Quarterly Choctaw Nation Sample FDPIR Store Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by Trista Winnett

• Location
  Address

• Personnel

Manager

• Can Manager describe the system used to determine food needs when ordering?

  Yes

  No

  N/A

• Can Manager provide procedures for receipt of shipments, etc.?

  Yes

  No

  N/A

• Is the most recent FNS-152 report for this location available?

  Yes

  No

  N/A

• Can manager readily explain how complaints are handled, including verbal complaints, alleging discrimination?

  Yes

  No

  N/A

• Is an updated equipment listing for this location available?

  Yes

  No

  N/A

• Is rodent control being monitored?

  Yes

  No

  N/A

• Are no show clients being contacted, via mail, phone call, home visit, etc.?

  Yes

  No

  N/A

• Is a current OEH Report on hand?

  Yes

  No

  N/A

• Are periodic staff meetings held at this location and documented?

  Yes

  No

  N/A

• Are temperature readings up to date for both cold and dry storage areas?

  Yes

  No

  N/A

• Are mileage logs being monitored?

  Yes

  No

  N/A

Certification Procedures/Management

• Application includes a description of the violations and consequences in understandable terms and in prominent lettering.

  Yes

  No

  N/A

• All forms are up to date to include current information as well as current approval by USDA and the Civil Rights Non-Discrimination Statement.

  Yes

  No

  N/A

• Dual participation controls are in force?

  Yes

  No

  N/A

• Certification procedures are followed as stated in the FNS-501.

  Yes

  No

  N/A

• Documentation of Quality Control of case file review is readily available.

  Yes

  No

  N/A

• Case files are kept in secure storage.

  Yes

  No

  N/A

• Are applications available to all clients and potential clients either in person, by mail, phone, authorized representative, or website?

  Yes

  No

  N/A

Record Retention/Management

• Are records, including training, certification files, issuance logs, commodity receipts, fair hearing records, claims records, management reviews, audit reports, investigations, civil rights complaints, FNS reports, etc. are kept for 3 years?

  Yes

  No

  N/A

Customer Service/Satisfaction

• Are boxes or bags provided to clients for transporting USDA Foods?

  Yes

  No

  N/A

• Is adequate access to the office provided for disabled participants?

  Yes

  No

  N/A

• Is an employee with the ability to speak the Tribes indigenous language available at all times?

  Yes

  No

  N/A

• Can staff readily explain how complaints are handled, including verbal complaints, alleging discrimination?

  Yes

  No

  N/A

• Is assistance provided by staff to participants who are unable to carry their USDA Foods to their car?

  Yes

  No

  N/A

• Is home delivery of USDA Foods provided for those senior citizens and disabled persons who are unable to pick up their USDA Foods at the distribution site?

  Yes

  No

  N/A

• Are special needs of others, such as blind, hearing-impaired, or handicapped participants considered?

  Yes

  No

  N/A

• Is seating adequate to accommodate all participants waiting for service?

  Yes

  No

  N/A

• Are current and upcoming events and activities communicated effectively to FDPIR participants?

  Yes

  No

  N/A

• Is a suggestion box set up for participant input?

  Yes

  No

  N/A

Warehouse Procedures/Compliance

• Are inventory levels below a three month supply?

  Yes

  No

  N/A

• Are claim loss register logs established?

  Yes

  No

  N/A

• Are pallets at least 18" from the wall, 2' from the ceiling and 6" a part?

  Yes

  No

  N/A

• Are all loses reported correctly?

  Yes

  No

  N/A

Staff Interactions/Involvement

• Is a suggestion box set up for employee input?

  Yes

  No

  N/A

• Are employees encouraged to make suggestions for improvements in the program?

  Yes

  No

  N/A

Nutrition Education

• Are on going Nutrition Education incentives being conducted?

  Yes

  No

  N/A

Training

• Is customer service conducted periodically at the distribution site, and are corrective actions undertaken to ensure adequate service is provided to participants?

  Yes

  No

  N/A

• Do employees receive adequate training on customer service, including answering questions in a professional manner, handling complaints, dealing with people in a professional manner, and program facilitation in general, etc.?

  Yes

  No

  N/A

General Compliance

• Are over issuance claims handled by the guidelines set within the FNS-501?

  Yes

  No

  N/A

• Is signage displayed with current guide rates in view for FDPIR participants?

  Yes

  No

  N/A

• Is signage displayed advising FDPIR participants to accept only quantities of USDA Foods that they can consume?

  Yes

  No

  N/A

• Is Civil Rights compliance being met including training staff, outreach materials provided, posters posted, and program materials printed with current statement?

  Yes

  No

  N/A

• Latest version of AIS installed on computers.

  Yes

  No

  N/A

• Is a place available to post public notices of an informational, educational and/or promotional nature?

  Yes

  No

  N/A

Telephone

• Extension/phone answered within three rings.

  Yes

  No

  N/A

• Staff spoke clearly and audibly.

  Yes

  No

  N/A

• Staff used caller's name once known.

  Yes

  No

  N/A

• If person caller requested was not available, did staff offer assistance.

  Yes

  No

  N/A

• Extension/phone answered with department/program name, staff name and offer of assistance.

  Yes

  No

  N/A

• Voice mail recording was answered in three rings, and include a greeting, department/program name, staff's name and message explaining when call would be returned.

  Yes

  No

  N/A

• Staff was informative, courteous, and patient.

  Yes

  No

  N/A

• Was there minimal background noise or interruptions.

  Yes

  No

  N/A

• Staff offered further assistance at end of call never disconnected before caller.

  Yes

  No

  N/A

• Staff made proper referrals for services not provided by said program.

  Yes

  No

  N/A

• Staff was knowledgable, professional, and able to answer questions in a way that was easily understood.

