BY

FOOD SERVICE
GUIDELINES AND
NUTRITION
TEAM
STANDARD Damian Francis, PhD; Ivey Whitworth, MS; & Emma Vann

ASSESSMENT IN
BALDWIN COUNTY,
GA
TABLE OF CONTENTS
INTRODUCTION .................................................................................................................. 3
BACKGROUND .................................................................................................................... 3
METHODOLOGY ................................................................................................................. 6
SETTING(S) .................................................................................................................................... 6
RECRUITMENT ............................................................................................................................. 7
MEASURES ........................................................................................................................... 7
DATA MANAGEMENT & ANALYSIS ................................................................................. 8
RESULTS ............................................................................................................................... 9
KEY TAKEAWAYS ............................................................................................................. 10
NEXT STEPS ........................................................................................................................ 10
LIMITATIONS .................................................................................................................... 10
FIGURES ............................................................................................................................. 12
WORKS CITED ................................................................................................................... 18
APPENDIX A: FSG STRATEGY LOGIC MODEL .............................................................. 19
APPENDIX B: INVITATION EMAIL ................................................................................. 19
APPENDIX C: SURVEY ...................................................................................................... 20
APPENDIX D: INFORMED CONSENT FORM .................................................................. 29
INTRODUCTION
The CHSI has conducted research and provided service with community stakeholders for the last
20 years. Our primary mission is to collaborate with community partners to improve the health of
the residents of central Georgia through research and education concerning contemporary health
problems and social issues. The CHSI has a track record of working with rural underserved
communities, including the development of the Live Healthy Baldwin Project, a community-wide
initiative that centered on reducing the childhood obesity epidemic by increasing opportunities for
healthy food choices and physical activity. The center has worked with non-profit and government
partners to establish critical policy and infrastructure, such as community school gardens, low-
income family farmers market, and a more walkable and bicycle friendly community.

In the last year, led by Dr Francis, an Epidemiologist and Nutrition scientist, the CHSI has
conducted a county-wide survey of all food/retail stores using the healthy food assessment index.
This data provides baseline information of availability of healthy foods such as fruits and
vegetables at the County level. The CHSI is currently convenor of a county food insecurity
dialogue that includes government and non-governmental representatives involved in the operation
of food banks, pantries, and food distribution sites. The CHSI also has significant experience in
conducting community needs assessment through mixed methods approach including focus
groups/listening sessions, surveys, and windshield assessment. To date we have conducted two
such needs assessment within the North Central Health District.

BACKGROUND
Food service guidelines are standards that when used can create healthier food and beverages
options and food service operations in various community facilities and communities (CDC,
2022). Food service guidelines can be implemented and used within a wide range of settings and
venues. They can be used in settings such as government facilities, hospitals and healthcare
facilities, colleges and universities, private worksites, and parks and recreations centers (CDC,
2022). Food service guidelines can be used in venues such as cafeterias, snacks bars, concession
stands, micro markets, and vending machines within the identified settings (CDC, 2022). When
food service guidelines are used, they may contribute to employee’s health and wellness,
improve healthy food options, strengthen local food systems, and could improve facility
management of resources and more (CDC, 2022).

The first food service guidelines for federal facilities were released in March of 2011 by the U.S.
Department of Health and Human Services (HHS) and the U.S. General Services Administration
(GSA) and became known as the Health and Sustainability Guidelines for Federal Concessions
and Vending Operations (Food Service Guidelines Federal Workgroup, 2017). These were
created and released in order to help employees make healthier food and beverage choices within
these federal facilities as well as working towards creating an efficient and environmentally
beneficial food service system (Food Service Guidelines Federal Workgroup, 2017). In 2017, the
Food Service Guidelines for Federal Facilities was published by a working group of over sixty
scientist and food service operators that work for nine different federal agencies (CDC, 2022).
The goals of the Food Service Guidelines for Federal Facilities are to encourage and increase
availability of healthier food and beverages, ensure that environmentally responsible practices
are observed in food service venues, as well as minimizing the risk of foodborne illness through
ensuring food safety practices are being followed within facilities (CDC, 2022). FSG for Federal
Facilities is broken down into four sections (1) food and nutrition standards, (2) facility
efficiency, environmental support, and community development standards, (3) food safety
standards, and (4) behavioral design (Food Service Guidelines Federal Workgroup, 2017).

