The Summer Food Service Program

Food That's In When School is Out!

2009 Monitor's Guide

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United States Department of Agriculture

Food and Nutrition Service

> "In accordance with Federal law and U.S. Department of Agriculture
> policy, this institution is prohibited from discriminating on the
> basis of race, color, national origin, sex, age, or disability."
>
> To file a complaint of discrimination, write USDA, Director, Office of
> Civil Rights, 1400 Independence Avenue, SW, Washington, D.C.
> 20250-9410 or call, toll free (866) 632-9992 (Voice). TDD users can
> contact USDA through local relay or the Federal Relay at (800)
> 877-8339 (TDD) or (866)377-8642 (relay voice users). USDA is an equal
> opportunity provider and employer.

Revised December 2008

**CONTENTS**

**Introduction** 1

Organizational Structure 1

Training 2

**Monitor Responsibilities** 3

Visits and Reviews 4

Review Procedures 5

Conducting the Review 5

Before the Meal Service Begins 5

Observe Meal Preparation 6

Observe the Meal Service 6

Civil Rights 7

Claiming Meals 7

Before You Leave the Site 8

Monitor Site Review Form 8

**Additional Responsibilities** 9

Beneficiary Data Form 9

Potential Meal Service Problems 9

Site Activities 9

**Records** 11

Daily Meal Count Records 11

Daily Record Reviews 11

Accuracy of Records 12

Collection of Site Forms 12

**Meal Pattern Requirements** 13

Monitoring Meals 13

Reimbursable Meals 13

Summer Food Service Program Meal Patterns 14

Delivery of Meals 15

When Meals are Served 15

Unitized Meals 15

Meal Pattern Exceptions 15

Keep These Food Safety Rules in Mind 16

**Questions and Answers** 18

**Sample Forms**

Pre-Operational Visit Form 20

First Week Visit Form 21

Site Review Form 22

Racial/Ethnic Data Form 25

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**Introduction**

> In this book, you will find information on:

-   how the Summer Food Service Program (SFSP) is organized;

-   your responsibilities as a monitor;

-   the records that you are required to complete and instructions on
    how to fill them out;

-   the meal pattern requirements for meals being served; and

-   samples of the forms you'll need.

This guidance is designed to give you, as a monitor, a working knowledge
of the SFSP, and your duties and responsibilities as the sponsor\'s
representative.

The SFSP provides nutritious meals to children during vacation periods
that are similar to those offered under the National School Lunch and
School Breakfast Programs during the school year. Meals are provided to
children 18 years of age or under, and to individuals over 18 who have
been determined by the State to be mentally or physically disabled and
who participate in a public or nonprofit school program established for
the disabled. Meals are served at open, restricted open, or closed
enrolled sites in areas where poor economic conditions exist. Meals also
may be served at migrant feeding sites, National Youth Sports Program
(NYSP) sites, and residential and nonresidential camps.

**Organizational** SFSP sites are operated by public or private
nonprofit sponsors\--

**Structure** school food authorities, colleges and universities, or
residential summer camps; by units of local, municipal, county, State,
or Federal government; and by private nonprofit organizations that meet
certain legislated and regulatory criteria. The SFSP is administered
within each State by the State education agency, or by an alternate
State agency, or the appropriate Regional Office of the U.S. Department
of Agriculture\'s Food and Nutrition Service (FNS).

Your role as an SFSP monitor is of particular importance. As the key
link between the sponsor and the site personnel, you must make sure that
the sites operate smoothly in accordance with program guidance and
requirements. This direct link between the sponsor\'s office and the
food service sites is essential to ensure that the program functions
properly. As the sponsor\'s representative, you must develop and
maintain open communications and cooperative relationships with site
supervisors and staff. You also should make everyone aware that you will
work with the site staff to help correct any problems and give
additional training as necessary.

Open communication with your supervisor also is essential so that the
sponsor is aware of any site problems and what is being done to resolve
them. This also will provide opportunities for the sponsor to provide
you with any additional guidance you may need.

The sponsor is financially responsible for any meals served incorrectly
or served to ineligible people. This could mean a substantial loss of
money to the sponsor if problems at the sites are not corrected. Your
responsibilities as a monitor will differ depending on whether meals are
prepared on site or delivered to the site(s) by the sponsor or a food
service management company (or vendor). This guidance covers monitoring
of both types of operations: where the vendor delivers meals to the
sponsor\'s sites and where sponsors prepare their own meals.

**Training** Your sponsor is required to hold training sessions on
program duties for monitors and other sponsor personnel. At the training
session, the sponsor will do the following:

-   explain monitor duties and responsibilities;

-   distribute monitor review forms and any other records you may need
    to keep, such as mileage records;

-   train on procedures for monitoring meal counts, adjusting meal
    preparation or deliveries, reporting complaints to the vendor, and
    collecting site records; and,

-   ![](media/image4.jpeg){width="1.75in"
    height="2.4506944444444443in"}assign the sites for which you will be
    responsible (the sponsor may chose to do it at the training or at
    some point before you begin your duties).

You also may be asked to attend the training session required for site
supervisors. This meeting will familiarize you with the specific duties
of site supervisors and allow you to meet the site supervisors with whom
you will be working directly.

Many people working at sites may not be familiar with operating food
service programs or they may not be accustomed to maintaining records.
During your many reviews and visits, you will find it necessary to
explain the importance of complying with program rules and show how
operations can be improved. This type of ongoing training of site
personnel is a basic responsibility of each monitor. You may decide that
it is necessary to give new site workers additional training in program
requirements. It is important to document this training in your report.

**Monitor Responsibilities**

Effective monitoring is necessary for many reasons. Monitoring ensures
that sites operate according to program guidelines and that accurate
site records are available to justify payment to the sponsor. But most
important, monitoring ensures that children in the community are getting
nutritious meals. To be an effective monitor, you will be required to
spend enough time at each assigned site to check all pertinent
operations. Therefore, you must know the program requirements so you can
spot problems at the sites quickly and recommend solutions.

As an official representative of the sponsor, you will be responsible
for:

-   checking site operations to make sure that the sites maintain
    adequate records and that the program is operating in accordance
    with the requirements;

-   conducting site training as necessary, including training on the
    nondiscrimination policy;

-   conducting pre-operational visits for new and problem sites;

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-   visiting all assigned sites within the first week of operation to
    ensure that the food service is operating smoothly and that any
    needed adjustments are made or problems resolved;

-   reviewing food service operations of all assigned sites within the
    first 4 weeks of operation to thoroughly examine the meal service
    from start to finish, correcting problems and providing additional
    training where necessary;

-   revisiting sites as necessary;

-   reconciling any discrepancies in meal counts and records with the
    site supervisor;

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-   suggesting corrective action to the site supervisor for problems
    encountered;

-   preparing reports of your site visits and reviews and ensuring that
    copies of the reports are included in an official file for each
    site; and

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-   informing the sponsor about problems found at a site and ensuring
    that corrective action is completed and documented.

**Visits and Reviews** When monitors observe program operations at
sites, they will usually make either a "visit" or a "review." A site
"visit" requires a monitor to ensure that the food service is operating
smoothly and that any apparent problems are immediately resolved. A site
"review" requires the monitor to determine if the site is meeting
**all** the various program requirements. To accomplish this, a monitor
will have to observe a complete meal service from beginning to end. All
visits and reviews must be conducted and documented. Sample
Pre-Operational, First Week Site Visit, and Site Review Forms may be
found at the end of this manual.

The type of visits and reviews required are:

1.  **Pre-operational Visits:** Pre-operational visits are conducted for
    new and problem sites before a site operates the summer program.
    These visits are required to determine that the sites have the
    facilities to provide meal service for the anticipated number of
    children in attendance and the capability to conduct the proposed
    meal service.

2.  **Site Visits:** All sites must be visited at least once during the
    first week of operation. These visits are required to make sure the
    food service operation is running smoothly and to verify information
    such as the site address, storage, holding and preparation
    facilities, and serving capacity.

3.  **Site Reviews:** All sites must be reviewed at least once during
    the first four weeks of program operations. If a site operates less
    than four weeks, the sponsor must still conduct a review. You will
    have to observe delivery or preparation of meals, service of meals,
    children eating the meals, and clean up after meals. During each
    review you should discuss any concerns or problems with the site
    supervisor and other site staff. You also should instruct the site
    supervisor to call the sponsor\'s office immediately when help is
    needed and you are not there.

**Review Procedures** Before reviewing the sites, you should be familiar
with the site

> information sheets that your sponsor will give you. These sheets
> include the meal delivery schedules (time of delivery, type(s) of
> meal(s), and number of meals), and menus for each site. The site
> information sheets describe the staffing pattern, method of meal
> preparation, meal services and times, and, if applicable, the approved
> level of meal service at the sites.
>
> Sponsors of most sites may be approved to serve up to two meals daily.
> There are several allowable meal combinations such as breakfast and
> lunch, breakfast and supper, breakfast and snack, or lunch and snack.
> Please check with your sponsor for other allowable meals. This does
> not apply to sites where meals are served primarily to children of
> migrants or to residential camps. These sponsors may be approved to
> serve up to three meals or two meals and one snack with State agency
> approval.

As the summer progresses, you should be familiar with the records
submitted by each site and any corrective action taken on any prior
reviews or visits.

**Conducting Before the Meal Service Begins**

**the Review**

-   Plan to arrive at the site before food is delivered or meals are
    prepared.

