Child Nutrition Program Self Assessment Checklist

Transcription

1 Child Nutrition Program Self Assessment Checklist The Self Assessment Checklist (SAC) can be used by a Contract Entity (CE) to evaluate its program and identify areas for improvement. To be in compliance, CE staff should be able to respond "YES" to the questions. Questions are separated by topics. Additional information can be found in referenced section in the Administrator's Reference Manual (ARM). If the assessment reveals areas that need improvement, CE staff should refer to their Education Service Center (ESC) CNP Calendar for training opportunities and inform their ESC Child Nutrition Specialist to request technical assistance. APPLICATION /AGREEMENT (ARM, SECTION 2) Is the reviewing official title, listed on the Public Media Release the same as that indicated in the NSLP Contract Entity(CE) Application on TX UNPS? Is the hearing official title, as indicated on the Notice/Letter to Households the same as that indicated in the NSLP CE Application on TX UNPS? Is the hearing official a person who is not involved in the determination, confirming and/or verification process? Is the collection procedure in use at each serving site the same as the approved collection procedure in the Policy Statement, Attachment B? (Attachment B is located on TX UNPS, under Downloadable Forms, and must be downloaded, filled out and sent to TDA.) Is a copy of the free and reduced price meals Policy Statement (AttachmentB) available to each campus in the district? Is the medium of exchange for free, reduced price and paid meals: Coded in a manner that does not cause overt identification of children receiving free and reduced price meals? (Prohibited codes include color coding, single digits and use of obvious identifiers such as F, R and P). Available through prepayment or charging thus making free and reduced price meal b. recipients appear as students who have prepaid or charged? Distributed using a common location at a common time for all students to obtain their c. tickets or tokens? Collected in a manner that ensures that the same procedures are used for all categories of d. meals? Did the Contract Entity (CE) send out a Public Media Release (Attachment C) to the media and community/grass roots organizations that includes the letter to parents, application form and the complete income eligibility guidelines? Was a copy of the newspaper article or the letter of transmittal page, along with the media package, kept as documentation? CE Child Nutrition Programs DO NOT have to pay for the Public Media Release to be published. CE must only show proof that a Public Media Release was sent to local news medias for publication. The actual medium can be a local news paper, school paper or newsletter. Has the CE updated SITES (all schools with TEA # and their total enrollment, eligible students, percentages, etc.) as part of the annual renewal process through the TX UNPS? 8. What if the district needs to Amend the Policy Statement? ELIGIBILITY (ARM, SECTION 4)

2 THIS SECTION IS NOT APPLICABLE TO RCCI's WITHOUT DAY STUDENTS Are the CE's free and reduced price meal applications readily retirevable by campus? Were the current school year's applications, notice/letter to households and eligibility guidelines used by each school in the CE? Are the parents or guardians of all children enrolled in the CE given a free and reducedprice meal application at the beginning of the school year? Are foreign language translations available or is a translator available? Have the applications been reviewed for accuracy? Do all income applications include: * name(s) of student(s) for whom application is made? * names of all household members? * signature of an adult household member? social security number of the adult who signed the application (LAST FOUR * NUMBERS OF THE SSN) OR indication that he/she does not have one? * income of each household member, by source? * NO income boxes checked, if no income? b. Do all SNAP/TANF applications include: * name(s) of student(s)? valid SNAP/TANF number (Eligibility DeterminationGroup * Number/SAVVERS/TIERS)? (10 digit numbers are case numbers only!) * signature of an adult household member? c. Are all foster and institutionalized children on individual applications? Is the CE using a Multiple Child or Multiple Use Application? Was the correct eligibility determination made for each application processed? Are all children in the household receiving the same level of benefits? EXCEPTION: Siblings of Head Start, Early Head Start, Even Start, Migrant, or Homeless students may receive a different level of benefit. Does the CE have a system for Zero Income Applications (applications indicating "zero income" or "not working"): If the household enters 0 as income, it should be processed as an income application and the student(s) would be certified eligible for free meals. The eligibility will be valid for the entire school year, plus the first 30 operating days of the following school year. If benefits are being increased, are they changed within 3 operating days? If benefits are being reduced or terminated, are they changed withing 10 calendar days? NOTE: At the beginning of a new year once they turn in a new application the status is immediate NO GRACE PERIODS ARE GIVEN AS IT IS A NEW YEAR & A NEW APPLICATION. ELIGIBILITY (ARM, SECTION 4) (continued)

