Acelero CACFP Monitoring Form (Draft)

• Conducted on

  Date

• Prepared by

  Select Ricardo Barrios, Food Service Coordinator Stephanie Manchester, Food Service Coodinator Rachael Seaberg, Director of Monitoring and Compliance Operations Cassandre Fernandez, Director of Analysis

  • Ricardo Barrios, Food Service Coordinator
  • Stephanie Manchester, Food Service Coodinator
  • Rachael Seaberg, Director of Monitoring and Compliance Operations
  • Cassandre Fernandez, Director of Analysis
• Location (Center Address)
  Address

• Classroom

• Person Contacted At Facility

• Visit Type

  Announced Visit

  Unannounced Visit

• Approved Meal Service Time Listed on Schedule A

  Date

• Observed Meal

  Breakfast

  AM SUPP.

  Lunch

  PM SUPP.

  DINER

• Time Meal Served

  Date

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• (9) Is the facility currently licensed?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

• CACFP Eligibility Requirement

  Yes

  No

  N/A

• Monitoring Enrollment/Eligibility

  Yes

  No

  N/A

• USDA Component Requirements

  Yes

  No

  N/A

• USDA Portion Size Requirements

  Yes

  No

  N/A

• Attendance Procedures

  Yes

  No

  N/A

• Meal Count Procedures

  Yes

  No

  N/A

• Meal Service Procedures

  Yes

  No

  N/A

• Civil Rights Procedures

  Yes

  No

  N/A

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

(14) List the components of the observed meal:

• Milk

  Yes

  No

  N/A

• Juice, Fruit or Vegetable

  Yes

  No

  N/A

• Bread / Bread Alternate

  Yes

  No

  N/A

• Fruit or Vegetable

  Yes

  No

  N/A

• Meat / Meat Alternate

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

• Formula or Breast Milk

  Provided by Facility

  Provided by Parents

• Infant Cereal

  Provided by Facility

  Provided by Parents

• Infant Meat or Meat Alternate

  Provided by Facility

  Provided by Parents

• Infant Fruit or Vegetable

  Provided by Facility

  Provided by Parents
(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

  Date

• Meal Count

• Attendance

• Eligibility/Enrollment

• If Vended, List # Meals Delivered

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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

  Date

• Meal Count

• Attendance

• Eligibility/Enrollment

• If Vended, List # Meals Delivered

• List Findings Identified during Last Review.

• Current Findings:

• Technical Assistance Provided / Corrective Action(s):

• Additional Comments