Each vending operator/supplier ("Operator") will complete this Self Report in August 2009
and annually therafter as directed by Interior Health's Purchasing Department.
The Operator is considered to be the organizational group that fills the machines with
The Operator will complete a separate Self Report for each "vending location". They may
submit multiple Self Reports.
4 A "vending location" is defined as any single standing machine, or any bank of machines.
5 A facility/site might have more than one vending location.
6 A facility/site might have more than one vending operator/suppliers.
The Operator might serve more than one location in any one facility/site. All of the
Operator's Self Reports for a single facility/site must be submitted together.
The Operator might serve more than one facility/site. The Operator may choose to submit
all Self Reports for all facilities/sites together.
Operators are to submit Aug 2009 Self Reports by the 31st to
9 email@example.com AND firstname.lastname@example.org . Operators may
copy these reports to other Interior Health staff if desired (eg. Site Administrators).
Assistance in completing Self Reports can be found at: Dial-A-Dietitian 1-800-667-3438 for
10 Scorecard/Brand Name Food List website assistance; OR Cathy Richards 250-980-5049
for Self-Report excel chart assistance.
Failure to submit all appropriate Self Reports may result in temporaray or permanent
termination of vending operations.
Detailed Instructions for completing a Self-Report can be found on the Template included
in this excel workbook.
The number of times an item is to be counted is not the same as a machine inventory or
sales inventory. Count an item only once for each time a vending button/visual slot is
Note: related to it. For example, a machine with 10 button selections would have 10 items
counted (including those that are 'sold out'), even though there might be 70 items in the
stock of the machine.
Vending: Self-Report Form -- Hot Beverage Vending
This excel chart completes your self-report on your vending machine location
(machine or bank of machines). Type ONLY in WHITE cells.
Results #DIV/0! #DIV/0! #DIV/0! #DIV/0! 2009, , ,
City/Community Step 1: Save this blank form as "vending self-report template". Now resave it with a personalized
IH Facility Name name, eg. "YYYY Site Location # machines". Fill in cells C4 to C19 (location, etc).
Product Provided By Step 2: Use www.brandnamefoodlist.ca website's "Scorecard" function to list as many of the
machine's contents as possible. eg. brand name hot chocolate, brand name broth. Note: very few hot
Machine Filled By beverage items are on the website. You may choose to skip this step and go directly to Step 3.
Location within facility 2a) If all items in the machine could be found on the brandnamefoodlist website, fill in cells F38-I38
# of machines at this location (final numbers from your website scorecard), & go directly to Steps 5 & 6.
Machine #1: Type 2b) If some items were not on the website, keep track of these & proceed through Steps 3-6.
Machine #2: Type Step 3: See instructions below. (You will need a Registered Dietitian to double check the Choose Rating. Dial-
A-Dietitian can help you with a few items 1-800-667-3438. They may recommend a Private Practise RD if you have a
DD/MM/YY long list of unrated products.)
Self Report Submitted By Step 4: See instructions below. Step 5: Advertising Question. Step 6: If Goals not met, revise vending
(your name) items &/or advertising and record actions taken. Step 7: ReSave the completed self report.
Phone Number x-xxx-xxx-xxxx Step 8: E-mail or print and mail the Self Report to email@example.com AND
firstname.lastname@example.org . Be sure to include the Scorecard you created for this location using
From Company/Department the brand name food list website.
Step 3: Unlisted Products: a) List here the products in your hot beverage machine that are not on the Scorecard that you created in Step 2 using the
brandnamefoodlist. b) Enter a number* in the column for the appropriate Choose Rating as assessed by a Registered Dietitian (*enter 1 if the product
appears once, 2 if the product appears twice, etc). c) For condiments, enter "0" in the NR and CL columns if the condiment does not exceed the
fat/trans/sugar/salt limits described at http://www.bced.gov.bc.ca/health/criteria_charts.pdf. Enter "1" in the NR column if it exceeds any of those limits. d)
Record the Dietitian's name and registration number.
RD's Current CDBC Registration Number
Registered Dietitian's Name: (http://www.collegeofdietitiansbc.org/ public register):
Manufacturer Product Name Flavour Size Not Choose
Choose Least Choose Most
eg. Café Lux Coffee Black 175 mL 1
eg. Café Lux condiment: sugar white 0-8 mL 0 0
eg. Café Lux condiment: whitener hazelnut 0-30 mL 1
TOTALS Do not type in this row. Template will automatically calculate. 0 0 0 0
Step 4: Scorecard Results: List here the "Number of Items" Not Recom- Choose
Choose Least Choose Most
(not the percentages ) for each category shown at the bottom of the mended Sometimes
scorecard if you created one at www.brandnamefoodlist.ca Website Scorecard
(a copy of the Scorecard must accompagny this form for verification ). Results #
Total # Items in
each Choose 0 0 0 0
Do not type in these rows. The template will automatically
calculate and assess your totals and percentages. % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Goal 0% 0% <50% >50%
Goal Met? #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Step 5: Does the hot beverage machine advertise Not Recommended or Choose Least items? no data
Step 6: If Choice or Advertising Goals "Not Met", record actions taken to meet Goals (Since Inventory Taken)
Action Taken All Goals Met? Date MM DD