-   Check to make sure that the assigned site supervisor or at least one
    alternate supervisory person who has been trained in program
    requirements is onsite. This person must be present during the meal
    service.

-   Observe food delivery or meal preparation. Are meals handled
    according to local health codes? For example, does the refrigerated
    truck operate at the correct temperature? Are meals delivered on
    time? If the sponsor prepares the meals, are the facility and
    equipment adequate for the number of meals needed?

-   For sites with delivered meals, observe if the site supervisor is
    counting the number of meals delivered. Does the number delivered
    equal the number ordered? Does the delivery receipt show what meal
    is being delivered and the delivery date and time?

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-   Observe whether the site supervisor signs only for delivered meals
    that are complete and wholesome and does not accept poor or
    incomplete meals or meals that are wholly or partially spoiled.

-   Compare the number of meals delivered or prepared onsite with the
    daily participation records; observe trends and, when appropriate,
    advise the sponsor and site supervisor to adjust the meal order to
    prevent excessive leftovers or excessive service of second meals.

-   Make sure the site supervisor signs only *accurate* delivery
    receipts, making corrections as necessary on the slip before signing
    or refusing to sign if an entire delivery is rejected.

**Observe Meal Preparation**

-   Compare a meal delivered or prepared with the menu. Was the
    scheduled meal delivered or prepared that day?

-   Observe the preparation of a meal if meals are not delivered. (Are
    the portion sizes correct? Were all components included?)

-   Observe whether workers meet the health standards set by State and
    local authorities. Check to see if any problems found by health
    officials have been corrected. (Are raw fruits and vegetables
    thoroughly washed before cooking and serving? Are hot and cold foods
    kept at the proper temperatures?)

**Observe the Meal Service**

-   ![](media/image5.jpeg){width="1.5in" height="2.375in"}Observe the
    *entire* meal service from delivery/preparing meals to clean up
    after the meal service. Does the meal service occur within the
    approved time frame?

-   Are children served complete meals?

-   Is only one meal served to each child?

-   Are unauthorized adults served?

-   Are all meals eaten at the site? Do the State agency and the sponsor
    allow a piece of fruit or vegetable to be taken off-site? If so, is
    the site supervisor able to manage this optional policy adequately?

-   Is a site worker counting the meals as they are being served?

-   Check plate waste (trash) for acceptability of menu items.

-   Check to see that trash is being removed from the site on a regular
    basis. Are garbage bags and cans closed securely?

-   Does the site comply with sponsor and local health department
    procedures for handling and storing extra food?

**Civil Rights**

-   Check to see if the site\'s nondiscrimination poster is displayed in
    a prominent place. If not, the sponsor should provide the site
    supervisor with the poster.

-   Determine if meals are served to all attending children, regardless
    of the child\'s race, color, national origin, sex, age, or
    disability.

-   Make sure that all children have equal access to services and
    facilities at the site regardless of race, color, national origin,
    sex, age, or disability.

-   Observe whether or not informational material in the appropriate
    translations is available concerning the availability and
    nutritional benefits of the program.

**Claiming Meals**

-   Count the number of first meals served to children.

-   Count the number of second meals (if any) served to children. When
    seconds are served, check to make sure that they are only served
    after all children present have received their first meal. Determine
    if the number of seconds being served appears excessive. Remember
    that all reimbursable meals must be complete meals.

-   Count the number of ineligible meals served and note the reason. For
    example, incomplete meals served or meals served to adults.

-   If your sponsor is a school food authority, the sites you monitor
    may use "offer versus serve" (OVS). This means that participants may
    choose not to take one or more items that are offered. At these
    sites, a complete meal would be a meal that meets the OVS rules
    established by your State agency and sponsor. Check with your
    sponsor to make sure you understand the OVS rules.

-   Do your counts and the site supervisor\'s counts match?

-   Some sites you review may have been approved to serve a maximum
    level of meals at each meal service. Check with your sponsor to make
    sure that sites with such approval do not claim meals in excess of
    the maximum number approved for each meal service.

-   Review daily records kept by the site supervisor. Determine whether
    they are complete and accurate records.

-   Check records to see if the same number of meals has been claimed
    for three or more days, and if this number is inconsistent with the
    number of meals served the day of the review.

-   If meals were served outside the approved time frame, were they
    disallowed?

-   Are there many leftover meals? Are seconds recorded? If adjustments
    are not being made, instruct the site supervisor to make adjustments
    in the meal order as necessary.

-   Compare all counts and calculations with the site supervisor\'s
    corresponding records and resolve any discrepancies.

**Before You Leave The Site**

-   Complete the monitor\'s review form. Record your arrival and
    departure times. Record all violations and any corrective action
    taken.

-   Make corrections on site, if possible. Be sure to document all
    corrective action.

-   Report problems to the sponsor.

-   Conduct a revisit, if necessary.

**Monitor Site** You must complete a monitor site review form after each
review. **Review Form** Your sponsor will provide you with these forms.
The form includes

> your arrival and departure times, the site supervisor\'s name,
> certification statement of violations found, corrective action taken,
> and time and number of meals served. These forms are required records
> for the sponsor.

You must thoroughly explain the specific nature and extent of any
problems and the action to be taken to correct these problems. For
example, you would record \"19 meals were served without milk.\" You
then would document the action the site supervisor agreed to take to
correct the situation. For example, agreeing to supply copies of
receipts for a specified period of time indicating that the appropriate
amount of milk had been purchased.

> **Additional Responsibilities**

+-----------------+----------------------------------------------------+
| **Beneficiary** | You must complete a racial/ethnic data form to     |
|                 | report the categories of participating children at |
| **Data Form**   | each site. This form must be completed at least    |
|                 | once during the site\'s operation or once per      |
|                 | session for camps. A sample Racial/Ethnic Data     |
|                 | Form is included on page 27.                       |
+-----------------+----------------------------------------------------+

> You should determine a child\'s racial and ethnic categories visually
> using your best judgment. A child may be included in the racial and
> ethnic categories to which he or she appears to belong, identifies
> with, or is regarded as a member of by the community. Racial AND
> ethnic categories should be identified for each child.

**Potential Meal** Experience has shown that monitoring the food service
at sites is

**Service Problems** necessary to ensure good meal quality. Problems
need to be solved quickly and routinely. As a monitor, you need to
remind site supervisors often of their responsibility to promptly report
changes in participation (up or down) to the sponsor. You also may need
to explain to the site supervisor how to report participation changes.
If a site has a maximum approved level for meals, you should emphasize
that your sponsor will not receive reimbursement for the meals that
exceed the maximum approved level for each meal service.

Sometimes participation at sites drops during the summer and the sponsor
is not notified. When this happens, either too many meals are delivered
or too much food is prepared and both food and money are wasted. The
site supervisor should guard against over-ordering or preparing
excessive meals. *This is a serious violation.* If a site is receiving
or preparing too many meals, you should emphasize to the site supervisor
that the meal order must be adjusted and report that need to your
sponsor. This is especially important since excessive leftovers or
seconds or the number of meals prepared may affect the sponsor\'s claim
(second meals served in excess of two percent of first meals for the
claiming period are not reimbursed). You must follow your sponsor\'s
procedures for transferring or returning excess meals, or stopping the
meal service.

**Site Activities** As the monitor, you are responsible for staying
informed about the plans of each site supervisor. Know the activity
schedule of each assigned site. If the site will not be open on a
certain day, the sponsor must be alerted in advance so meal deliveries
can be cancelled and reviews are not scheduled for that day.

If the site is planning a field trip that will affect the time or
location of meal services, the sponsor must notify the vendor, if
applicable, and should inform the State agency. The State agency also
should be notified of any changes (additions and/or cancellations) to
scheduled field trips. If the State agency is not notified before the
field trip, meals served may be considered "consumed off-site" and not
be reimbursed. Care must be taken to ensure the safety and quality of
the meals by using adequate storage equipment to transport them.

> Sometimes sponsors experience problems because sites cease operations
> earlier than originally scheduled. As the monitor, you should ensure
> your sponsor is promptly notified if the site decides to close earlier
> than the date indicated on the site information sheet.
>
> On-site activities encourage kids to keep coming back and to bring
> along their friends. Therefore, let your sponsor know if you observe
> any activities at sites that could be used to help promote the SFSP
> and increase participation at other sites.

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> **Records**

**Daily Meal Count** Sponsors will provide site supervisors with a
supply of daily

**Records** record forms. This form is very important and must be
completed each day. Sponsors will not receive money for the meals served
at their sites if the sites do not keep this daily record. This record
must be accurate, and site staff must enter the appropriate information
at the end of each meal service. You may be required to collect this
record daily or weekly from each site, and return them to the sponsor\'s
office. A frequent, uniform basis of collection is necessary to minimize
the possibility of losing these records, since sponsors receive
reimbursement for the meals they serve based on this daily record.

This record must include the number of meals delivered or prepared, by
type (breakfast, snack, lunch, supper). Vended programs must support
this information with a signed delivery receipt. Programs with a central
kitchen also should support this information with a signed delivery
receipt for good program management. A designated member of the site
staff must verify the adequacy and number of meals delivered by checking
the meals when they are delivered to the site.

The record also must include the number of:

-   complete first meals served to children, by type;

-   complete second meals served to children, by type;

-   excess meals, or meals left over;

-   non-reimbursable meals; and

-   meals served to program adults, if any; and

-   meals served to non-program adults, if any.