3 1 All CE's are required to use the Direct Certification (DC) list. (DC lists are not available to private schools, but Districts are allowed to share with private schools in their are) Is an original DC list kept on file at the CE? b. Is the CE updating the second list as needed? c. Is the CE updating the DC list monthly (with dates of enrollment)? d. Are benefits being issued for the entire year? e. Are the DC benefits being extended to all household members? f. Are the names of those enrolled students that DC is being extended to added to the DC list or clearly noted on the master roster with effective dates? g. What documentation is the district using to denote that DC benefits are extended to all household members? (Please explain.) h. How is district identifying other siblings in the district to extend the benefits? (Please explain.) i. Is the CE maintaining each year's list for 5 years (public and charter schools)? 1 Is the Notice of Predetermined Eligibility (Letter) sent to the parent or guardian of each directly certified student? 1 Does the Notice of Predetermined Eligibility Include: Their children are eligible for free meals? b. No further application is required? c. The household should notifiy the LEA if they do not want their children to receive free benefits? 1 Is the date that the notice is sent noted beside the name of the student on the direct certification (DC) list or elsewhere? What if a predetermined eligible submits an application? VERIFICATION (ARM, SECTION 6) THIS SECTION IS NOT APPLICABLE TO RCCI's WITHOUT DAY STUDENTS. Based on count taken of approved meal applications on file on October 1, were an adequate number of meal applications selected for verification? Did the CE conduct the BASIC Error Prone Method of verification? Were the applications reviewed for accuracy by confirming official PRIOR to verification? If the application was incorrectly approved, did the household receive an adverse action letter? b. Was a new application pulled for verification? c. Did the confirming official sign on the application? d. Is the confirming official's signature different than the reviewing official's signature? If the CE has a technology based system: Has the CE requested a waiver to review apps as part of the verification process? b. Does the CE have the letter on file? During Verification: Was all required documentation obtained during the verification process? b. Were 4 consecutive weeks used to determine the household's income? VERIFICATION (ARM, SECTION 6) (Continued) c. On the non response households, was a follow up done?

4 d. Was the follow up notification documented and signed on the application? Was the verification process completed by November 15th? Is the verification process documented on the application? b. Is the information documented on the CE Verification Summary in TX UNPS? Is the CE Verification Summary completed, signed by verifying official and on file? 8. Is the Verification Record used for each application? Are households whose benefits must be reduced or terminated given the required 10 day 9. notification prior to the change? If families are removed from the program, and reapply by February... must be reported in TX UNPS by March 1st. COUNTING & CLAIMING (ARM, SECTION 7) Is the count, by category, taken at the point of service? If the cashier is at the beginning of the line, is there a monitor stationed at the end of the line who removes any meal from the count that does not contain sufficient components in order to claim reimbursement? In family style meal service, does the supervising adult ensure the minimum required portions are available on the table, including choice of milk? Is there a system in place to ensure that second meals are not claimed for reimbursement? Is there a trained substitute cashier? After viewing the collection procedure in operation, does it appear that it yields an accurate count by category? Observe the cashier(s) at the end of the serving period to ensure that the count as taken on the line is the same as that reported on the daily record. Perform the same procedures the cashier performs. Count the number of meals by category from the tickets, roster, etc. and compare your numbers to the cashier's reported numbers. Compare the counts by category taken on the day of the review to counts recorded for prior days that month to determine if they are reasonable. Have a report run from the point of sale to show what meals were served and what level of benefits were provided to students. Manually count the categories and check against what the report shows is the count. Look for adult meals or a la carte sales being put in the free or reduced price category If there is more than one serving line, are the counts from all lines properly consolidated? Is the master roster/list current? Do the names on the list of eligible students match approved applications on file and on the categorical eligible (DC, DC Extension (DCE), Migrant, Foster, Homeless, Runaway, Head Start, Early Head Start, and Even Start) lists? If more than one master roster/list is used are all lists the same? Are changes due to withdrawals, transfers, etc. reflected on the list or on another tracking document dated and initialed by responsible person? Is the count of eligible students updated on a daily basis or in a timely manner? Are attendance adjusted eligible students by category compared to daily meal counts for 1 each school (Accuclaim Edit Check )? COUNTING & CLAIMING (ARM, SECTION 7) (Continued)

