CACFP Time and Task Form for Centers INSTRUCTIONS: This form must be completed for staff performing Child and Adult Care Food Program (CACFP) duties if any CACFP funds are used for wages. For each day worked enter the start time, end time and the total hours worked for the day. Indicate the number of CACFP hours worked on food service, administration, and total CACFP hours. Examples of CACFP duties include, but are not limited to: menu planning, grocery shopping, cooking and serving meals, clean-up after meals, processing Enrollment & Income Eligibility Forms, consolidating meal attendance, etc. Employee Name Month/Year (please print legibly) TOTAL HOURS WORKED CACFP HOURS WORKED TOTAL HOURS WORKED CACFP HOURS WORKED Total Total Total Total Food CACFP Food CACFP Start Time End Time Hours CACFP Start Time End Time Hours CACFP Date Date Service Admin Service Admin Worked Hours Worked Hours 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 16 TOTAL TOTAL I certify that this is an accurate record of the number of hours worked on the Child and Adult Care Food Program. Date Employee’s Signature
CACFP Time and Task Form for Centers INSTRUCTIONS: This form must be completed for staff performing Child and Adult Care Food Program (CACFP) duties if any CACFP funds are used for wages. For each day worked enter the start time, end time and the total hours worked for the day. Indicate the number of CACFP hours worked on food service, administration, and total CACFP hours. Examples of CACFP duties include, but are not limited to: menu planning, grocery shopping, cooking and serving meals, clean-up after meals, processing Enrollment & Income Eligibility Forms, consolidating meal attendance, etc. Employee Name (please print legibly) Month/Year TOTAL HOURS WORKED CACFP HOURS WORKED TOTAL HOURS WORKED CACFP HOURS WORKED Date Start Time End Time Total Hours Worked Food Service CACFP Admin Total CACFP Hours Date Start Time End Time Total Hours Worked Food Service CACFP Admin Total CACFP Hours 1 17 2 18 3 19 4 20 5 21 6 22 7 23 8 24 9 25 10 26 11 27 12 28 13 29 14 30 15 31 16 TOTAL TOTAL I certify that this is an accurate record of the number of hours worked on the Child and Adult Care Food Program. Employee’s Signature Date