**Daily Record** Review the daily records kept by the site supervisor.
Check to make

**Reviews** sure forms are completed and signed. If meals are not
prepared on site, the information on the delivery receipts should match
the information on the forms. Site supervisors should have a signed
delivery receipt available to show the deliveries for all meals served.
The delivery receipt should at a minimum indicate what meal has been
delivered, the number of meals delivered and the delivery date and time.
If the number of meals delivered is the same as the number served each
day, or the same number of meals is recorded each day, this may mean
that no one is actually counting the number of meals received and
served. Be sure to observe and take appropriate corrective action.

**Accuracy of** Remind site supervisors that complete and accurate daily

**Records** records at the site level are the only way to document
program performance and guarantee the sponsor\'s reimbursement. The sole
basis for reporting the number of meals served is accurate daily
records. These records account for all categories of meals served and
are signed by the site supervisors. Familiarize yourself with the forms
to be used for this purpose since you will be assisting site supervisors
in the proper use of these forms.

**Collection of** If your responsibilities include collecting site forms
and delivery

**Site Forms** receipts, be sure to keep collections on schedule. If
records cannot be obtained from a particular site, this is a *serious*
problem that your sponsor should know about immediately.

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**Meal Pattern Requirements**

As a monitor, you will check meals at sites to see that the meal pattern
requirements are being met. These requirements assure well-balanced,
nutritious meals that supply the kinds and amounts of foods that
children require to meet their nutrient and energy needs. You must make
sure that meals served at your assigned sites meet the meal pattern
requirements listed on the following page.

**Monitoring Meals** Compare the menus of the meals to be served at each
site with the meal pattern requirements and learn to recognize meal
deficiencies. Remember that each meal must contain all required
components and that the served quantity of each component must meet the
minimum portion size. If meals are incomplete, if portions are too
small, or if the food is spoiled, children are not getting a nutritious
meal. Spoiled food, juice, or milk can make the children sick. Make sure
site personnel do not serve any spoiled food to children.

If meals are delivered by a vendor, the site supervisors should record
any deficiencies on the delivery receipts and discuss any problems with
you. You should immediately report any problems with deliveries or meals
to the sponsor so that the vendor can be promptly notified.

**Reimbursable**

**Meals**

+----------------------+-----------------------+-----------------------+
| **For a Meal to be   |                       |                       |
| Reimbursable it Must |                       |                       |
| Contain: \***        |                       |                       |
+----------------------+-----------------------+-----------------------+
| # Breakfast          | # Lunch or Supper     | # Snack               |
+----------------------+-----------------------+-----------------------+
| \- One serving of    | \- One serving of     | \- Must contain two   |
| milk;                | milk;                 |                       |
|                      |                       | food items from       |
| \- One serving of a  | \- Two or more        |                       |
|                      | servings              | different components. |
| vegetable or fruit   |                       |                       |
|                      | of vegetables and/or  | However, juice        |
| or a full-strength   |                       |                       |
|                      | fruits;               | cannot be served      |
| juice; and           |                       |                       |
|                      | \- One serving of     | when milk is          |
| \- One serving of    | grain                 |                       |
| grain or bread.      |                       | served as the only    |
|                      | or bread; and         |                       |
| \- A meat or meat    |                       | other component.      |
|                      | \- One serving of     |                       |
| alternate is         | meat or meat          |                       |
| optional.            | alternate.            |                       |
+----------------------+-----------------------+-----------------------+

> \* At sites where "Offer Versus Serve" is allowed, meals that are
> [offered]{.underline} to participants must meet the meal patterns as
> shown in the chart above.

**Summer Food Service Program Meal Patterns**

+---------------------------+--------------+-------------+-------------+
| **Food Components**       | *            | **Lunch or  | *           |
|                           | *Breakfast** | Supper**    | *Snack^1^** |
|                           |              |             |             |
|                           |              |             | **(Choose   |
|                           |              |             | two**       |
|                           |              |             |             |
|                           |              |             | **of the    |
|                           |              |             | four)**     |
+---------------------------+--------------+-------------+-------------+
| **Milk**                  | 1 cup (8 fl. | 1 cup (8    | 1 cup (8    |
|                           | oz.)^2^      | fl. oz.)^3^ | fl. oz.)^2^ |
| Milk, fluid               |              |             |             |
+---------------------------+--------------+-------------+-------------+
| **Vegetables and/or       | ½ cup        | ¾ cup       | ¾ cup       |
| Fruits**                  |              | total^4^    |             |
|                           | ½ cup (4 fl. |             | ¾ cup (6    |
| Vegetable(s) and/or       | oz.)         |             | fl. oz.)    |
| fruit(s), or              |              |             |             |
|                           |              |             |             |
| Full-strength vegetable   |              |             |             |
| or fruit juice or         |              |             |             |
|                           |              |             |             |
| an equivalent quantity of |              |             |             |
| any combination of        |              |             |             |
|                           |              |             |             |
| vegetables(s), fruit(s),  |              |             |             |
| and juice                 |              |             |             |
+---------------------------+--------------+-------------+-------------+
| **Grains and Breads^5^**  | 1 slice      | 1 slice     | 1 slice     |
|                           |              |             |             |
| Bread, or                 | 1 serving    | 1 serving   | 1 serving   |
|                           |              |             |             |
| Cornbread, biscuits,      | ¾ cup or 1   | ½ cup       | ¾ cup or 1  |
| rolls, muffins, etc., or  | oz.^6^       |             | oz.^6^      |
|                           |              | ½ cup       |             |
| Cold dry cereal, or       | ½ cup        |             | ½ cup       |
|                           |              |             |             |
| Cooked pasta or noodle    | ½ cup        |             | ½ cup       |
| product, or               |              |             |             |
|                           |              |             |             |
| Cooked cereal or cereal   |              |             |             |
| grains or an              |              |             |             |
|                           |              |             |             |
| equivalent quantity of    |              |             |             |
| any combination of        |              |             |             |
|                           |              |             |             |
| grains/breads             |              |             |             |
+---------------------------+--------------+-------------+-------------+
| **Meat and Meat           | (Optional)   | 2 oz.       | 1 oz.       |
| Alternates**              |              |             |             |
|                           | 1 oz.        | 2 oz.       | 1 oz.       |
| Lean meat or poultry or   |              |             |             |
| fish or alternate protein | 1 oz.        | 1 large egg | ½ large egg |
| product,^7^ or            |              |             |             |
|                           | ½ large egg  | ½ cup       | ¼ cup       |
| Cheese, or                |              |             |             |
|                           | ¼ cup        | 4 tbsp.     | 2 tbsp.     |
| Eggs, or                  |              |             |             |
|                           | 2 tbsp.      | 1 oz.=      | 1 oz.       |
| Cooked dry beans or peas, |              | 50%^8^      |             |
| or                        | 1 oz.        |             | 4 oz. or ½  |
|                           |              | 8 oz. or 1  | cup         |
| Peanut butter or soynut   | 4 oz. or ½   | cup         |             |
| butter or other           | cup          |             |             |
|                           |              |             |             |
| nut or seed butters, or   |              |             |             |
|                           |              |             |             |
| Peanuts or soynuts or     |              |             |             |
| tree nuts or seeds, or    |              |             |             |
|                           |              |             |             |
| Yogurt, plain or          |              |             |             |
| sweetened and flavored,   |              |             |             |
| or                        |              |             |             |
|                           |              |             |             |
| An equivalent quantity of |              |             |             |
| any combination           |              |             |             |
|                           |              |             |             |
| of the above meat/meat    |              |             |             |
| alternates                |              |             |             |
+---------------------------+--------------+-------------+-------------+

For the purpose of this table, a cup means a standard measuring cup.

^1^ Serve two food items. Each food item must be from a different food
component. Juice may not be served when milk is served as the only other
component.

^2^ Shall be served as a beverage, or on cereal, or use part of it for
each purpose.

^3^ Shall be served as a beverage.

^4^ Serve two or more kinds of vegetable(s) and or fruit(s) or a
combination of both. Full-strength vegetable or fruit juice may be
counted to meet not more than one-half of this requirement.

^5^All grain/bread items must be enriched or whole grain, made from
enriched or whole-grain meal or flour, or if it is a cereal, the product
must be whole-grain, enriched or fortified. Bran and germ are credited
the same as enriched or whole grain meal or flour.

^6^ Either volume (cup) or weight (oz.) whichever is less.

^7^ Must meet the requirements in Appendix A of the SFSP regulations.

^8^ No more than 50 percent of the requirement shall be met with nuts or
seeds. Nuts or seeds shall be combined with another meat/meat alternate
to fulfill the requirement. When determining combinations, 1 oz. of nuts
or seeds is equal to 1 oz. of cooked lean meat, poultry, or fish.

**Delivery of Meals** Make sure the site supervisor and designated site
personnel know that meals must be delivered within one hour before each
meal service if proper facilities do not exist onsite for storing the
food.

**When Meals** In addition to making sure that meals served meet the
meal pattern

**Are Served** requirements, be aware of time restrictions for the meal
service (except at residential camps). Ensure that:

-   Three hours elapse between the beginning of one approved meal
    service (including snacks) and the beginning of another (Refer to
    *Policy Memo: Flexibility of Time Restrictions on Meal Service,
    dated January 29, 2002,* for reasonable variances from the meal
    service requirements to accommodate unique circumstances).