5 When the daily meal counts by category exceed the Average Daily Attendance (ADA), is the validity of the count examined and documented prior to the submission of the claim? 1 Are counts on the daily record of meals served that reflect patterns of numbers; repetition of numbers; constant counts by category; served count equal to delivered count; identical counts for breakfast and lunch; 100% participation; or category counts exceeding the number of eligible students: 1 Researched for errors? b. Corrected as required? Are prepaid and charged meals counted on the day served, not the day the money is 1 collected? Are students issued an original and a minimum of three replacement meal tickets or are special meal arrangements allowed before a student is charged for the fourth replacement 1 ticket? Is an On Site Review of the lunch meal (or breakfast for breakfast only schools) counting and claiming procedure completed and documented prior to February 1st, unless the CE 1 has only one feeding site? 18. Is corrective action of the counting and claiming procedure developed as needed? Is a follow up review conducted within 45 calendar days to ensure that corrective action 19. was taken? Does CE qualify for Severe Need Breakfast? 20. Is district receiving Severe Need Supplement, noted on monthly claim? BREAKFAST PROGRAM (ARM, SECTION 8) Food Based Menu Planning, Current Requirements Is the CE using Food Based Menu Planning System? If CE answered NO, what Menu Planning System is CE using for Breakfast? Are each of the required food items offered on every breakfast menu? Have all CE BREAKFAST recipes been checked to ensure that they actually contribute the expected yield per serving? Are the purchased prepared items documented the same as those received, prepared and served in all of the CE's kitchens? This is determined by using the Food Buying Guide for Child Nutrition Programs, the amount of creditable ingredients called for in the recipe, and the number of portions the recipe yields to determine contribution per portion. Is a CN Label or signed manufacturer's specification, with regard to the contribution of all purchased prepared meat/meat alternate food items, on file? Documentation is not required for products that are 100% meat and can be weighed in the cooked state; for example 100% beef patty. It is recommended to have a MMA Product Analysis Sheet specifying how many ounces of product must be served to yield your desired MMA equivalent. Product labels attached to the back of food production records are an easy way to monitor the products actually used in each of the CE's kitchens. BREAKFAST PROGRAM (ARM, SECTION 8) Cont'd.