The majority of Americans spend most of their days at work and generally receive their foods at
worksites, cafeterias, or community agencies. The CDC has found that over seven million adults
eat or drink at a cafeteria every given day, and over nine million do so from a vending machine
(CDC, 2022). At these worksites, community facilities, and in the cafeterias and vending
machines that local residents have access to, these foods are often lacking in nutrients and are
generally high in calories, sugars, sodium, and added sugars (CDC, 2022). Poor dietary habits
can lead to chronic diseases such as obesity, diabetes, and heart disease, and currently chronic
diseases are responsible for 70% of all deaths in the United States (CDC, 2022). The introduction
of food service guidelines and nutrition standards can improve the diets of those who receive
their foods from these institutions through encouraging the consumption of healthier foods and
beverages (CDC, 2022).

The implementation and enforcement of food service guidelines and nutrition standards may
reduce chronic diseases that are related to diet such as obesity, diabetes, and heart disease. It is
important to follow food service and nutrition guidelines as it may improve residents, recipients,
and/or employee’s diets through increasing availability and overall consumption of nutrient-
dense foods. These guidelines can also promote and increase environmental sustainability
through the reduction in food waste and energy use (CDC, 2022). Through the implementation of
these guidelines there can be significant long term cost savings through reduced healthcare costs
as a result of improved health outcomes (Abrahams-Gessel et al., 2022). Facilities implementing
food service and nutrition guidelines can impact the sales, intake, and availability of healthier
food options (Lawry-Warnock et al., 2023). By implementing and improving these guidelines in
these facilities there should be increased purchasing and distribution of healthier food options
which can lead to improved health behaviors and outcomes as well as creating an overall
healthier food system (Kimmons et al., 2012).

Research on food service guidelines and nutrition standards is rather new with the majority of
research occurring over the last fifteen years. Current research is being conducted on the
implementation and effectiveness of food service guidelines and other benefits of enforcing these
practices (Lowry-Warnock et al., 2023). The growing recognition on the importance of healthy
eating environments has encouraged research on this topic. Through current research it has
highlighted need for updating and implementing food service guidelines in facilities where they
were not present before. It is essential that in these settings we are using evidence-based
practices that serve the needs of the community and that these practices are not based solely on
statistics but on population needs and community disease profile. There are updates needed due
to evolving public health research and food service practices as well as current advancements in
nutrition sciences.

Despite the increasing research into food service guidelines and nutrition standards and their
effect on individuals and communities there are still gaps present in the research. Some of the
gaps in current research and efforts includes lack of research into guidelines creation and
implementation in food pantries and community agencies, inadequate integration at the college
and university setting, and a lack of enforcement and evaluation metrics. The U.S. charitable
food system is complex and is composed of food banks, food banks, and community agencies.
Although in recent years research into the charitable food system has increased, there is still so
much more that can and needs to be done in regard to how to actually implement nutrition
standards in these agencies. Research has shown it is most important to begin with the foodbanks
which is where the majority of food pantries source the food that they distribute (Levi et al.,
2022).

There is also further research needed to address the inadequate integration of food service
guidelines and nutrition standards at the college and university setting, especially beyond the
campus dining setting. The time students spend in college is when crucial dietary habits and
patterns are formed, and by promoting and creating a healthy food environment at this stage it
can promote life-long healthy dietary practices and the mitigation of chronic diseases (Fandetti et
al., 2023). It is important that when analyzing the food environment at colleges and universities,
we look beyond campus dining and at the other food and beverages available to students in the
dorms and in vending machines around campus. The largest gap in regards to research and
current practices in food service guidelines and nutrition standards is the lack of enforcement and
evaluation metrics. There is a dire need for uniformed expectations and enforcement of food
service guidelines and nutrition standards. Although institutions might have food service
guidelines and nutrition standards in place there is often a lack of enforcement mechanisms and
reporting. Without clear expectations of enforcement and proper evaluation of currently used
methods it hinders the efforts to assess compliance and measure outcomes. By establishing
enforcement and evaluation metrics this can enhance the effectiveness of the efforts addressed in
food service guidelines and nutrition standards.

Further research is needed to address the gaps in research on food service guidelines and
nutrition standards. To address these gaps policy and collaboration from stakeholders,
researchers, and policymakers is needed. Our research is attempting to address these gaps in
research and implementation of food service guidelines, as the majority of our respondents were
food pantries and community agencies. In the first year of this project we will focus on two
milestones, (1) reviewing the food service guidelines landscape in Baldwin County, Georgia, for
setting(s) of interest and (2) developing a food service guidelines action plan with key partners
that will guide your food service guidelines work in the selected setting(s).
METHODOLOGY
SETTING(S)
To better understand the current food service guideline landscape and gaps in Baldwin County,
Georgia we assessed institutions where food is sold/served/distributed excluding public schools,
restaurant, and grocery stores. These agencies were identified across the county through a web-
based search, phone inquiries, and referrals from stakeholders. We identified hospitals, colleges
and universities, food pantries, senior living and assisted living facilities, and other community
agencies.

