Online application

Part I - Company / Restaurant profile

Name of company / restaurant *
Company / restaurant website
Total number of employees *
Number of smoking employees (if known)

Contact information

Contact person *
Title *
Telephone *
Fax
Email *
Address *


Part II - Encourage employees to quit smoking and promote smoke-free culture

  1. Does your company/ restaurant provide information to employees on hazards of smoking and smoking cessation?*

  2. Does your company/ restaurant implement any measures to encourage the employees to quit smoking?*

  3. Does your company/ restaurant promote the importance of smoke-free culture and lifestyle to the general public? *

  4. Does your company / restaurant implement smoke-free policy in outdoor seating areas?*

  5. Did any of your employees quit smoking successfully?*

    Number of successful quitters*
    Quitters' history of smoking*
    years
    Sharing of quitters
  6. Please introduce the concept and implementation schedule of the smoke-free policy of your company / restaurant.


Part III - Supplementary Information

Please provide other supplementary information about your company/restaurant's support and promotion of smoke-free culture in the space below



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Part Ⅳ - Declaration

  • I hereby declare that the information provided is true and correct to the best of my knowledge.
  • I understand that the Organizer will conduct observational visit or request our company/ restaurant to provide further information if necessary.
  • I agree that the Organizer can use the information provided in this form for the purpose of promotion and publicity of this programme.
  • I agree to abide by the terms and conditions that are set out in the "Smoke-free Catering Force" Programme.
  • I agree that all decisions made by the Organizer are final and binding.

*Mandatory