KIPP CHILD NUTRITION – SITE OBSERVATION FORM

• Conducted on

  Date
• Location
  Address

• Prepared by

Site Information

• Date:

  Date

• Site Manager:

• Kitchen Lead:

• Breakfast Start Time:

  Date

• Lunch Start Time:

  Date

Staff

• How many Sodexo employees?

• How many Temp employees?

• Appropriate/Clean uniform?

  Yes

  No

  N/A

• Hairnets/Gloves?

  Yes

  No

  N/A

• Hand/wrist jewelry/nail polish removed?

  Yes

  No

  N/A

Required Signage

• Are Food Manager Certification(s) posted in public view?

  Yes

  No

  N/A

• Are Food Handlers Certifications on site?

  Yes

  No

  N/A

• Health Permit posted in public view?

  Yes

  No

  N/A

• Most recent Inspection Report posted in public view?

  Yes

  No

  N/A

• Justice for All poster posted?

  Yes

  No

  N/A

• Updated menus posted?

  Yes

  No

  N/A

• Meal Components/OVS/Pre-Plating signage posted?

  Yes

  No

  N/A

• Updated rosters available?

  Yes

  No

  N/A

• TV on w/remote?

  Yes

  No

  N/A

School Breakfast Program (SBP) - Child Nutrition Requirements

• Menu items being served?

  Yes

  No

  N/A

• Reimbursable Meals being served?

  Yes

  No

  N/A

• Any substitutions?

  Yes

  No

• Are the meals served meeting minimum meal pattern requirements?

  Yes

  No

  N/A

• Quality of food acceptable?

  Yes

  No

  N/A

• Did they run out of food?

  Yes

  No

• Do students have meal cards?

  Yes

  No

  N/A

• Are the meal counts reflected in Primero Edge?

  Yes

  No

  N/A

• Record Breakfast Meal Count.

• Record Enrollment.

• Does the meal count exceed enrollment?

  Yes

  No

National School Lunch Program (NSLP) - Child Nutrition Requirements

• Was lunch delivered at least 20 minutes prior to meal service? Record lunch delivery time.

  Date

• Was the line setup in a timely manner? Record line setup time.

  Date

• Menu items being served?

  Yes

  No

  N/A

• Reimbursable meals being served?

  Yes

  No

  N/A

• Any substitutions?

  Yes

  No

• Technician Sheet complete for B & L meal services?

  Yes

  No

  N/A

• Includes substitutions or carryovers?

  Yes

  No

  N/A

• Production Sheet complete for B & L meal services?

  Yes

  No

  N/A

• Includes substitutions or carryovers?

  Yes

  No

  N/A

• Are the meals served meeting minimum meal pattern requirements?

  Yes

  No

  N/A

• Quality of food acceptable?

  Yes

  No

  N/A

• Did they run out of food?

  Yes

  No

• Do students have meal cards?

  Yes

  No

  N/A

• Are the meal counts reflected in Primero Edge?

  Yes

  No

  N/A

• Record Lunch Meal Count.

• Does the meal count exceed enrollment?

  Yes

  No

Food Safety

• HACCP Log complete?

  Yes

  No

  N/A

• Temperature Log complete?

  Yes

  No

  N/A

• Calibration Log complete?

  Yes

  No

  N/A

• Sanitizer Log Complete?

  Yes

  No

  N/A

• Ice Machine Cleaning Log complete?

  Yes

  No

  N/A

• Areas underneath equipment, floors, walls, air vents clean to sight and touch?

  Yes

  No

  N/A

• Inside equipment clean to sight and touch?

  Yes

  No

  N/A

• Safe food handling? [No bare hand contact, no cross contamination, etc.]

  Yes

  No

  N/A

Enhanced Snack (CACFP) Requirements

• Are snack bags clean to sight and touch?

  Yes

  No

  N/A

• Menued items being served?

  Yes

  No

  N/A

• Reimbursable Meals being served and bagged together?

  Yes

  No

  N/A

• Any substitutions?

  Yes

  No

• Are the meals meeting meal pattern requirements?

  Yes

  No

  N/A

• Quality of food acceptable?

  Yes

  No

  N/A

• Did they run out of food?

  Yes

  No

• Snacks delivered after 2:30?

  Yes

  No

  N/A

• Snacks consumed before 3:30? If consumed before 3:30, record Teacher's Name.

  Yes

  No

• Justice for All posters posted in hallways?

  Yes

  No

  N/A

• Are snack rosters legible and completed?

  Yes

  No

  N/A

• Are the snack counts reflected in Primero Edge?

  Yes

  No

  N/A

• Record the Snack Count.

• Does the snack count exceed enrollment?

  Yes

  No