-   Four hours elapse between lunch and supper when a migrant or day
    camp site serves lunch and supper with no afternoon snack between
    the two meals.

-   Supper begins before 7:00 p.m. (unless the State agency grants a
    waiver) and, in all cases, ends by 8:00 p.m.

-   The serving period for lunch and supper does not exceed two hours.

-   The serving period for breakfast and snacks does not exceed one
    hour.

**Unitized Meals** All meals must be served as complete units. This
means that every component of the meal must be served at the same time
to the child (except at sites where "offer versus serve" or OVS is
allowed. This is discussed in the next paragraph). Sometimes site
workers might want to split up a meal between several children or serve
an incomplete meal to a child. Except where OVS is allowed, the complete
meal **must** be served to each child as a unit. The nutritional value
of the meal depends on each child receiving all the components. *Serving
incomplete meals or serving components separately are serious
violations*. Your sponsor cannot receive reimbursement for incomplete
meals served to children.

**Meal Pattern** In some cases, sponsors may be approved to serve meals
that meet

**Exceptions** the meal pattern requirements of other Child Nutrition
Programs instead of the SFSP meal pattern requirements. Also, OVS is an
option for school sponsors that provide meals under the National School
Lunch Program. At OVS sites, the completed meal that meets the SFSP meal
pattern requirements, as shown on page 13, must be [offered]{.underline}
to participants. However, participants may choose not to take one or
more of the food items offered. **Your sponsor will provide you with the
appropriate requirements for the sites you are monitoring that have been
granted an exception.**

+-----------------------------------------------------------------------+
| **Keep These Food Safety Rules in Mind**                              |
|                                                                       |
| -   Bacteria can grow rapidly between 40°F and 140°F, which includes  |
|     room temperature. This is known as the *danger* *zone*.           |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Avoid holding foods in this temperature *danger zone*. Do not     |
|     hold a food in the temperature *danger* *zone* for longer than    |
|     two **hours.** After two hours discard the food.                  |
|                                                                       |
| -   Keep meals and milk not being served at the time in the           |
|     refrigerator or cooler at a temperature of 40°F or below. Hot     |
|     meals should be in a warming unit or insulated box at a holding   |
|     temperature of 140°F or more.                                     |
|                                                                       |
| -   Remember that you cannot determine food safety by sight, taste,   |
|     odor, or smell. If there is *any* doubt, throw the food away.     |
|                                                                       |
| -   Train food service employees on safe food handling, on the safe   |
|     use of all types of equipment, and on personal hygiene.           |
|                                                                       |
| -   Keep a fire extinguisher and first-aid kit handy and instruct all |
|     personnel in their use.                                           |
|                                                                       |
| The four core messages of Clean, Separate, Cook and Chill will help   |
| you keep your food safe to eat.                                       |
|                                                                       |
| [CLEAN]{.underline}                                                   |
|                                                                       |
| -   Wash hands frequently and properly, for at least 20 seconds with  |
|     soap and *hot* water. Use a *separate* hand wash sink, not sinks  |
|     used for food preparation or dishwashing. Always wash hands after |
|     touching hair or face.                                            |
|                                                                       |
| -   Use disposable towels when drying hands. Discard disposable       |
|     towels after each use.                                            |
|                                                                       |
| -   Cough or sneeze into disposable tissues ONLY, and wash hands      |
|     afterwards. If you sneeze on food or food production areas,       |
|     discard the food and clean and sanitize the food production area. |
|                                                                       |
| -   Persons with colds, or other communicable diseases should **not** |
|     be permitted to work in food preparation areas.                   |
|                                                                       |
| -   All superficial cuts should be covered with a bandage and a       |
|     disposable glove.                                                 |
|                                                                       |
| -   Any person with an infected cut or skin infection should **not**  |
|     be permitted to work with food.                                   |
|                                                                       |
| -   Use disposable gloves properly. Wash hands before putting on      |
|     gloves, avoid touching skin, carts, refrigerator, freezer, oven   |
|     doors, money, or any unclean surfaces. Throw the gloves away      |
|     after using or touching anything other than food.                 |
|                                                                       |
| -   Follow instructions exactly on how to use and clean kitchen       |
|     equipment.                                                        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Keep all equipment such as cutting boards, can openers, grinders, |
|     slicers, and work surfaces clean and sanitized. Sanitize          |
|     equipment and work surfaces between use with raw and cooked       |
|     foods. Check with local health department codes for a list of     |
|     sanitizing agents.                                                |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Use plastic cutting boards. Purchase adequate number of cutting   |
|     boards to prevent cross contamination during food production.     |
|                                                                       |
| -   Empty garbage cans daily. They should be kept tightly covered and |
|     thoroughly cleaned. Use plastic or paper liners.                  |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Keep These Food Safety Rules in Mind**                              |
|                                                                       |
| [SEPARATE]{.underline}                                                |
|                                                                       |
| -   Avoid cross-contamination.                                        |
|                                                                       |
| -   Use appropriate utensils to pick up and handle food.              |
|                                                                       |
| -   Never touch ready-to-eat foods with your bare hands.              |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   If using hands, wear disposable plastic gloves and do not touch   |
|     anything unclean with the gloves. Throw the gloves away after     |
|     using or touching anything other than food.                       |
|                                                                       |
| -   Prepare sandwiches and salads with a minimum amount of handling.  |
|                                                                       |
| -   As a food safety precaution, you may want to use two sets of      |
|     cutting boards: one for meats, and one for vegetables and fruits. |
|     Buying plastic cutting boards in different colors will help to    |
|     keep them straight.                                               |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Prevent juices from raw meat, poultry, or seafood from dripping   |
|     on ready-to-eat foods, such as salad greens, either in the        |
|     refrigerator or during preparation.                               |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Store ready-to-eat foods *above* raw uncooked foods.              |
|                                                                       |
| [COOK]{.underline}                                                    |
|                                                                       |
| -   Be sure thermometers are available and use them properly.         |
|     Calibrate thermometers on a regular basis.                        |
|                                                                       |
| -   To make sure that meat and poultry are cooked all the way         |
|     through, use a food thermometer.                                  |
|                                                                       |
| -   Cook foods to minimal required internal temperatures for safety.  |
|                                                                       |
| **Minimum Internal Temperatures for Safety**                          |
|                                                                       |
| **(based on the *2005 FDA Food* *Code*)**                             |
|                                                                       |
|   ------------------ -----------------------------------------------  |
|   165 ۫ F for 15      Poultry, stuffing, stuffed fish, pork or beef;   |
|   seconds            pasta stuffed with eggs, pork, casseroles,       |
|                      reheating leftovers.                             |
|                                                                       |
|   155 ۫ F for 15      Ground meats, beef, lamb, veal, pork,            |
|   seconds            pasteurized eggs held on steam table, cubed or   |
|                      Salisbury steaks, fish nuggets or sticks         |
|                                                                       |
|   145 ۫ F for 15      Seafood, beef, pork, veal steaks, & roasts       |
|   seconds            (medium rare), eggs cooked to order and served   |
|                      immediately.                                     |
|                                                                       |
|   140 ۫ F for 15      Fresh, frozen, or canned fruits and vegetables   |
|   seconds            that are going to be held on a steam table or    |
|                      in a hot box.                                    |
|   ------------------ -----------------------------------------------  |
|                                                                       |
| -   DO NOT partially cook foods. Partial cooking may encourage        |
|     bacteria to grow before cooking is completed.                     |
|                                                                       |
| -   If the serving of a hot food must be delayed, keep it at a        |
|     holding temperature of 140°F or above.                            |
|                                                                       |
| CHILL                                                                 |
|                                                                       |
| -   Keep cold foods COLD! (Refrigerate or chill food at 40 °F or      |
|     below)                                                            |
|                                                                       |
| -   Keep frozen food in a freezer at 0 °F or lower.                   |
|                                                                       |
| -   Cool hot food from 140°F to 70°F within two hours. If during the  |
|     cooling process food temperatures do not reach 70°F immediate     |
|     action is required or food must be discarded. Cool foods from     |
|     70°F to 40°F or below within four hours. DO NOT ALLOW ANY FOODS   |
|     TO COOL AT ROOM TEMPERATURE.                                      |
|                                                                       |
| -   Refrigerate or freeze properly cooled leftovers in covered, two   |
|     inch shallow containers.                                          |
|                                                                       |
| -   Divide large containers of soups, sauces, or vegetables so that   |
|     the smaller portions will cool more quickly. Stirring throughout  |
|     the chilling process will shorten the total cooling time. An ice  |
|     paddle or ice bath will also help to rapidly cool foods.          |
|                                                                       |
| -   Leave airspace around containers or packages to allow circulation |
|     of cold air so that rapid cooling is ensured.                     |
|                                                                       |
| -   Once cooled, tightly cover and date leftovers.                    |
|                                                                       |
| -   DO NOT THAW FOODS AT ROOM TEMPERATURE. Thaw poultry and meat in a |
|     refrigerator and not on counters. Refreeze only if ice crystals   |
|     are still present.                                                |
+-----------------------------------------------------------------------+

**Questions and Answers**

> **1. As a monitor, what are some of my major responsibilities?**
>
> You are the direct link between the sponsor and the sites -- the
> official representative of the sponsor. It is your responsibility to
> ensure the sites operate smoothly and in accordance with program
> guidance and requirements, by checking site operations, conducting
> training with site personnel when necessary, conducting
> pre-operational visits for sites, and conducting visits and reviews of
> all your assigned sites to ensure food service is operating properly.
> You also must reconcile meal counts, prepare accurate reports of your
> visits and reviews, and inform your sponsor and site supervisors of
> any problems found. A description of your responsibilities can be
> found on page 3 of this handbook.
>
> **2. What is the difference between a site "visit" and site
> "review"?**
>
> When you monitor program operations at a site, you will make either a
> "visit" or a "review." A site "visit" requires you to make sure that
> the food service is operating smoothly and that any problems are
> immediately resolved. A site "review" requires you to determine if the
> site is meeting all program requirements. To accomplish this, you will
> have to observe the entire meal service from beginning to end. All
> visits and reviews must be documented. You will find a sample visit
> and review forms on pages 20 to 26 of this handbook, but you should
> use the forms provided by your sponsor.

