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Greenopia Questionnaire - Groceries

Welcome to Greenopia! We're thrilled that you are applying to join our network. Please fill in this questionnaire, which has some fairly detailed questions about your products, services and general practices. The questions fall into 3 sections: Healthy for You, Healthy for the Planet and Healthy for the Community. If you qualify we will onboard you onto our system, send you a window decal and include you in our listings. If you do not, our relationship doesn't end here! If you wish to try again we can let you know which areas to focus on based on your responses.

Name of Business

Business Location Address

Website

Email Address

Phone Number

Describe your business in a few sentences

Upload any photos of your business that you would like to feature

Upload your logo here

How many locations does your business have?

If your business has more than one location, you can upload them as a file here, or enter them by text in the box below

Please enter additional business locations by text here if you prefer

Is your business a certified B Corp?

Do you have delivery/service vehicles that operate on Alternative Fuels (Biofuels), hybrid, or electric engines?

What percentage of your waste does your business recycle?

Less than 25%
25%
50%
75%
At least 90%

Are you a part of sustainability association/program in your city, e.g. by the government or an NGO?

What other sustainability associations/programs are you a part of?

Are all or most of your cleaning products environment-friendly (e.g. biodegradable, non-toxic, green production)?

Does your business utilize Low Flow Water fixtures?

Does a significant portion of your power (>20%) come from Renewable Resources such as wind, geothermal, small hydro, biomass, or solar?

Are most of your appliances Energy Star certified?

What percentage of your household cleaning tools (mops, sponges, etc) are made from environmentally friendly materials?

Less than 25%
25%
50%
75%
At least 90%
n/a

What percentage of your personal care tools (hairbrushes, toothbrushes, etc) are made with environmentally friendly materials?

Less than 25%
25%
50%
75%
At least 90%
n/a

What percentage of your household paper products (paper towls, toilet paper, etc) are made from recycled content and whitened without chlorine?

Less than 25%
25%
50%
75%
At least 90%
n/a

If applicable, briefly describe your building's green design or construction (10 words max):

Does your business have any accredited certifications related to health?

If so, what are they?

For each of the following food & product types that you might serve in your establishment, please estimate what percentage is certified organic, natural or biodynamic (if you don't offer that these options, select n/a):
	Less than 25%	25%	50%	75%	At least 90%	n/a
Produce
Meat & Poultry
Seafood
Eggs
Dairy Products
Canned & Dry Goods
Non-Dairy Beverages
Prepared Foods
Personal Care Products

In your business, approximately what percentage of the jobs created offer regular, predictable hours?

None
25%
50%
75%
All

In your business, approximately what percentage of the jobs created offer paid vacation, sick and leave time?

None
25%
50%
75%
All

Do you have any specific project designed with or targeted to benefit under-represented groups or communities?

In your business, approximately what percentage of the jobs created offer a payment above the minimum-wage of your State?

None
25%
50%
75%
All

Do you take steps in ensuring fair hiring practices?

Does your business give back by supporting any charitable or nonprofit causes, financially or in other ways?

Does your business have disability access?

In due course, Greenopia will offer a marketing package for $10 per month, allowing you to offer incentives and promotions to our users. Would you be interested in this service?

Check this box to confirm you have read and agree to Greenopia's terms and conditions..