Fillable SCHOOL NUTRITION PROGRAM (West Virginia Department of Education)

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SCHOOL NUTRITION PROGRAM (West Virginia Department of Education)

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SCHOOL NUTRITION PROGRAM
SITE MONITORING REVIEW
SCHOOL NAME:
CURRENT ENROLLMENT:
CEP or Non CEP
MEAL OBSERVED:
Lunch
Breakfast
DATE:
ARRIVAL TIME:
DEPARTURE TIME:
SERVING TIME:
OVS or Serve
Monitor the entire meal count by
observation and interview – from benefit
issuance until meals are counted and
recorded on the report to the district
office and answer the following
questions. Document any issues needing
corrective action,
Today’s Menu (Record all Food Items Served and Serving Sizes)
YES
NO
1. Strategy:
Traditional Grab & Go Breakfast in the Classroom Second Chance
Other:
2. Is a civil rights poster displayed in a prominent location at the site?
3. Is the most recent food safety inspection or notice advising the public of the availability of its
review posted?
4. Signage identifying what constitutes a reimbursable meal visible for students?
MEALS SERVED/MEAL COUNTS
1. Do all of the meals served and claimed contain all required food components?
2. Are all menu items available to students?
3. Does the assigned person recognize a reimbursable meal?
4. Are correct portion sizes being used on all serving lines?
5. If Offer vs. Serve is used: How many menu items must a student select today? __________
6. If offer vs. serve is utilized at this site, does each student have the opportunity to select his/her
own food items for the reimbursable meal?
7. Are only reimbursable meals (those meals priced as a unit and meeting menu pattern
requirements) recorded for reimbursement at point of service?
8. Are meal counts taken at the point of service or an OCN approved alternative? Describe
9. Is there a method for counting non-reimbursable meals separately from reimbursable meals
(Example: second meals, extra milk, meals that do not meet meal pattern)
10. Are adequate procedures in place to prevent the claiming of more than one reimbursable
breakfast/lunch per day per child?
11. Does the system prevent overt identification of the children eligible for free and reduced price
meals?
12. Does the cashier know the policies for: A la carte?
Second Meals?
Adult Meals?
13. Is a trained back up cashier available?
14. Are there procedures for meal counting and claiming when the primary counting and claiming
system is not available?
15. Is free water available to all students in the meal service location?
16. Does school adhere to WVDE required meal times (only applicable to public schools)
Each students must have 10 minutes for breakfast/ 20 minutes for lunch.
17. Is special dietary needs documentation on file for meals not meeting the USDA meal pattern?
HACCP/FOOD SAFETY
1. Is Food Safety Checklist updated for the past month?
2. Is HACCP plan available and employees have signed?
3. Is staff following HACCP plan and standard operating procedures?
4. Are thermometers located in all refrigerators and freezers and temperatures documented daily?
5. Are dishwasher temps up to date?
6. Were thermometer calibration checklist complete?
7. Are food Temps documented for day of service and prior day/month?
8. Does the sanitizer solution have the correct pH?
9. Were onsite storage violations observed?
PRODUCTION
1. Were production records completed for the meal reviewed?
2. Do production records match inventory records?
3. Are production records filled out completely?
4. Do production records show that adequate amounts of food prepared for the last 5 days?
5. Is proper documentation kept to support meal pattern compliance (i.e. CN labels, ingredient
statements, nutrition facts labels, recipes)?
6. Production records match PRIMERO records for date; ______________________
If no explain:
SMART SNACKS, if applicable
1. Are items in the vending machine(s) Smart Snack compliant?
2. Are food fundraisers Smart Snack complaint?
3. Does the school prohibit foods containing non-nutritive sweeteners (only applicable to public
schools)?
4. Does the school prohibit foods containing caffeine (only applicable to public schools)?
SHARE TABLES
1. Does school have a share table?
2. If applicable, does school follow the county share table plan?
MEAL CLAIMING
Are internal controls (edits, monitoring, etc.) established to ensure that daily counts do not
exceed the number of students eligible or in attendance and that an accurate claim is made?
Record today’s meal counts by category and compare to the total number of students
eligible by category
Number of Students
Approved by Category
Today’s Meal Counts
by Category
FREE
REDUCED
PAID
CORRECTIVE ACTION: Corrective Action Plan required for any “No” answers above -be sure to
specify date corrective action(s) will be implemented:
TECHNICAL ASSISTANCE:
_______________________________________________
School Representative
________________________________________________ _________________________
SFA Reviewer
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SCHOOL NUTRITION PROGRAM (West Virginia Department of Education)

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Completed 18 November 2020

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