11. List enrichment activities offered on day of review: Meal Observation 12. Meal Observed: Breakfast Lunch Supper Snack 1 Snack 2 Meal not observed 13. Is the meal served at the approved time as indicated on the site application? Yes No □ □ Observed Meal Menu Milk: M/MA: Veg: Fruit/Veg: Grain: Fat-free □ Fat-free flavored □ 1% Low fat □ Serving Size: Serving Size: Serving Size: Serving Size: Whole □ 14. Does the meal meet the meal pattern(s) requirements? Yes No □ □ 15. Do the minimum portions served meet the meal requirements for each Yes No □ □ 16. age If group? Offer vs. Serve is used, is it used correctly? Yes No N/A □ □ □ 17. Is an adequate supply of all food components available? Yes No □ □ 18. Are medical statements on file for participants with special dietary Yes No □ □ 19. needs? Explain site’s system for tracking attendance and meal counts: 20. Are the daily meal count and attendance records correct, complete and no, explain: Yes No N/A 21. Does the site have completed delivery tickets on file? □ □ □ Yes No 22. Do menus meet all requirements of CACFP? □ □ If no, explain: 23. For the five previous serving days, record the attendance and meal counts for each meal served Date Total Breakfast Total Total Snack 1 Total Snack 2 Total 1. Attendance 2. 3. 4. 5. 5-Day Average Note: To determine 5-day average, total each column, divide by 5 and round up if needed. Today’s Count
11. List enrichment activities offered on day of review: Meal Observation 12. Meal Observed: Breakfast Lunch Supper Snack 1 Snack 2 Meal not observed 13. Is the meal served at the approved time as indicated on the site application? □ Yes □ No Observed Meal Menu Milk: □ Fat-free □ Fat-free flavored □ 1% Low fat □ Whole M/MA: Serving Size: Veg: Serving Size: Fruit/Veg: Serving Size: Grain: Serving Size: 14. Does the meal meet the meal pattern(s) requirements? □ Yes □ No 15. Do the minimum portions served meet the meal requirements for each age group? □ Yes □ No 16. If Offer vs. Serve is used, is it used correctly? □ Yes □ No □ N/A 17. Is an adequate supply of all food components available? □ Yes □ No 18. Are medical statements on file for participants with special dietary needs? □ Yes □ No 19. Explain site’s system for tracking attendance and meal counts: 20. Are the daily meal count and attendance records correct, complete and no, explain: 21. Does the site have completed delivery tickets on file? □ Yes □ No □ N/A 22. Do menus meet all requirements of CACFP? □ Yes □ No If no, explain: 23. For the five previous serving days, record the attendance and meal counts for each meal served Date Total Attendance Breakfast Total Total Snack 1 Total Snack 2 Total 1. 2. 3. 4. 5. 5-Day Average Note: To determine 5-day average, total each column, divide by 5 and round up if needed. Today’s Count