6 Child Nutrition Program Self Assessment Checklist Does the CE utilize Offer versus Serve at Breakfast? Please specify age/grade groups that practice Offer vs Serve: Has or will the CE conduct(ed) any activities to promote participation in the School 1 Breakfast Program (SBP)? 18. Have all barriers to participation in the SBP been removed? Example: Bus schedules are changed so students have time to eat breakfast and/or breakfast is offered during nontraditional hours. 19. Targets for growth in the SBP: Has the CE set targets for growth in the SBP? b. Have they met those targets? 20. Are CE's child nutrition menus evaluated for variety, appeal and acceptability? 2 Are complete food production records maintained on all breakfasts claimed for reimbursement? Do Breakfast Food Production Records show: planned numbers by age/grade group? separate planned numbers for adults / a la carte? accurate case numbers (Ex: 8 cs)? serving portions defined (EX: 144/1, 59 svg/cs, 25 svg / #)? accurate meal contributions (Ex: 2oz MMA, 2ozG, V or F)? other required information (L.O. from w/ date, pounds, etc.)? If breaded fruit products are used, is a CN Label or manufacturer's specification regarding their contribution to the meal pattern on file? Are 100% juice based drinks that are used to contribute to the lunch pattern credited properly, to not exceed half of the day's requirement for fruit? Are utensils that yield standard sized servings used for portioning all menu items? Does the CE offer a variety of milk during the BREAKFAST meal? Variety is defined as different flavors, or fat grades. Milk includes skim flavored & unflavored and 1% unflavored. Is the variety of milk offered on every reimbursable line throughout the entire breakfast serving period, including breakfast in the classroom? Is each student permitted to select from the required choices of milk? Are all required components offered in sufficient amounts BEFORE the cashier counts the meal as reimbursable? If the CE is operating under Offer vs Serve, is the student allowed to select his/her choice from the number of food items offered? Please describe how menus are evalutate at your district? (Example: staff or student advisory committee) Do the portion sizes of the served menu appear to match portion sizes of the planned menu? Is the menu meeting the required nutrient standards for calories, fat and all other required 2 nutrients? BREAKFAST PROGRAM (ARM, SECTION 8) Cont'd.

7 2 2 Are all items on the served menu accounted for on the planned menu and nutrient analysis? Are CE's child nutrition menus evaluated for variety, appeal and acceptability? Please describe how menus are evalutate at your district? (Example: staff or student advisory committee) If the CE is on the Assisted Nutrient Standard Menu Planning System, did TDA review and approve the menu planning system prior to implementation? (The review is required if the 3 CE changed their menu planning system after May 200) LUNCH PROGRAM (ARM, SECTION 9) Is the CE using a Food Based Menu Planning System? Are each of the required food items offered on every lunch menu by age/grade group? (please assess each age/grade group K 5, 6 8 & 9 12 on following sheets) Do Lunch Food Production Records show: planned numbers by age/grade group? separate planned numbers for adults / a la carte? accurate case numbers (Ex: 8 cs)? serving portions defined (EX: 144/1, 59 svg/cs, 25 svg / #)? accurate meal contributions (Ex: 2oz MMA, 2ozG, V or F)? other required information (L.O. from w/ date, pounds, etc.)? Is CE implementing Cycle Menus? Is CE offering choices? Does each serving line meet the minimum requirements for menu planning? Are 100% juice based drinks that are used to contribute to the lunch pattern credited properly, to not exceed half of the day's requirement for fruit? Are utensils that yield standard sized servings used for portioning all menu items? Does the CE offer a variety of milk during the LUNCH meal? Variety is defined as different flavors, or fat grades. Milk includes skim flavored & unflavored and 1% unflavored. Is the variety of milk offered on every reimbursable line throughout the entire lunch serving period on all lines, including lunch in the classroom or field trips? Is each student permitted to select from the required choices of milk? Are all required components offered in sufficient amounts BEFORE the cashier counts the meal as reimbursable? If the CE is operating under Offer vs Serve, is the student allowed to select his/her choice from the number of food items offered? K 5 MENU PATTERN Does the planned menu and nutrient analysis meet the nutrition standards for the week? Are appropriate substitutions being made within the 2 week time frame? Is the menu planning pattern well advertised to the students? Does the cashier know the minimum amount of items the students may choose? Are children notified that extra sides taken would be charged? Food Based Menu Planning Do all reimbursable meals contain either a of FRUIT or of VEGETABLE (any subgroup) on each reimbursable tray?

