Implementation Plan Checklist for Agencies and Sites Use this checklist to adopt and implement the Healthy Nutrition Guidelines. Submit the completed checklist with your application for recognition and success story. Agencies can work towards recognition for the Choose Well program at the same time as working towards Washington Wellness’ Team WorkWell’s Zo 8 Award. Name of applicant: Position: Contact information: email: phone: Where do you work? How would you describe your worksite? State Executive Agency Site of State Executive Agency Other agency or organization (voluntary adoption) ALIGNMENT WITH ACTIVITY DUE BY ZO 8 AWARD Adopt a healthy nutrition policy and send copy to the July 1, 2014 Standard 6.1 Gain policy Department of Health. Include the contact information for your support for wellness agency or site’s point-of-contact programs Communicate policy change to employees Standard 6.4 Inform employees of environmental supports Complete workplace assessments and send to Department of December Standard 3.4 Collect data Health (check all that apply): 31, 2015 about your organization Environmental assessment (required for all) Implementation Tool for Cafeterias Implementation Tool for Institutions Implement all applicable guidelines (check all that apply): December Standard 5.4 Choose Vending 31, 2016 awareness activities, and Standard 6.3 Get Meetings and Events environmental support for Cafeterias wellness. Institutions Promote HealthCare Authority’s Annually Standard 5.2 Promote (State Agencies only) Health Assessment Employee Health Assessment Complete at least four activities to promote healthy eating February 1 Standard 5.1 Choose of each year activities and interventions, in the workplace (describe activities below): and 1. Standard 5.4 Choose 2. awareness type activities 3. 4. Submit a success story February 1 N/A of each year Submit application for recognition with this completed February 1 N/A implementation checklist of each year Please submit all forms to the Department of Health at
Implementation Plan Checklist for Agencies and Sites Use this checklist to adopt and implement the Healthy Nutrition Guidelines. Submit the completed checklist with your application for recognition and success story. Agencies can work towards recognition for the Choose Well program at the same time as working towards Washington Wellness’ Team WorkWell’s Zo 8 Award. Name of applicant: Position: Contact information: email: phone: Where do you work? How would you describe your worksite? State Executive Agency Site of State Executive Agency Other agency or organization (voluntary adoption) ACTIVITY DUE BY ALIGNMENT WITH ZO 8 AWARD Adopt a healthy nutrition policy and send copy to the Department of Health. Include the contact information for your agency or site’s point-of-contact July 1, 2014 Standard 6.1 Gain policy support for wellness programs Communicate policy change to employees Standard 6.4 Inform employees of environmental supports Complete workplace assessments and send to Department of Health (check all that apply): Environmental assessment (required for all) Implementation Tool for Cafeterias Implementation Tool for Institutions December 31, 2015 Standard 3.4 Collect data about your organization Implement all applicable guidelines (check all that apply): Vending Meetings and Events Cafeterias Institutions December 31, 2016 Standard 5.4 Choose awareness activities, and Standard 6.3 Get environmental support for wellness. (State Agencies only) Promote HealthCare Authority’s Employee Health Assessment Annually Standard 5.2 Promote Health Assessment Complete at least four activities to promote healthy eating in the workplace (describe activities below): 1. 2. 3. 4. February 1 of each year Standard 5.1 Choose activities and interventions, and Standard 5.4 Choose awareness type activities Submit a success story February 1 of each year N/A Submit application for recognition with this completed implementation checklist February 1 of each year N/A Please submit all forms to the Department of Health at
340-224-ImplementationPlanChecklistforAgenciesandSites.docx