Milestone 1) Review of FSG Landscape

For milestone one, we assessed food service guidelines and nutrition standards landscape through
an interviewer administered survey. This initial assessment will improve our understanding of
current gaps and what resources are needed to attain adequate implementation of food service
guidelines. The assessment will include identification of viable anchor institutions as well as
identifying existing local/site level practice or capacity for food service, food procurement, and
food distributions in the charitable food system, and specific foods and beverages offered. The
assessment will also assist in indicating the engagement of local partners and their food service
managers, representatives, or nutrition staff.

The assessment will utilize CDC guidance to address six categories: (1) agency background; (2)
food service venues; (3) nutrition policies, standards, and practices in place; (4) authority over
food services; (5) the contracting process; and 6) food environment and capacity. The baseline
assessment will also determine the extent to which food and beverages offered in selected
institutions meet current food service guidelines. This assessment will inform our understanding
of current practices related to food safety, behavioral design and energy/waste efficiency in
institutions that serve, sell, and/or distribute foods. This data will contribute to addressing nutrition,
chronic diseases, and food service and nutrition guidelines challenges in Georgia.

Project activities for milestone one was conducted between January and April of 2024.

Milestone 2- Developing an Action Plan

Food service guidelines are important in influencing healthy behaviors at the system and individual
level. These policies often create a culture of health and support healthy eating and physical
activity. Once embedded into organization policies and food vendor contracts, the food service
guidelines may improve productivity, limit employee/employer healthcare expenditure and
supports healthy development through the life stages. In year one, we will work with the targeted
institutions from our food service guideline landscape assessment to develop a food service
guidelines action plan. These action plans will guide institutions in how to develop, enhance,
and/or implement existing food service guidelines that align with the Food Service Guidelines for
Federal Facilities and/or the Healthy Eating Research Nutrition Guidelines for the Charitable Food
System. The action plans will identify the setting of focus as well as specific goals, objectives, and
strategies for each identified setting.

Through our output of milestones one and two there is an expected short-term outcome of
increasing access to healthier foods and an expected long-term outcome of improving health
behaviors and outcomes and this can be seen in our strategy model (Appendix A). The focus of
this report will be on milestone one, a review of the food service guidelines landscape in
Baldwin County, Georgia.

RECRUITMENT
For this assessment and project, we used targeted recruitment. Stakeholders and their facilities
were identified and placed into six categories: (1) federal, state, and local government facilities,
(2) hospitals and healthcare facilities, (3) colleges and universities, (4) private worksites, (5)
parks and recreation centers, (6) non-profit organizations. To be eligible to participate, agency
representatives must be eighteen years of age and older and institutions must operate within
Baldwin County, Georgia and are responsible for food being sold/served/distributed. Before
emails (Appendix B) were sent out, institutions were contacted to verify contact information for
their dining services manager/nutrition coordinator/food and beverage services/dieticians and/or
vending machine managers. Invitations were then sent for participation in our listening session
and the study overall. The listening session was used to gauge interest of local stakeholders and
develop a sampling frame for study recruitment. Here we introduced the concept of the project,
the requirements to participate, as well as what the next steps of the project would look like.
Additionally, the agencies that did not participate in the listening session were contacted through
personal visits, emails, and/or phone calls.