3\. What are some of the things I should look for during the meal
preparation or meal service?

> On the day of your visit, you should observe the meal preparation and
> if meals are delivered, note if they were delivered on time. If
> prepared at the site, note if whether or not the meals were prepared
> within the health and safety standards set forth by the sponsor and
> the local or State health authorities. When observing the meal
> service, note the number of meals delivered or prepared, the number of
> complete meals served to children and program adults, the number of
> leftover meals, the number of non-reimbursable meals served, if any,
> and whether or not the meals are being counted accurately by site
> personnel. You also should ensure that nondiscrimination posters are
> in place and that all children have access to and are being served
> meals. Finally, you should complete your forms before you leave, and
> make corrective actions on site, if at all possible. A full listing of
> what to look for begins on page 5 of this handbook.
>
> **4. Should I be concerned with food safety, or is that the
> responsibility of the workers at the site?**
>
> Although it is a primary responsibility of site staff to ensure meals
> are being safely prepared, it is your responsibility to report whether
> they are taking appropriate steps to make sure the foods they receive
> or prepare are safe for children to consume. Note whether staff check
> the temperature of foods they receive from a central kitchen, or
> whether they check the temperature of foods they prepare on-site. Note
> where and how they store foods, and check that the temperatures on
> refrigerators or freezers are adequate. During food preparation, check
> to see if staff are following local or State health and safety
> standards. Also check to see that there are fire extinguishers and
> first aid kits nearby and available for use.
>
> **5. What is a meal pattern requirement?**
>
> A meal pattern requirement is a listing of food components that are
> required to be served to the children participating in the SFSP. Each
> component in each meal must be present in order for your sponsor to
> receive reimbursement for that meal. When the meal pattern
> requirements are followed, not only does the sponsor receive proper
> reimbursement, but the child eating the meal receives a well-balanced,
> nutritious meal that supplies the kinds and amounts of foods that will
> meet their nutrient and energy needs. You can find the SFSP Meal
> Pattern Requirements on pages 14 and 15 of this handbook.

![](media/image8.jpeg){width="2.75in" height="2.125in"}

![](media/image9.jpeg){width="2.245138888888889in" height="1.5in"}

+-----------------------------------------------------------------------+
| ######### PRE-OPERATIONAL VISIT WORKSHEET                             |
+-----------------------------------------------------------------------+
| Site name:                                                            |
| \_\_\_\_\_\                                                           |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| Site number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                         |
|                                                                       |
| Site address:                                                         |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\         |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Site telephone number:                                                |
| \_\_\_\_\_\_\_\_\_\_\_\                                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Person to contact for use of site:                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Type of site (check appropriate type):                                |
|                                                                       |
| \_\_\_\_\_ Recreation center \_\_\_\_\_ Park                          |
|                                                                       |
| \_\_\_\_\_ School \_\_\_\_\_ Residential camp                         |
|                                                                       |
| \_\_\_\_\_ Church \_\_\_\_\_ Play street                              |
|                                                                       |
| \_\_\_\_\_ Playground \_\_\_\_\_ Other                                |
|                                                                       |
| \_\_\_\_\_ Settlement house                                           |
|                                                                       |
| Estimated number of children the site could serve: \_\_\_\_\_\_       |
|                                                                       |
| Estimated number of needy children in area: \_\_\_\_\_\_\_\_\_\_\_\_  |
|                                                                       |
| Estimated number of personnel needed to adequately control the food   |
| service: \_\_\_\_\_\_\_\_\_\_\_\_                                     |
|                                                                       |
| Is another site needed in this area? \_\_\_\_\_ Yes \_\_\_\_\_ No     |
|                                                                       |
| Are the present facilities adequate for an organized meal service?    |
| \_\_\_\_\_ Yes \_\_\_\_\_ No                                          |
|                                                                       |
| If answer is no,                                                      |
| comments:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_                                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| For the estimated number of children, does the site have: Yes No      |
|                                                                       |
| Shelter for inclement weather? \_\_\_\_\_\_\_ \_\_\_\_\_\_\_          |
|                                                                       |
| Adequate cooking facilities (if applicable)? \_\_\_\_\_\_\_           |
| \_\_\_\_\_\_\_                                                        |
|                                                                       |
| Adequate storage for prepared or delivered food? \_\_\_\_\_\_\_       |
| \_\_\_\_\_\_\_                                                        |
|                                                                       |
| Storage space for records at site? \_\_\_\_\_\_\_ \_\_\_\_\_\_\_      |
|                                                                       |
| Adequate refrigeration? \_\_\_\_\_\_\_ \_\_\_\_\_\_\_                 |
|                                                                       |
| > Access to a telephone? \_\_\_\_\_\_\_ \_\_\_\_\_\_\_                |
|                                                                       |
| What type of organized activities are possible or planned at this     |
| site?                                                                 |
| \_\_\_\_\_\_\_                                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_                                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| > Improvements or corrective actions needed before site operates:     |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                      |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**                                |
|                                                                       |
| **Monitor's Signature Date**                                          |
+-----------------------------------------------------------------------+

+---------------------------------------------------+------------------+
| **First Week Visit Form**                         |                  |
+---------------------------------------------------+------------------+
| Date of site visit: \_\_\_\_\_\_\_\_\_\_          |                  |
| Monitor\'s arrival time: \_\_\_\_\_\_\_\_\_\_     |                  |
| Departure time: \_\_\_\_\_\_\_\_\_\_              |                  |
|                                                   |                  |
| Site name:                                        |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Site |                  |
| address:                                          |                  |
| \_\_\_\_\_\_\_\_\                                 |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
|                                                   |                  |
| Discussion with site staff (list names):          |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_              |                  |
+---------------------------------------------------+------------------+
| **Areas of Discussion**                           | **Notes and      |
|                                                   | Observations**   |
+---------------------------------------------------+------------------+
| Has the site supervisor attended training         |                  |
| session?                                          |                  |
+---------------------------------------------------+------------------+
| Are meals being counted and signed for?           |                  |
+---------------------------------------------------+------------------+
| Are all required records being completed?         |                  |
+---------------------------------------------------+------------------+
| Are meals served as second meals excessive?       |                  |
+---------------------------------------------------+------------------+
| Do meals meet meal pattern requirements?          |                  |
+---------------------------------------------------+------------------+
| Is there proper sanitation/storage?               |                  |
+---------------------------------------------------+------------------+
| Is the site supervisor following procedures       |                  |
| established to make meal order adjustments?       |                  |
+---------------------------------------------------+------------------+
| Are meals served within appropriate time frames?  |                  |
+---------------------------------------------------+------------------+
| Are all meals served and consumed onsite? (Note   |                  |
| if State agency and sponsor allow fruits or       |                  |
| vegetables to be taken off site).                 |                  |
+---------------------------------------------------+------------------+
| Is each meal served as a unit?                    |                  |
+---------------------------------------------------+------------------+
| Are there any problems with delivery?             |                  |
+---------------------------------------------------+------------------+
| Is there documentation of children\'s income      |                  |
| eligibility, if applicable?                       |                  |
+---------------------------------------------------+------------------+
| Is there a nondiscrimination poster, provided by  |                  |
| the sponsor, on display in a prominent place?     |                  |
+---------------------------------------------------+------------------+
| List any problems that were noted during the      |                  |
| visit, and any corrective actions that were       |                  |
| initiated to eliminate the problems:              |                  |
|                                                   |                  |
| \_\_\                                             |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
|                                                   |                  |
| \_\_\_\_\_\_\_\_\_\                               |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
| \_\_\_\_\_\_\_\_\_\_\_\                           |                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                  |
|                                                   |                  |
| **Site Supervisor's Signature Monitor's           |                  |
| Signature** Site supervisor\'s signature          |                  |
| Monitor\'s signature                              |                  |
+---------------------------------------------------+------------------+