8 M/MA Fruit Veggies DGV Child Nutrition Program Self Assessment Checklist Is the CE planning the daily minimum MMA portion required and NOT exceeding the weekly goal (maximum)? (1 oz/ day & 8 10oz / week) Is the CE planning the daily minimum Fruit portion required and meeting the weekly goal? ( per day & 2 per week) Is the CE planning the daily minimum Vegetable portion required and meeting the weekly subgroup goals? (3/4c per day & 3 3/4c per week) Is CE planning vegetable subgroups on the same day, on differing lines, thus limiting a student from selecting both? Dark Green Leafy Vegetables (RAW) are credited as half the volume? Is CE meeting weekly DGV goal? (list veggies & amounts that meet weekly goal) G/B ROV 3/4c BPL SV OV Add V 1c GB doc. Red Orange Vegetables Is CE meeting weekly ROV goal? (list veggies & amounts that meet weekly goal) Beans Peas & Legumes Is CE meeting weekly BPL goal? (list veggies & amounts that meet weekly goal) Do any menus offering dry peas or beans as contributing to the MMA component EXCLUDE the the use of the BPL Vegetable subgroup component in the same meal? Starchy Vegetables Is CE meeting weekly SV goal? (list veggies & amounts that meet weekly goal) Other Vegetables Is CE meeting weekly OV goal? (list veggies & amounts that meet weekly goal) Additional Vegetables Is CE meeting weekly AV goal? (list veggies & amounts that meet weekly goal) Is the CE planning the daily minimum GB portion required and not exceeding the weekly goal (maximum)? (1 oz / day & 8 9 oz / week) Does the CE have Whole Grain Rich (WGR) product documentation for all products? Label / Ingredients? Recipes? Group A? OR Group B? No Documentation for WGR products (lists products missing supporting documentation): Is CE planning half of the Grains from Whole Grain Rich sources? (please list ex:) 1/2 servings are WGR Is CE not exceeding 2 grain based desserts per week? Is the variety of milk offered on every reimbursable line throughout the entire lunch serving period? (1 c / day & 5 c / week) Milk Dietary Specifications Weekly Average Requirements Does each cycle menu meet minimum & not EXCEED maximum Calorie ranges? Calories ( average calories / week) Does each cycle menu NOT exceed the Sodium restrictions? <1230 mg average / week Sodium (Sodium restrictions begin SY 2014/2015) Sat Fat Is each cycle menu average < 10% of total calories from Saturated Fat average / week? Dietary Specifications Daily Requirement Trans Fat Please cirle kinds: 6 8 MENU PATTERN Skim (Flavored), Skim (Unflavored), 1% (Unflavored), other: Are all items on menu denoted as containing "ZERO" grams of Trans fat per serving on a daily basis? (Note: FDA allows products w/ less than.5gm / serving to count as zero. Excludes naturally occurring fats.)