MEASURES
A landscape review of food service guidelines was completed using the Center for Diseases
Control and Prevention (CDC) Food Service Guidelines Organizational Assessment Tool
(Appendix C) operationalized in Qualtrics. The survey included collecting data on food service
policies, practices, and capacity (organizational assessment) and specific foods and beverages
offered. The assessment utilizes CDC guidance to address six categories: (1) agency background;
(2) food service venues; (3) nutrition policies, standards, and practices in place; (4) authority
over food services; (5) the contracting process; and 6) food environment and capacity. The
baseline assessment also determines the extent to which food and beverages offered in selected
institutions meet current food service guidelines. The survey will also collect information on the
challenges that these facilities currently or could potentially face in regard to complying and/or
instituting food service guidelines and nutrition standards. The assessment will also provide
information on the resources that these facilities would find helpful in creating and following
food service guidelines and nutrition standards.
Before conducting our survey we applied and received approval from Georgia College & State
University Institutional Review Board (IRB) #20399. The survey and informed consent form
(Appendix D) was distributed to the designated point of contact at each individual institution and
was offered either in-person or over the phone. Informed consent was collected from all
participants before their participation and completion of the survey. Surveys were completed
over a three-week period in the Spring of 2024. The survey took about twenty-five minutes to
complete and included background information as well as information on the current facilities
and food service guidelines and nutrition standards that were already in place. Along with survey
completion we asked that institutions provide (1) documentation of the types and number of food
service venues in your agency, (2) documentation of the number of meals, snacks, and/or
vending machines for food items sold/served in the food service venues, (3) food service
policies, permits, contracts and/or agreements for the food service venues, (4) documentation of
any food service guidelines/nutrition standards used in food service venues, including
procurement contracts. The survey responses along with requested documentation will provide
the information needed for the landscape review.

DATA MANAGEMENT & ANALYSIS

For milestone one we primarily collected data via a survey but also from a listening session. The
data was collected and stored in a manner to maintain anonymity of the participants and their
institutions. The data was only collected by the study facilitators and was kept away from the
public and was stored in a secure location to protect the participants identities. The data from
Qualtrics was exported to Excel for data cleaning. Data analysis was conducted in STATA 17.0.

For our quantitative variables such as total number of meals and snacks served, agency setting
and number of venues, number of and topics addressed in standards we utilized descriptive
statistics. Data on agency setting/ venues, nutrition policies standards and practices in place,
authority, contracting process, and environmental capacity were reported by frequencies and
proportions. This allowed us to quantitatively assess the current landscape of food service
guidelines and nutrition standards in Baldwin County, Georgia. We also conducted a qualitative
analysis of our open-ended survey questions using coding and thematic analysis methods for the
responses. This allowed us to identify patterns and recurring themes in facilities responses which
allowed us to gain a better understanding of the facilities and participants perspectives.

By using both quantitative and qualitative approaches this allowed us a comprehensive overview
of the data that was collected from the survey. This allowed us to capture and understand the
trends in the data as well as provided us with nuanced insights that will inform the development
of recommendations for enhancing or implementing food service guidelines and nutrition
standards.
RESULTS
Sixteen agencies participated in our landscape review survey. Institution and agencies were
asked to identify their setting and could select the option that would allow them to best identify
themselves. Almost one-half (n=7) identified as a distributive meal program (Figure 2). When
looking at health promotion strategies that agencies engage in 37.5% of institutions engaged in
no health promotion strategies, 25% engaged in nutrition policies to increase the availability of
healthier foods and , 19% engaged in health education. For those who identified “other” as the
health promotion strategies they engaged in their responses included: hospital clinic offered to
employees, incentives for gym membership, as well as outside education resources being
provided (Figure 1)

Of the institutions that sold food, 43% were vending machines, 28.5% sell food in
cafes/cafeterias, and the remaining 28.5% identified “other” as their response (Figure 3). Of
those that indicated other they sold food either in micro markets or sold food to other facilities,
for example a food bank selling it food pantries. In our institutions that serve food, the majority
(61.6%) is served through a distributive meal program, and 15.4% of institutions that serve food
served meals to institutionalized populations.

Ten out of sixteen institutions currently follow food service guidelines, with five not currently
following any, and one reported being unsure (Figure 4). Of those ten who do currently adhere to
food service guidelines, nine responded that their guidelines/standards were mandatory, with one
reporting that they follow them voluntarily. The most frequent rationale reported for using food
service guidelines was aligns with the agency’s mission (43.7%), followed by 25% who reported
modeling healthy and sustainable practices for other agencies (Figure 5). Only one institution
reported improving employee health and wellness as a rationale for using food service
guidelines/nutrition standards.

