• (1) Do meal(s) observed meet all USDA component
    requirements as listed in Schedule B?

  • (2) Do meal(s) observed meet all USDA portion size
    requirements as listed in Schedule B?

  • (3) Do infant meals meet all USDA component and portion
    size requirements as listed in Schedule B?

  • (4) Are meal counts taken at the point of meal service for
    all meals served to enrolled participants on the CACFP
    Standardized Meal Count Form?

  • (5) Are meal counts taken at the point of meal service for
    all program staff?

  • (6) Is there a dated menu available for the meal observed?

  • (7) Are attendance records available for all enrolled
    participants?

  • (8) Is the Child And Adult Care Food Program Eligibility
    Application on file for each participant?

  • (9) Is the facility currently licensed?

  • (10) Does the facility have a current health and sanitation
    certificate?

  • (11) Does the facility have a current fire and building
    inspection certificate?

(12) Have facility personnel been trained in the following CACFP requirements?

  • CACFP Eligibility Requirement

  • Monitoring Enrollment/Eligibility

  • USDA Component Requirements

  • USDA Portion Size Requirements

  • Attendance Procedures

  • Meal Count Procedures

  • Meal Service Procedures

  • Civil Rights Procedures

  • (13) List the additional training area(s) that facility personnel need:

(14) List the components of the observed meal:

  • Milk

  • Juice, Fruit or Vegetable

  • Bread / Bread Alternate

  • Fruit or Vegetable

  • Meat / Meat Alternate

  • (15a) Does the observed meal meet the minimum USDA requirements as specified in the Child and Adult Care Food Program, Schedule B?

  • (15b) Does the facility serve meals to infants?

  • (15c) List food items provided by the facility and/or parent

  • Formula or Breast Milk

  • Infant Cereal

  • Infant Meat or Meat Alternate

  • Infant Fruit or Vegetable

  • (16) 5-Day Reconciliation and Meal Count Variation Review
  • Review the five (5) previous days for the SAME MEAL SERVICE and list the total meal counts, attendance and enrollment figures.

  • Date

  • Meal Count

  • Attendance

  • Eligibility/Enrollment

  • If Vended, List # Meals Delivered

  • Do the attendance and enrollment/eligibility records support the meal counts?

  • Do the meal counts show variation for the 5-day period?

  • If No, continue to review 10 additional days (for a total of 15 consecutive days) for THE SAME
    MEAL SERVICE, and list the total meal counts, attendance and enrollment figures.

  • Date

  • Meal Count

  • Attendance

  • Eligibility/Enrollment

  • If Vended, List # Meals Delivered

Findings

  • List Findings Identified during Last Review.

  • Current Findings:

  • Technical Assistance Provided / Corrective Action(s):

  • Additional Comments

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.