Program Questionnaire

Please review and complete this questionnaire within 30 days of receipt.

 

*Organization Name:
*Manager:
*Address:
*Date: 

*Tier:

 Tier One businesses typically have more produce, fresh grocery, and shelf-stable foods to donate, and include: 
• Wholesale food vendors 
• Food service providers 
• Food distributors 
• Grocery stores and supermarkets greater than 10,000 square feet.		Tier Two businesses typically have more prepared foods to donate, which often require more careful handling to meet food safety requirements (e.g. time and temperature controls), and include:
• Hotels with an on-site food facility and 200 plus rooms
• State agencies greater than 5,000 square feet or 250 plus seats
• Large venues and events
• Restaurant facilities greater than 5,000 square feet or 250 plus seats
• Health facilities with an on-site food facility and 100 plus beds
*Email:

 

“Edible Food”- Means: Food intended for human consumption that is fit to be consumed.

 

Are you currently donating edible food? 
If you are not, where is the edible food going? 

*Who are you partnering with, where is the food going?

(List all services or organizations you are donating to.)

 

*Does your establishment have a contract or written agreement with all organizations you donate to on file available for inspection?

Yes / No 
*What is the name, address and contact information of the company(s) you are partnered with? 
*How is the food getting there? 
*How often do you donate? 
*Do you keep track of what you donate? 

*Approximately how much do you donate?

(If you are using more than one service or organization for donation, please separate the donated weight to each facility.)

Food Recovery Organization #1: 

​Food Recovery Organization #2: 

Food Recovery Organization #3: 

Pounds/month (Org. #1): 

Pounds/month (Org. #2): 

Pounds/month (Org. #3): 

*What types of food are you donating? 
*What are the current barriers with donating more edible food? 
*How could those barriers be overcome? 

 

Please note: Contracts and written agreements are required between the commercial edible food generator and a food recovery service or organization per State Regulation: SB 1383. Section 18991.4 (2)

 



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