Among those who follow food service guidelines and nutrition standards we evaluated the topics
addressed within their guidelines. The most prominent guideline topic among these institutions
were related to nutrition behaviors (e.g. promoting/offering fruits and vegetables, calorie
information through labeling, and healthier food and beverage choices with signs and symbols)
(Figure 6). Topics such as sodium, saturated fats, and calories were also addressed by four or
more institutions. Three institution identified other topics that were not a part of the survey and
indicated that their guidelines addressed increasing baked options, increasing offering of no or
low sugar beverages, and food storage/handling. One third of those following food service
guidelines, indicated that their guidelines include offering free drinking water (Figure 7). One in
four agencies indicated that they participate in waste reduction, recycling, and composting
programs,

We also assessed information on the environment and capacity that surrounds the food service
venues within these agencies. Respondents were asked “Which challenges does your agency face
regarding the development of or compliance with food service guidelines and nutrition
standards?” The singular most reported challenge was a lack of funding support or cost concerns
(n=10). The next most shared challenges reported by facilities were challenges with customer
dissatisfaction with changes, a lack of consumer demand for healthier food products, and lack of
nutrition expertise (Figure 8).

The survey collected data on what information agencies thought would be helpful to support
using food service guidelines/nutrition standards. Most reported the need for a website dedicated
to food service guidelines and resources (68.8%) followed by training for staff, and assistance
with how to market and promote healthy items (Figure 9). Among those selecting the other
category help was requested in areas such as ways to introduce behavioral change, recipe design,
on-site training, and patient education (Figure 9A).

KEY TAKEAWAYS
There is limited engagement in health promotion strategies among places that sell or serve food
in Baldwin County, Georgia. Most agencies identified themselves as a distributive meal program
which includes food pantries, churches, and senior centers. Vending machines were the most
frequently reported venue used to sell foods. There are opportunities for improvement in agency
use and implementation of food service guidelines as one in three agencies reported not using
food service guidelines. Even though their standards address nutrition behaviors and limiting
nutrients such as sugars, fat, and sodium, very few agencies have as their rationale the promotion
of health and prevention of diseases as a motivation for using food service guidelines. There is a
dearth of information on sustainability standards in agencies’ food service guidelines. The
greatest challenge identified by facilities in developing or complying with food service
guidelines was fiscal related followed by challenges with customer demand and satisfaction and
then staffing challenges.

NEXT STEPS
Between May and June of 2024, we will develop a food service guidelines action plan as part of
milestone two. These action plans will guide institutions in how to develop, enhance, and/or
implement existing food service guidelines that align with the Food Service Guidelines for
Federal Facilities and/or the Healthy Eating Research Nutrition Guidelines for the Charitable
Food System. The action plans will identify the setting of focus as well as specific goals,
objectives, and strategies for each identified setting.

LIMITATIONS
One of the limitations of our study was gaps in data, primarily due to participants not submitting
their contracts and policies as requested. Despite continued efforts to request these documents,
some facilities did not provide the necessary policies and information, resulting in gaps in our
data. Another limitation was the responsiveness and engagement of our participants throughout
the study. Despite engagement attempts some facilities only participated in the listening session,
yet not the survey, or did not respond at all. While we reached out to a diverse range of
stakeholders in Baldwin County, Georgia, including food pantries, hospitals, jails, prisons,
private worksites, colleges and universities, not all recruited facilities chose to participate in the
study. We initially reached out to forty institutions, and then recruited twenty-five facilities for
participation and had sixteen completed surveys, for a non-response rate of 36%.
FIGURES
Fig. 11 What is the process for adopting food service guidelines,
nutrition standards and or changing current purchasing practices
within your agency?
WORKS CITED
Abrahams-Gessel, S., Wilde, P., Zhang, F. F., Lizewski, L., Sy, S., Liu, J., Ruan, M., Lee, Y.,
Mozaffarian, D., Micha, R., & Gaziano, T. (2022). Implementing federal food service guidelines
in federal and private worksite cafeterias in the United States leads to improved health outcomes
and is cost saving. Journal of Public Health Policy, 43(2), 266–280.
https://doi.org/10.1057/s41271-022-00344-y

CDC. (2022, February 7). Healthier Food. Centers for Disease Control and Prevention.
https://www.cdc.gov/nutrition/food-service-guidelines/index.html

Fandetti, S. M., Dahl, A. A., Webster, C., Morium Barakat Bably, Coffman, M. J., & Racine, E.
F. (2023). Healthy Food Policies Documented in University Food Service
Contracts. International Journal of Environmental Research and Public Health, 20(16), 6617–
6617. https://doi.org/10.3390/ijerph20166617

Food Service Guidelines Federal Workgroup. Food Service Guidelines for Federal Facilities.
Washington, DC: U.S. Department of Health and Human Services; 2017.