+----------------------+--------+--------+--------+--------+--------+
| **SITE REVIEW FORM** |        |        |        |        |        |
|                      |        |        |        |        |        |
| **SUMMER FOOD        |        |        |        |        |        |
| SERVICE PROGRAM**    |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| NOTE: To be          |        |        |        |        |        |
| completed during     |        |        |        |        |        |
| first four weeks of  |        |        |        |        |        |
| operations.          |        |        |        |        |        |
|                      |        |        |        |        |        |
| Sponsor:             |        |        |        |        |        |
| \_\_                 |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| Site:                |        |        |        |        |        |
| \_\_\_\_\_\_\_       |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
|                      |        |        |        |        |        |
| Site                 |        |        |        |        |        |
| contact:\_\_         |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| Name Title           |        |        |        |        |        |
|                      |        |        |        |        |        |
| Site                 |        |        |        |        |        |
| address:\_\_         |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
|                      |        |        |        |        |        |
| Telephone: Date of   |        |        |        |        |        |
| review:              |        |        |        |        |        |
| \_\_                 |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
|                      |        |        |        |        |        |
| Monitor\'s arrival   |        |        |        |        |        |
| time: Departure      |        |        |        |        |        |
| time:\_\_            |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
|                      |        |        |        |        |        |
| Site                 |        |        |        |        |        |
| supervisor:          |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
|                      |        |        |        |        |        |
| Regular site: Camp   |        |        |        |        |        |
| site: Average daily  |        |        |        |        |        |
| participation (if    |        |        |        |        |        |
| applicable):         |        |        |        |        |        |
| \_\_\_\_\_\_\_\_     |        |        |        |        |        |
|                      |        |        |        |        |        |
| Today\'s attendance: |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| Approved meal        |        |        |        |        |        |
| service time:        |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_   |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
| \_\_\_\_\_\_\_\_\_\_ |        |        |        |        |        |
|                      |        |        |        |        |        |
| Type(s) of meals     |        |        |        |        |        |
| reviewed:            |        |        |        |        |        |
|                      |        |        |        |        |        |
| Breakfast Snack      |        |        |        |        |        |
| Lunch Snack Supper   |        |        |        |        |        |
|                      |        |        |        |        |        |
| Approved level(s)    |        |        |        |        |        |
|                      |        |        |        |        |        |
| of meal service      |        |        |        |        |        |
| \_\_\_\_\_\_\_\_     |        |        |        |        |        |
| \_\_\_\_\_\_\_\_     |        |        |        |        |        |
| \_\_\_\_\_\_\_\_     |        |        |        |        |        |
| \_\_\_\_\_\_\_\_     |        |        |        |        |        |
| \_\_\_\_\_\_\_       |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Day of visit         | Bre    | AM     | Lunch  | PM     | Supper |
|                      | akfast | Snack  |        | Snack  |        |
+----------------------+--------+--------+--------+--------+--------+
| \# meals delivered   |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| \# meals/milk from   |        |        |        |        |        |
| previous day         |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Time meals delivered |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Time meals served    |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| \# first meals       |        |        |        |        |        |
| served to children   |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| \# second meals      |        |        |        |        |        |
| served to children   |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| \# meals served to   |        |        |        |        |        |
| Program adults       |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| \# meals served to   |        |        |        |        |        |
|                      |        |        |        |        |        |
| non-Program adults   |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| \# meals leftover    |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+

