VOC caulking. +1 pointwe use low-VOC carpeting. +1 pointwe use low-VOC upholstery. +1 point

Regarding awareness and education (check all that apply):

we practice social sustainability by participating in community food education programs or community give-back programs. +3 pointswe have an environmental team that meets at least quarterly, or sustainability conversations are incorporated into our daily practices. +1 pointwe advertise our sustainable efforts through local publications (print or A/V media). +1 pointwe have recently calculated the average energy use (electricity, natural gas, and water) per month or year for our building +3 pointswe review monthly bills to track water and energy usage over time, looking for sudden increases in use

Regarding social sustainability and wellness (check all that apply):

we hire from the neighborhood. +1 pointwe provide benefits to part-time and full-time employees (health, dental, family leave, etc.). +1 pointwe encourage employee volunteer time. +1 pointwe display artwork by local artists. +1 pointwe display plants or images of plants inside the restaurant. +1 pointour location is handicap-accessible. +1 point

Awards, certifications and memberships (check all that apply):

Our building is LEED-certified. +4 pointsWe are certified through the Green Restaurant Association (or comparable program). +1 pointOther; please explain (you may qualify for bonus points during your in-person audit):

This self-assessment should give you a good idea of what your certification score will be, but it is not a final score; the GDAKC coordinator will perform your official audit and issue your official certification. Your answers from this survey will be available at the time of the audit in an effort to streamline the process with respect for everyone's time and priorities.

Are you ready to schedule your audit? Do you have questions?

Please reach out to the GDAKC coordinator.

gdakc@bridgingthegap.org

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