Kimmons, J., Wood, M., Villarante, J. C., & Lederer, A. (2012). Adopting Healthy and
Sustainable Food Service Guidelines: Emerging Evidence From Implementation at the United
States Federal Government, New York City, Los Angeles County, and Kaiser
Permanente. Advances in Nutrition, 3(5), 746–748. https://doi.org/10.3945/an.112.002642

Levi, R., Schwartz, M., Campbell, E., Martin, K., & Seligman, H. (2022). Nutrition standards for
the charitable food system: challenges and opportunities. BMC Public Health, 22(1).
https://doi.org/10.1186/s12889-022-12906-6

Lowry-Warnock, A., Strombom, N., Mugavero, K., Harris, D., Blanck, H. M., & Onufrak, S.
(2022). Advancing Healthy Food Service in the United States: State Food Service Guidelines
Policy Adoption and Implementation Supports, 2015-2019. American Journal of Health
Promotion, 37(3), 300–312. https://doi.org/10.1177/08901171221123311
APPENDIX A: FSG STRATEGY LOGIC MODEL

APPENDIX B: INVITATION EMAIL

This email was sent to invitees inviting them to the informational meeting/listening session and
to participate in the study.

Good Afternoon,

My name is Emma Vann and I intern for Georgia College’s Center for Health and Social
Issues. Here at the Center, we have partnered with the Department of Public Health North Central
Health District and CDC in the Supporting Health Initiatives and Nurturing Equity (SHINE) Program.
Through this program, we are working to identify and improve the current food service guidelines
here in Milledgeville. We have identified you as a stakeholder in this and would love for you to
attend our informational stakeholder meeting on Tuesday, January 30th, at 8:30 AM at the County
Government Building located at 1601 N. Columbia Street, Milledgeville, GA. Breakfast will be
provided as we learn more about what food service guidelines are and more!

We do request that you RSVP by Friday, January 26th. Please RSVP

to emma.vann@bobcats.gcsu.edu or 478-445-1432. If you have any questions before our
meeting, please reach out!

Thank you, and I look forward to seeing you at 8:30AM Tuesday, January 30th!

Thanks,
Emma Vann
APPENDIX C: SURVEY
Vending machines: automated currency-operated facility dispensing a variety of food and refreshment items.
There is not an on-site manager, and the vendor does not provide customers with eating accommodations.
Concession stands, snack bars, and/or carts: facilities engaged in selling limited lines of refreshment and prepared
food items necessary for a light meal service, such as soups, salads, and sandwiches. Food and refreshment items
may be prepared on or off the premises and usually are wrapped or placed in containers at point of sale. There is an
on-site manager, and customers may or may not be provided with eating accommodations.
Meals served to institutionalized populations: meals served to people residing in jails, prisons, probation
camps/juvenile halls, nursing homes, or other facilities such as psychiatric hospitals. Patrons are limited to
what’s provided to them.
Distributive meal programs: meals distributed to seniors or children such as after-school snack programs and
senior congregate and home-delivered meals.
Patient meals: served to patients in the hospital or long-term care settings such as nursing homes.

Agency Background Information

This section of the tool may be used to capture background information about your agency. Please fill out the contact and
agency information sections in the space provided below if you are completing this tool for your agency or are working
with other partners.

1. Contact information (Complete in the space provided.)

Survey completed by (name):
Job title:
Telephone number:
E-mail address:

2. Agency information (Complete in the space provided.)

Agency name:
Agency facility:
Number of employees:
Mailing address:
Agency contact person (for future communication):
Job title:
Telephone number:
E-mail address:

3. Does your agency serve or sell food in cafeterias, vending machines, concession stands/
snack bars, distributive meal programs, meals served to institutionalized populations,
or hospital patient meals? (Select one answer)
Yes No Don’t know

Please STOP if your answer to Question 3 is “No.” Thank you for your willingness to participate!
You do not need to complete the rest of this survey.

2
4. Which types of health promotion strategies does your agency engage in?
(Check all that apply)
Nutrition policies to increase the availability of healthier foods
Health education (e.g., skills development and behavior change classes, awareness-building brochures, posters)
Links to related employee services (e.g., referral to employee assistance programs)
Integration of health promotion into your agency’s culture (e.g., health promotion being part of mission statement)
Employee screenings with adequate treatment and follow-up (e.g., health risk assessments, biometric screenings)
Other (please specify):
None

Setting and Food Service Venues

This section of the tool may be used to capture information about the food service venues in your agency.