  Yes

  No

  N/A

Staff Interactions with Participants

• Staff acknowledged the guest with eye contact and smile.

  Yes

  No

  N/A

• Staff introduced themselves to guest.

  Yes

  No

  N/A

• Staff speaks first with friendly, polite greeting and offer of assistance.

  Yes

  No

  N/A

• Staff addressed guest by name once known.

  Yes

  No

  N/A

• Staff offered the correct service or referral.

  Yes

  No

  N/A

• Staff was knowledgeable, professional, and able to answer questions in a way that was easily understood.

  Yes

  No

  N/A

• Staff handled request to guest's satisfaction.

  Yes

  No

  N/A

• Staff thanked guest at close of process, offered a referral, and/or extended a parting pleasantry.

  Yes

  No

  N/A

• Staff was well groomed, neatly attired in clean garments.

  Yes

  No

  N/A

• Staff name tag was visible and in good condition.

  Yes

  No

  N/A

• Staff did not slouch, keep hands in pockets or arms folded.

  Yes

  No

  N/A

• Staff made eye contact during interaction.

  Yes

  No

  N/A

Safety

• First aid kits present and easily accessible.

  Yes

  No

  N/A

• Fire extinguishers checked on a monthly basis and documented.

  Yes

  No

  N/A

• Is the physical environment at the office and warehouse neat, orderly, attractive, safe and free of hazards for children?

  Yes

  No

  N/A

• Wet floor signs present if needed.

  Yes

  No

  N/A

• Are evacuation routes clearly posted in case of emergency?

  Yes

  No

  N/A

• Blood born pathogen kit present and easily accessible.<br>

  Yes

  No

  N/A

• Is adequate safety lighting present and working properly?

  Yes

  No

  N/A

Kitchen

• Stove clean?

  Yes

  No

  N/A

• Cabinet tops clean?

  Yes

  No

  N/A

• Trash receptacles well maintained?

  Yes

  No

  N/A

• Floors clean?

  Yes

  No

  N/A

Office Area

• Desk/work areas neat and orderly?

  Yes

  No

  N/A

• Trash receptacle well maintained.<br>

  Yes

  No

  N/A

Store Area/Warehouse

• Checkout stands clean?

  Yes

  No

  N/A

• Is office, store and warehouse maintained at a comfortable temperature?

  Yes

  No

  N/A

• Shelves clean?

  Yes

  No

  N/A

• Shelves adequately stocked?

  Yes

  No

  N/A

• Is lighting adequate in all areas of building?

  Yes

  No

  N/A

• Is a clear path, free of obstacles, maintained for the use of wheeled carts or other devices used to transport food from the warehouse or store to the parking lot?

  Yes

  No

  N/A

General Interior

• Appropriate notices/ materials posted set in a protective sleeve or enclosed in a display case/frame, in good conditions free of stains and damage.

  Yes

  No

  N/A

• Windows and doors were free of prints and smudges.

  Yes

  No

  N/A

• Walls, ceilings, and floors free of spots, dust, and in good condition.<br>

  Yes

  No

  N/A

• Building interior had consistently comfortable air temperature, no odors.

  Yes

  No

  N/A

• Lighting at appropriate level with no burned out light bulbs.

  Yes

  No

  N/A

• Plants/floral fresh, dust free and in good condition.

  Yes

  No

  N/A

• Television turned on, in working condition and at an appropriate sound level.

  Yes

  No

  N/A

• Brochures/reading material in good condition and we'll organized.

  Yes

  No

  N/A

• Restroom walls and floors free of dirt and debris.

  Yes

  No

  N/A

• Restroom toilet, sink, faucet, fixtures, and mirror in good working condition; free of spots and rust.

  Yes

  No

  N/A

• Restrooms stocked with sufficient supplies and waste receptacles well maintained.

  Yes

  No

  N/A

• Garbage receptacles easily located and well maintained.

  Yes

  No

  N/A

• Ample and accurate directional/signs free of markings and in good condition.

  Yes

  No

  N/A

• Furniture free of spots, dust, debris, in good condition, maintained and organized.

  Yes

  No

  N/A

• Area is welcoming and inviting to guest.

  Yes

  No

  N/A

• Interior we'll organized, free of debris, and hazards.

  Yes

  No

  N/A

General Exterior

• Driveway area and curb in good condition, free of stains and damage.

  Yes

  No

  N/A

• Planters, lawn and walkways were well kept, mowed and trimmed.

  Yes

  No

  N/A

• Entrance area in good condition, free of stains and damage.

  Yes

  No

  N/A

• Exterior walls free of markings, free of stains and damage.

  Yes

  No

  N/A

• Ample and accurate directional/informational signs on grounds, free of markings and in good condition.

  Yes

  No

  N/A

• Premises free of debris.

  Yes

  No

  N/A

• Adequate parking space available.

  Yes

  No

  N/A

• Sufficient illumination in all outside areas.

  Yes

  No

  N/A

• Free of hazards.

  Yes

  No

  N/A

Case File Reviews

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question checked

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of Action

  Yes

  No

  N/A

• Complete worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal conscientious

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question asked

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question qnswered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS cards in file

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

• Proof of Tribal descent

  Yes

  No

  N/A

• SS card

  Yes

  No

  N/A

• Address verification

  Yes

  No

  N/A

• Income verification

  Yes

  No

  N/A

• Complete application

  Yes

  No

  N/A

• Complete notice of action

  Yes

  No

  N/A

• Complete income worksheet

  Yes

  No

  N/A

• Other verification as needed

  Yes

  No

  N/A

• Well explained narrative

  Yes

  No

  N/A

• SNAP question answered

  Yes

  No

  N/A

• File complete and passes audit

  Yes

  No

  N/A

Audit Summary