Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Have staff members received the required annual training on the approved civil rights and complaint procedures

  • Is the current, "...And Justice For All posters displayed prominently in all service areas (sites and applicable administrative offices)?

  • Does your institution have documentation of civil rights training

  • Is the current official version of the USDA nondiscrimination policy statement included on all organization materials (parent handbooks, brochures, fliers, promotional materials, menus) that menu USDA or CACFP?

  • Does you institution provide written materials and translations of written materials, and/or translators of interpretive services, as needed to convey CACFP benefits to all participants and potential participants and family without regard to race, color, national origin, age, disability, sex, gender identity, religion, reprisal and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all of part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department?

  • Are civil rights complaint forms available at all sites and applicable administrative offices?

  • Does your institution have an established written procedure to receive complaints alleging discrimination?

  • Is a civil rights complaint log maintained at all sites?

  • Is WIC information posted in view of all participants? Is this information available in multiple languages as needed for the participants being served?

  • Is the "Building for the Future Flyer" posted in view of all participants? Is this information available in multiple languages as needed for the participants being served?

  • Is the "Building for the Future" information sheet, with the sponsor's contact information provided during enrollment or first home visit?

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. You should independently determine whether the template is suitable for your circumstances.