1. Your agency’s setting (Check all that apply)

Work site
Prison, probation camp, or juvenile hall
Assisted living/nursing home community
Park and recreational facility (e.g., baseball field, golf course, beach)
Distributive meal program (e.g., senior meals or after-school snack programs)
Hospital patient meal service
Community agency
Other (please specify):

2. Which food service venue(s) does your agency use to sell or serve food? (Check all that apply)
Sold at:
Cafeterias / cafés
Vending machines
Concession stands, snack bars, and/or carts
Other (please specify):
Served at:
Distributive meal program (e.g., senior meals, after-school snacks)
Meals served to institutionalized populations (e.g., prisons, probation camps/juvenile halls)
Hospital patient meals
Other (please specify):

3
3. For each food service venue, please provide the following information: (Complete all that apply)
Number Total Number of Meals and Snacks
Food Service Venues of (Please provide the quantity sold or served in
Venues a given time period.)

Cafeterias / cafés Total Number: per Day Week Month

Vending machines Total Number: per Day Week Month

Concession stands, snack bars, and/or carts Total Number: per Day Week Month

Distributive meal program Total Number: per Day Week Month

Meals served to institutionalized populations Total Number: per Day Week Month

Hospital patient meals Total Number: per Day Week Month

Other (please specify):

Total Number: per Day Week Month

4. Which of the following meals or food does your agency serve or sell on a daily basis?
(Check all that apply)

Other
Food Service Venues Breakfast Lunch Dinner Snacks Beverages Catering
(Please Specify)

Cafeterias / cafés

Concession stands,
snack bars, and/or carts

Distributive meal program

Meals served to
institutionalized populations

Hospital patient meals

Other (please specify):

4
Nutrition Policies, Standards, and Practices in Place
This section of the tool may be used to capture information about the nutrition policies, standards, and practices in place
within your agency.

1. Does your agency currently follow any food service guidelines/nutrition standards?
(Select one answer)
Yes
No If no, skip to question 9.
Don’t know

2. Are the guidelines/standards mandatory or voluntary?

Mandatory
Voluntary
Don’t know

3. What is your agency’s rationale for using food service guidelines/nutrition

standards? (Check all that apply)
Prevention of obesity and chronic diseases (diabetes, etc.)
Economic benefits for local farms and companies
Improve employee health and wellness
Model healthy and sustainable practices for other agencies
Align with agency mission
Other (please specify):

4. Which topics do your food service guidelines/nutrition standards address?

(Check all that apply)
Water Promote/offer fruits and vegetables
Calories Calorie information through labeling
Sugar Healthier food and beverage choices with signs and symbols
Saturated fat Product placement to encourage healthier options
Trans fat Pricing incentives that promote healthier food and beverages
Sodium Percentage or number of healthy food and beverage choices available
Reduced-size portions/choices Other (please specify):
Fried foods
Dairy
Beverages

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5. What sustainability standards are addressed in your food service guidelines
or nutrition standards? (Check all that apply)
Participate in waste reduction, recycling, and composting programs
Promote and incentivize reusable beverages containers
Use green cleaning and pest-control practices
Use compostable and bio-based trays, flatware, plates, and bowls
Offer food that is organically, locally, or sustainably grown and labeled accordingly
Offer certified sustainable, shade-grown, or bird-friendly coffee and tea
Offer free drinking water
Other (please specify):
None

6. Does your agency include these food service guidelines/nutrition standards in a policy,
permit, contract, or similar agreement increasing access to healthier food and beverage
choices? (Select one answer)
Yes No Don’t know

7. If yes, what type of food service venues does the policy, permit, contract, or
agreement target? (Check all that apply)
Other
Food Service Venues Policy Permit Contract
(Please Specify)

Cafeterias

Vending machines

Concession stands, snack bars, and/or carts

Distributive meal program

Meals served to institutionalized populations

Hospital patient meals

Other

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8. Does your agency have food services operated by the Randolph-Sheppard Vending
Facility Program authorized by the Randolph-Sheppard Act? (Select one answer)
Yes No Don’t know

9. Does your agency have food service guidelines/nutrition standards that make
healthier food and beverage choices available during meetings and conferences
where food is offered? (Select one answer)
Yes No Don’t know

Authority
This section of the tool may be used to capture information about who in your agency has authority to make changes
related to foods sold or served in the agency.