+-----+-----+-------------+--------+--------------+--------------------+
| YES | NO  | EXPLAIN ANY |        |              |                    |
|     |     | \"NO\"      |        |              |                    |
|     |     | ANSWERS     |        |              |                    |
|     |     | BELOW       |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 1\. Does    |        |              |                    |
| \_\ | _\_ | the         |        |              |                    |
| _\_ | \_\ | staffing    |        |              |                    |
|     | _\_ | pattern     |        |              |                    |
|     |     | correspond  |        |              |                    |
|     |     | to that     |        |              |                    |
|     |     | listed on   |        |              |                    |
|     |     | the         |        |              |                    |
|     |     | approved    |        |              |                    |
|     |     | site sheet? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 2\. Has the |        |              |                    |
| \_\ | _\_ | site        |        |              |                    |
| _\_ | \_\ | supervisor  |        |              |                    |
|     | _\_ | attended    |        |              |                    |
|     |     | training    |        |              |                    |
|     |     | session?    |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 3\. Does    |        |              |                    |
| \_\ | _\_ | the site    |        |              |                    |
| _\_ | \_\ | have        |        |              |                    |
|     | _\_ | sufficient  |        |              |                    |
|     |     | food        |        |              |                    |
|     |     | service     |        |              |                    |
|     |     | s           |        |              |                    |
|     |     | upervision? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 4\. Are     |        |              |                    |
| \_\ | _\_ | meals       |        |              |                    |
| _\_ | \_\ | coun        |        |              |                    |
|     | _\_ | ted/checked |        |              |                    |
|     |     | before      |        |              |                    |
|     |     | signing     |        |              |                    |
|     |     | delivery    |        |              |                    |
|     |     | receipt?    |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 5\. Are     |        |              |                    |
| \_\ | _\_ | accurate    |        |              |                    |
| _\_ | \_\ | meal counts |        |              |                    |
|     | _\_ | taken of    |        |              |                    |
|     |     | meals       |        |              |                    |
|     |     | served?     |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 6\. Are     |        |              |                    |
| \_\ | _\_ | meals       |        |              |                    |
| _\_ | \_\ | served as   |        |              |                    |
|     | _\_ | second      |        |              |                    |
|     |     | meals       |        |              |                    |
|     |     | excessive?  |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 7\. Are     |        |              |                    |
| \_\ | _\_ | records of  |        |              |                    |
| _\_ | \_\ | adult meals |        |              |                    |
|     | _\_ | being kept? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 8\. Do      |        |              |                    |
| \_\ | _\_ | meals meet  |        |              |                    |
| _\_ | \_\ | approved    |        |              |                    |
|     | _\_ | menu?       |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 9\. Do      |        |              |                    |
| \_\ | _\_ | meals meet  |        |              |                    |
| _\_ | \_\ | meal        |        |              |                    |
|     | _\_ | pattern     |        |              |                    |
|     |     | re          |        |              |                    |
|     |     | quirements? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 10\. Are    |        |              |                    |
| \_\ | _\_ | meals       |        |              |                    |
| _\_ | \_\ | checked for |        |              |                    |
|     | _\_ | quality?    |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 11\. Is     |        |              |                    |
| \_\ | _\_ | there       |        |              |                    |
| _\_ | \_\ | proper      |        |              |                    |
|     | _\_ | sanitati    |        |              |                    |
|     |     | on/storage? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \   | \   | 12\. Is the |        |              |                    |
| _\_ | _\_ | site        |        |              |                    |
| \_\ | \_\ | supervisor  |        |              |                    |
| _\_ | _\_ | following   |        |              |                    |
|     |     | procedures  |        |              |                    |
|     |     | established |        |              |                    |
|     |     | to make     |        |              |                    |
|     |     | meal order  |        |              |                    |
|     |     | a           |        |              |                    |
|     |     | djustments? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \   | \   | 13\. Are    |        |              |                    |
| _\_ | _\_ | meals       |        |              |                    |
| \_\ | \_\ | served      |        |              |                    |
| _\_ | _\_ | within      |        |              |                    |
|     |     | appropriate |        |              |                    |
|     |     | time        |        |              |                    |
|     |     | frames?     |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 14\. Are    |        |              |                    |
| \_\ | _\_ | all meals   |        |              |                    |
| _\_ | \_\ | served and  |        |              |                    |
|     | _\_ | consumed    |        |              |                    |
|     |     | onsite?     |        |              |                    |
|     |     | (Note if    |        |              |                    |
|     |     | State       |        |              |                    |
|     |     | agency and  |        |              |                    |
|     |     | sponsor     |        |              |                    |
|     |     | allow       |        |              |                    |
|     |     | fruits or   |        |              |                    |
|     |     | vegetables  |        |              |                    |
|     |     | to be taken |        |              |                    |
|     |     | off-site).  |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 15\. Does   |        |              |                    |
| \_\ | _\_ | site have a |        |              |                    |
| _\_ | \_\ | place to    |        |              |                    |
|     | _\_ | serve       |        |              |                    |
|     |     | children    |        |              |                    |
|     |     | meals in    |        |              |                    |
|     |     | case of     |        |              |                    |
|     |     | inclement   |        |              |                    |
|     |     | weather?    |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \   | \   | 16\. Is     |        |              |                    |
| _\_ | _\_ | each meal   |        |              |                    |
| \_\ | \_\ | served as a |        |              |                    |
| _\_ | _\_ | unit?       |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 17\. Is the |        |              |                    |
| \_\ | _\_ | meal        |        |              |                    |
| _\_ | \_\ | delivery    |        |              |                    |
|     | _\_ | schedule    |        |              |                    |
|     |     | followed?   |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \_  | 18\. Are    |        |              |                    |
| \_\ | \_\ | there       |        |              |                    |
| _\_ | _\_ | provisions  |        |              |                    |
|     |     | for storing |        |              |                    |
|     |     | or          |        |              |                    |
|     |     | returning   |        |              |                    |
|     |     | excess      |        |              |                    |
|     |     | meals?      |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \_  | 19\. Is     |        |              |                    |
| \_\ | \_\ | there       |        |              |                    |
| _\_ | _\_ | do          |        |              |                    |
|     |     | cumentation |        |              |                    |
|     |     | of          |        |              |                    |
|     |     | children\'s |        |              |                    |
|     |     | income      |        |              |                    |
|     |     | e           |        |              |                    |
|     |     | ligibility, |        |              |                    |
|     |     | if          |        |              |                    |
|     |     | applicable? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 20\. Is     |        |              |                    |
| \_\ | _\_ | there a     |        |              |                    |
| _\_ | \_\ | nondis      |        |              |                    |
|     | _\_ | crimination |        |              |                    |
|     |     | poster,     |        |              |                    |
|     |     | provided by |        |              |                    |
|     |     | the         |        |              |                    |
|     |     | sponsor, on |        |              |                    |
|     |     | display in  |        |              |                    |
|     |     | a prominent |        |              |                    |
|     |     | place?      |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 21\. Are    |        |              |                    |
| \_\ | _\_ | meals       |        |              |                    |
| _\_ | \_\ | served to   |        |              |                    |
|     | _\_ | all         |        |              |                    |
|     |     | attending   |        |              |                    |
|     |     | children    |        |              |                    |
|     |     | regardless  |        |              |                    |
|     |     | of the      |        |              |                    |
|     |     | child\'s    |        |              |                    |
|     |     | race,       |        |              |                    |
|     |     | color,      |        |              |                    |
|     |     | national    |        |              |                    |
|     |     | origin,     |        |              |                    |
|     |     | sex, age,   |        |              |                    |
|     |     | or          |        |              |                    |
|     |     | disability? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 22\. Do all |        |              |                    |
| \_\ | _\_ | children    |        |              |                    |
| _\_ | \_\ | have equal  |        |              |                    |
|     | _\_ | access to   |        |              |                    |
|     |     | services    |        |              |                    |
|     |     | and         |        |              |                    |
|     |     | facilities  |        |              |                    |
|     |     | at the site |        |              |                    |
|     |     | regardless  |        |              |                    |
|     |     | of the      |        |              |                    |
|     |     | child\'s    |        |              |                    |
|     |     | race,       |        |              |                    |
|     |     | color,      |        |              |                    |
|     |     | national    |        |              |                    |
|     |     | origin,     |        |              |                    |
|     |     | sex, age,   |        |              |                    |
|     |     | or          |        |              |                    |
|     |     | disability? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| \_  | \   | 23\. Is     |        |              |                    |
| \_\ | _\_ | in          |        |              |                    |
| _\_ | \_\ | formational |        |              |                    |
|     | _\_ | material    |        |              |                    |
|     |     | concerning  |        |              |                    |
|     |     | the         |        |              |                    |
|     |     | a           |        |              |                    |
|     |     | vailability |        |              |                    |
|     |     | and         |        |              |                    |
|     |     | nutritional |        |              |                    |
|     |     | benefits of |        |              |                    |
|     |     | the Program |        |              |                    |
|     |     | available   |        |              |                    |
|     |     | in          |        |              |                    |
|     |     | appropriate |        |              |                    |
|     |     | tr          |        |              |                    |
|     |     | anslations? |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| **  |     |             |        |              |                    |
| Exp |     |             |        |              |                    |
| lan |     |             |        |              |                    |
| ati |     |             |        |              |                    |
| ons |     |             |        |              |                    |
| :** |     |             |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| MA  |     |             |        | ACTUAL COUNT | TYPE OF MEAL       |
| JOR |     |             |        |              |                    |
| V   |     |             |        |              |                    |
| IOL |     |             |        |              |                    |
| ATI |     |             |        |              |                    |
| ONS |     |             |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| 1\. |     |             |        | \_\_         | \_\_\_\_\_         |
| Ad  |     |             |        | \_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_ |
| ult |     |             |        | \_\_\_\_\_\_ |                    |
| me  |     |             |        |              | \_\_\_\_\_         |
| als |     |             |        | \_\_         | \_\_\_\_\_\_\_\_\_ |
| in  |     |             |        | \_\_\_\_\_\_ |                    |
| clu |     |             |        | \_\_\_\_\_\_ | \_\_\_\_\_         |
| ded |     |             |        |              | \_\_\_\_\_\_\_\_\_ |
| in  |     |             |        | \_\_         |                    |
| co  |     |             |        | \_\_\_\_\_\_ | \_\_\_\_\_         |
| unt |     |             |        | \_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_ |
| of  |     |             |        |              |                    |
| me  |     |             |        | \_\_         | \_\_\_\_\_         |
| als |     |             |        | \_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_ |
| ser |     |             |        | \_\_\_\_\_\_ |                    |
| ved |     |             |        |              | \_\_\_\_\_         |
| to  |     |             |        | \_\_         | \_\_\_\_\_\_\_\_\_ |
| chi |     |             |        | \_\_\_\_\_\_ |                    |
| ldr |     |             |        | \_\_\_\_\_\_ |                    |
| en. |     |             |        |              |                    |
|     |     |             |        | \_\_         |                    |
| 2\. |     |             |        | \_\_\_\_\_\_ |                    |
| O   |     |             |        | \_\_\_\_\_\_ |                    |
| ffs |     |             |        |              |                    |
| ite |     |             |        |              |                    |
| con |     |             |        |              |                    |
| sum |     |             |        |              |                    |
| pti |     |             |        |              |                    |
| on. |     |             |        |              |                    |
| (Do |     |             |        |              |                    |
| not |     |             |        |              |                    |
| i   |     |             |        |              |                    |
| ncl |     |             |        |              |                    |
| ude |     |             |        |              |                    |
| fru |     |             |        |              |                    |
| its |     |             |        |              |                    |
| and |     |             |        |              |                    |
| v   |     |             |        |              |                    |
| ege |     |             |        |              |                    |
| tab |     |             |        |              |                    |
| les |     |             |        |              |                    |
| if  |     |             |        |              |                    |
| a   |     |             |        |              |                    |
| llo |     |             |        |              |                    |
| wed |     |             |        |              |                    |
| by  |     |             |        |              |                    |
| St  |     |             |        |              |                    |
| ate |     |             |        |              |                    |
| age |     |             |        |              |                    |
| ncy |     |             |        |              |                    |
| and |     |             |        |              |                    |
| spo |     |             |        |              |                    |
| nso |     |             |        |              |                    |
| r). |     |             |        |              |                    |
|     |     |             |        |              |                    |
| 3\. |     |             |        |              |                    |
| M   |     |             |        |              |                    |
| ore |     |             |        |              |                    |
| t   |     |             |        |              |                    |
| han |     |             |        |              |                    |
| one |     |             |        |              |                    |
| m   |     |             |        |              |                    |
| eal |     |             |        |              |                    |
| ser |     |             |        |              |                    |
| ved |     |             |        |              |                    |
| at  |     |             |        |              |                    |
| one |     |             |        |              |                    |
| t   |     |             |        |              |                    |
| ime |     |             |        |              |                    |
| to  |     |             |        |              |                    |
| chi |     |             |        |              |                    |
| ldr |     |             |        |              |                    |
| en. |     |             |        |              |                    |
|     |     |             |        |              |                    |
| 4\. |     |             |        |              |                    |
| M   |     |             |        |              |                    |
| eal |     |             |        |              |                    |
| p   |     |             |        |              |                    |
| att |     |             |        |              |                    |
| ern |     |             |        |              |                    |
| not |     |             |        |              |                    |
| met |     |             |        |              |                    |
| (   |     |             |        |              |                    |
| spe |     |             |        |              |                    |
| cif |     |             |        |              |                    |
| y). |     |             |        |              |                    |
|     |     |             |        |              |                    |
| 5\. |     |             |        |              |                    |
| Me  |     |             |        |              |                    |
| als |     |             |        |              |                    |
| not |     |             |        |              |                    |
| ser |     |             |        |              |                    |
| ved |     |             |        |              |                    |
| as  |     |             |        |              |                    |
| a   |     |             |        |              |                    |
| un  |     |             |        |              |                    |
| it. |     |             |        |              |                    |
|     |     |             |        |              |                    |
| 6\. |     |             |        |              |                    |
| M   |     |             |        |              |                    |
| eal |     |             |        |              |                    |
| s   |     |             |        |              |                    |
| erv |     |             |        |              |                    |
| ing |     |             |        |              |                    |
| ti  |     |             |        |              |                    |
| mes |     |             |        |              |                    |
| not |     |             |        |              |                    |
| m   |     |             |        |              |                    |
| et. |     |             |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| CH  |     |             |        |              |                    |
| ECK |     |             |        |              |                    |
| IF  |     |             |        |              |                    |
| THE |     |             |        |              |                    |
| FOL |     |             |        |              |                    |
| LOW |     |             |        |              |                    |
| ING |     |             |        |              |                    |
| AP  |     |             |        |              |                    |
| PLY |     |             |        |              |                    |
|     |     |             |        |              |                    |
| (E  |     |             |        |              |                    |
| xpl |     |             |        |              |                    |
| ain |     |             |        |              |                    |
| any |     |             |        |              |                    |
| c   |     |             |        |              |                    |
| hec |     |             |        |              |                    |
| ked |     |             |        |              |                    |
| ite |     |             |        |              |                    |
| ms) |     |             |        |              |                    |
| EX  |     |             |        |              |                    |
| PLA |     |             |        |              |                    |
| NAT |     |             |        |              |                    |
| ION |     |             |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| 7\. |     |             |        |              |                    |
| No  |     |             |        |              |                    |
| r   |     |             |        |              |                    |
| eco |     |             |        |              |                    |
| rds |     |             |        |              |                    |
|     |     |             |        |              |                    |
| 8\. |     |             |        |              |                    |
| I   |     |             |        |              |                    |
| nco |     |             |        |              |                    |
| mpl |     |             |        |              |                    |
| ete |     |             |        |              |                    |
| r   |     |             |        |              |                    |
| eco |     |             |        |              |                    |
| rds |     |             |        |              |                    |
|     |     |             |        |              |                    |
| 9\. |     |             |        |              |                    |
| P   |     |             |        |              |                    |
| oor |     |             |        |              |                    |
| s   |     |             |        |              |                    |
| ani |     |             |        |              |                    |
| tat |     |             |        |              |                    |
| ion |     |             |        |              |                    |
|     |     |             |        |              |                    |
| 1   |     |             |        |              |                    |
| 0\. |     |             |        |              |                    |
| Ot  |     |             |        |              |                    |
| her |     |             |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| C   |     |             |        |              |                    |
| orr |     |             |        |              |                    |
| ect |     |             |        |              |                    |
| ive |     |             |        |              |                    |
| act |     |             |        |              |                    |
| ion |     |             |        |              |                    |
| dis |     |             |        |              |                    |
| cus |     |             |        |              |                    |
| sed |     |             |        |              |                    |
| w   |     |             |        |              |                    |
| ith |     |             |        |              |                    |
| (n  |     |             |        |              |                    |
| ame |     |             |        |              |                    |
| and |     |             |        |              |                    |
| t   |     |             |        |              |                    |
| itl |     |             |        |              |                    |
| e): |     |             |        |              |                    |
|     |     |             |        |              |                    |
| C   |     |             |        |              |                    |
| orr |     |             |        |              |                    |
| ect |     |             |        |              |                    |
| ive |     |             |        |              |                    |
| act |     |             |        |              |                    |
| ion |     |             |        |              |                    |
| tak |     |             |        |              |                    |
| en: |     |             |        |              |                    |
|     |     |             |        |              |                    |
| S   |     |             |        |              |                    |
| ite |     |             |        |              |                    |
| s   |     |             |        |              |                    |
| upe |     |             |        |              |                    |
| rvi |     |             |        |              |                    |
| sor |     |             |        |              |                    |
| \'s |     |             |        |              |                    |
| com |     |             |        |              |                    |
| men |     |             |        |              |                    |
| ts: |     |             |        |              |                    |
|     |     |             |        |              |                    |
| F   |     |             |        |              |                    |
| urt |     |             |        |              |                    |
| her |     |             |        |              |                    |
| act |     |             |        |              |                    |
| ion |     |             |        |              |                    |
| nee |     |             |        |              |                    |
| ded |     |             |        |              |                    |
| by  |     |             |        |              |                    |
| (   |     |             |        |              |                    |
| dat |     |             |        |              |                    |
| e): |     |             |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+
| I   |     |             |        |              |                    |
| c   |     |             |        |              |                    |
| ert |     |             |        |              |                    |
| ify |     |             |        |              |                    |
| t   |     |             |        |              |                    |
| hat |     |             |        |              |                    |
| the |     |             |        |              |                    |
| ab  |     |             |        |              |                    |
| ove |     |             |        |              |                    |
| in  |     |             |        |              |                    |
| for |     |             |        |              |                    |
| mat |     |             |        |              |                    |
| ion |     |             |        |              |                    |
| is  |     |             |        |              |                    |
| co  |     |             |        |              |                    |
| rre |     |             |        |              |                    |
| ct: |     |             |        |              |                    |
|     |     |             |        |              |                    |
| \   |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
|     |     |             |        |              |                    |
| M   |     |             |        |              |                    |
| oni |     |             |        |              |                    |
| tor |     |             |        |              |                    |
| \'s |     |             |        |              |                    |
| sig |     |             |        |              |                    |
| nat |     |             |        |              |                    |
| ure |     |             |        |              |                    |
| D   |     |             |        |              |                    |
| ate |     |             |        |              |                    |
| S   |     |             |        |              |                    |
| ite |     |             |        |              |                    |
| s   |     |             |        |              |                    |
| upe |     |             |        |              |                    |
| rvi |     |             |        |              |                    |
| sor |     |             |        |              |                    |
| \'s |     |             |        |              |                    |
| sig |     |             |        |              |                    |
| nat |     |             |        |              |                    |
| ure |     |             |        |              |                    |
| D   |     |             |        |              |                    |
| ate |     |             |        |              |                    |
|     |     |             |        |              |                    |
| \   |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
| \_\ |     |             |        |              |                    |
| _\_ |     |             |        |              |                    |
|     |     |             |        |              |                    |
| S   |     |             |        |              |                    |
| pon |     |             |        |              |                    |
| sor |     |             |        |              |                    |
| re  |     |             |        |              |                    |
| pre |     |             |        |              |                    |
| sen |     |             |        |              |                    |
| tat |     |             |        |              |                    |
| ive |     |             |        |              |                    |
| \'s |     |             |        |              |                    |
| sig |     |             |        |              |                    |
| nat |     |             |        |              |                    |
| ure |     |             |        |              |                    |
| D   |     |             |        |              |                    |
| ate |     |             |        |              |                    |
+-----+-----+-------------+--------+--------------+--------------------+

+--------------------------------------+-------------------------------+
| #####                                |                               |
| #### RACIAL and ETHNIC DATA FORM\*\* |                               |
+--------------------------------------+-------------------------------+
| Sponsor:                             |                               |
| \_\_\_\_\_\_\_\_\_\_                 |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
|                                      |                               |
| Site:                                |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_         |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
|                                      |                               |
| Address:                             |                               |
| \_\_\_\_\_\_\_\_\_\_                 |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
|                                      |                               |
| Site supervisor:                     |                               |
| \_\_\_\_                             |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                               |
|                                      |                               |
| NOTE: Both ethnic and racial         |                               |
| categories must be determined for    |                               |
| each child.                          |                               |
+--------------------------------------+-------------------------------+
| **Ethnic Categories**                | **Number of Participating     |
|                                      | Children**                    |
+--------------------------------------+-------------------------------+
| **Hispanic or Latino.** A person of  | []{.mark}                     |
| Cuban, Mexican, Puerto Rican, South  |                               |
| or Central American, or other        |                               |
| Spanish culture or origin,           |                               |
| regardless of race. The term         |                               |
| "Spanish origin" can be used in      |                               |
| addition to "Hispanic or Latino."    |                               |
+--------------------------------------+-------------------------------+
| **Non-Hispanic or Latino**           | []{.mark}                     |
+--------------------------------------+-------------------------------+
| **Racial Categories**                | **Number of Participating     |
|                                      | Children**                    |
+--------------------------------------+-------------------------------+
| **American Indian or Alaska          |                               |
| Native**. A person having origins in |                               |
| any of the original peoples of North |                               |
| and South America, (including        |                               |
| Central America), and who maintains  |                               |
| tribal affiliation or community      |                               |
| recognition.                         |                               |
+--------------------------------------+-------------------------------+
| **Asian.** A person having origins   |                               |
| in any of the original peoples of    |                               |
| the Far East, Southeast Asia, or the |                               |
| Indian subcontinent, including, for  |                               |
| example, Cambodia, China, India,     |                               |
| Japan, Korea, Malaysia, Pakistan,    |                               |
| the Philippine Islands, Thailand,    |                               |
| and Vietnam.                         |                               |
+--------------------------------------+-------------------------------+
| **Black or African American.** A     |                               |
| person having origins in any of the  |                               |
| black racial groups of Africa. Terms |                               |
| such as "Haitian" or "Negro" can be  |                               |
| used in addition to "Black or        |                               |
| African American."                   |                               |
+--------------------------------------+-------------------------------+
| **Native Hawaiian or Other Pacific   |                               |
| Islander.** A person having origins  |                               |
| in any of the original peoples of    |                               |
| Hawaii, Guam, Samoa, or other        |                               |
| Pacific Islands.                     |                               |
+--------------------------------------+-------------------------------+
| **White**. A person having origins   |                               |
| in any of the original peoples of    |                               |
| Europe, the Middle East or North     |                               |
| Africa.                              |                               |
+--------------------------------------+-------------------------------+
| Monitor\'s Signature                 | **\_                          |
|                                      | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                                      | _\_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                      |                               |
|                                      | Date                          |
+--------------------------------------+-------------------------------+

\*\* Note: Based on OMB Notice, [Revisions to the Standards for the
Classification of Federal Data on Race]{.underline}

> [and Ethnicity]{.underline}, published 10/30/97 *and* in FNS
> Instruction 113-1, [Civil Rights Compliance and Enforcement Nutrition
> Programs and Activities,]{.underline} published November 8, 2005. See
> Back for Instructions.

Instructions for Completing the Racial and Ethnic Data Form

-   The sponsor should complete this form for each site under its
    jurisdiction each year. Sponsors of residential camps must collect
    this information for each camp session. For all other sites, the
    sponsor must count the participating children at least once during
    the site's operation.

-   The sponsor may use visual identification to determine a
    participant's racial and ethnic category or the parents of a
    participant may be asked to identify the racial and ethnic group of
    their child(ren). A participant may be included in the group that
    he/she appears to belong, identifies with, or is regarded as a
    member by the community.

-   To provide flexibility and ensure data quality, separate categories
    shall be used when collecting and reporting race and ethnicity.
    Ethnicity shall be collected first. Respondents shall be offered the
    option of selecting one or more racial designations.

-   The sponsor must retain racial and ethnic data, as well as
    documentation for the data for 3 years and must safeguard this
    information to prevent its use for discriminatory purposes. Access
    to Program records containing racial and ethnic data should be
    limited to authorized personnel.