1. What authority currently or potentially could set or determine the food service
guidelines/nutrition standards for this agency? (Check all that apply)
Federal, state, or local government
Contracting or procurement officer
Organizational policy
Other (please specify):

2. What is the process for adopting food service guidelines/nutrition standards and/or
changing current purchasing practices within your agency? (Answer in the space provided below)

3. Whose approval is needed to set or change food service guidelines/nutrition standards?

(Answer in the space provided below)

4. If your agency has adopted food service guidelines/nutrition standards does your
agency monitor compliance of these guidelines? (Select one answer)
Yes No Don’t know

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5. If yes, how do you monitor compliance with the food service guidelines/nutrition
standards? Is there a designated person or agency that is responsible for monitoring?
(Answer in the space provided below)

Contracting Process
This section of the tool may be used to capture information about the contracting process related to food service within
your agency. Complete this section if you currently have food service related contracts/permits.

1. How does your agency make food service agreements? (Check all that apply)
Contract Other (specify):
Permit

2. Please indicate the date when each food service agreement at your agency will
be renewed:
Please include length of contracts (i.e., 1 year, 10 years, etc.).
Cafeterias / cafés
Vending machines
Concession stands, snack bars, and/or carts
Distributive meal program
Meals served to institutionalized populations
Hospital patient meals
Other (please specify)

3. Are any of the following options available in your agency for current contracts before
their expiration? (Check all that apply)
Current contract(s) can be amended to include food service guidelines
Contractor(s) can/will voluntarily use food service guidelines
No change possible
Other (please specify):

4. Do your agency’s contracts contain specific language on food service guidelines/

nutrition standards? (Select one answer)
Yes No Don’t know

5. Does your agency include sales reporting of food items in your contracts?
(Select one answer)
Yes No Don’t know

8
Environment and Capacity
This section of the tool may be used to capture information about the environment and capacity surrounding food service
venues in your agency.

1. Which challenges does your agency face regarding the development of or compliance
with food service guidelines/nutrition standards? (Check all that apply)
Lack of dedicated food service staff involved in operational processes, such as food preparation
Lack of trained staff
Lack of funding support or concerns about cost implications
Lack of food and nutrition expertise
Lack of kitchen equipment conducive to healthier food preparation
Contract/permits obligations that are hard to change
Customer dissatisfaction with changes
Lack of consumer demand for healthier food products
Lack of dedicated leadership staff involved in operational processes, such as supervising food preparation
Lack of work site wellness programs
Negative effect on profits earned
Other (please specify):

2. What information would be helpful to your agency in using food service guidelines/
nutrition standards? (Check all that apply)
How to market and promote healthier items
Contract/permit assistance
Case examples
Website dedicated to food service guidelines and resources
Training for food service staff on food service guidelines
Other (please specify):

9
APPENDIX D: INFORMED CONSENT FORM
INFORMED CONSENT

Food Service and Nutrition Guidelines in Georgia

You are being invited to participate in a research study about food service guidelines here in
Baldwin County This study is being conducted by Dr. Damian Francis and Emma Vann which
can be contacted at 478-445-1432 or at emma.vann@bobcats.gcsu.edu at Georgia College.

The questionnaire(s) will take about 25 to complete.

This survey is anonymous. We will remove all identifiable information from the data for data
analysis and reporting to maintain confidentiality and privacy of the institutions. The data will
only be collected by the study facilitators and will be kept away from the public and will be
stored in a secure location to protect the participants identities. No one will be able to identify
you or your answers, and no one will know whether or not you participated in the study.

This project will be assessing food service guidelines at institutions in which food is
sold/served/distributed here within Baldwin County excluding public schools, restaurants, and
grocery stores. This assessment will inform our understanding of current practices related to food
safety, behavioral design and energy/waste efficiency in institutions that serve, sold and or
distribute foods. This data will contribute to addressing nutrition, chronic diseases, and food
service and nutrition guidelines challenges in Georgia.
This research project is being conducted because of its potential benefits, either to individuals or
to humans in general. The expected benefits of this study include: improved food service
guidelines and nutrition standards, improved access to healthier foods, and improved health
behaviors and outcomes.

You are not likely to experience physical, psychological, social, or legal risks beyond those
ordinarily encountered in daily life or during the performance of routine examinations or tests by
participating in this study.

Your participation in this study is voluntary and you can revoke it at any time. By continuing
with this survey and clicking “I agree” to having completed the Inform Consent form you are
voluntarily agreeing to participate and you are acknowledging that you are 18 years of age or
older. You are free to stop answering questions at any time or to decline to answer any particular
question you do not wish to answer for any reason. If you are younger than 18, do not proceed.

*Research at Georgia College involving human participants is carried out under the oversight of
the Institutional Review Board. Address questions or problems regarding these activities to the
GC IRB Chair, email: irb@gcsu.edu.*