9 M/MA Fruit Veggies DGV Child Nutrition Program Self Assessment Checklist Is the CE planning the daily minimum MMA portion required and NOT exceeding the weekly goal (maximum)? (1 oz/ day & 9 10oz / week) Is the CE planning the daily minimum Fruit portion required and meeting the weekly goal? ( per day & 2 per week) Is the CE planning the daily minimum Vegetable portion required and meeting the weekly subgroup goals? (3/4c per day & 3 3/4c per week) Is CE planning vegetable subgroups on the same day, on differing lines, thus limiting a student from selecting both? Dark Green Leafy Vegetables (RAW) are credited as half the volume? Is CE meeting weekly DGV goal? (list veggies & amounts that meet weekly goal) ROV 3/4c BPL Red Orange Vegetables Is CE meeting weekly ROV goal? (list veggies & amounts that meet weekly goal) Beans Peas & Legumes Is CE meeting weekly BPL goal? (list veggies & amounts that meet weekly goal) Do any menus offering dry peas or beans as contributing to the MMA component EXCLUDE the the use of the BPL Vegetable subgroup component in the same meal? G/B SV OV Add V 1c GB doc. Starchy Vegetables Is CE meeting weekly SV goal? (list veggies & amounts that meet weekly goal) Other Vegetables Is CE meeting weekly OV goal? (list veggies & amounts that meet weekly goal) Additional Vegetables Is CE meeting weekly AV goal? (list veggies & amounts that meet weekly goal) Is the CE planning the daily minimum GB portion required and not exceeding the weekly goal (maximum)? (1 oz / day & 8 9 oz / week) Does the CE have Whole Grain Rich (WGR) product documentation for all products? Label / Ingredients? Recipes? Group A? OR Group B? No Documentation for WGR products (lists products missing supporting documentation): 1/2 servings are WGR Milk Dietary Specifications Weekly Average Requirements Does each cycle menu meet minimum & not EXCEED maximum Calorie ranges? Calories ( average calories / week) Sodium Does each cycle menu NOT exceed the Sodium restrictions? <1360 mg average / week (Sodium restrictions begin SY 2014/2015) Sat Fat Is each cycle menu average < 10% of total calories from Saturated Fat average / week? Dietary Specifications Daily Requirement Trans Fat Is CE planning half of the Grains from Whole Grain Rich sources? (please list ex:) Is the variety of milk offered on every reimbursable line throughout the entire lunch serving period? (1 c / day & 5 c / week) Please cirle kinds: Skim (Flavored), Skim (Unflavored), 1% (Unflavored), other: Are all items on menu denoted as containing "ZERO" grams of Trans fat per serving on a daily basis? (Note: FDA allows products w/ less than.5gm / serving to count as zero. Excludes naturally occurring fats.) 9 12 MENU PATTERN

10 M/MA Fruit Veggies DGV ROV 1 1/4c BPL Child Nutrition Program Self Assessment Checklist Is the CE planning the daily minimum MMA portion required and NOT exceeding the weekly goal (maximum)? (2 oz/ day & oz / week) Is the CE planning the daily minimum Fruit portion required and meeting the weekly goal? (1c per day & 5c per week) Is the CE planning the daily minimum Vegetable portion required and meeting the weekly subgroup goals? (1c per day & 5c per week) Is CE planning vegetable subgroups on the same day, on differing lines, thus limiting a student from selecting both? Dark Green Leafy Vegetables (RAW) are credited as half the volume? Is CE meeting weekly DGV goal? (list veggies & amounts that meet weekly goal) Red Orange Vegetables Is CE meeting weekly ROV goal? (list veggies & amounts that meet weekly goal) Beans Peas & Legumes Is CE meeting weekly BPL goal? (list veggies & amounts that meet weekly goal) Do any menus offering dry peas or beans as contributing to the MMA component EXCLUDE the the use of the BPL Vegetable subgroup component in the same meal? G/B SV OV 3/4c Add V 1 GB doc. Starchy Vegetables Is CE meeting weekly SV goal? (list veggies & amounts that meet weekly goal) Other Vegetables Is CE meeting weekly OV goal? (list veggies & amounts that meet weekly goal) Additional Vegetables Is CE meeting weekly AV goal? (list veggies & amounts that meet weekly goal) Is the CE planning the daily minimum GB portion required and not exceeding the weekly goal (maximum)? (1 oz / day & 8 9 oz / week) Does the CE have Whole Grain Rich (WGR) product documentation for all products? Label / Ingredients? Recipes? Group A? OR Group B? No Documentation for WGR products (lists products missing supporting documentation): 1/2 servings are WGR Milk Is CE planning half of the Grains from Whole Grain Rich sources? (please list ex:) Is the variety of milk offered on every reimbursable line throughout the entire lunch serving period? (1 c / day & 5 c / week) Please cirle kinds: Skim (Flavored), Skim (Unflavored), 1% (Unflavored), other: Dietary Specifications Weekly Average Requirements Does each cycle menu meet minimum & not EXCEED maximum Calorie ranges? Calories ( average calories / week) Does each cycle menu NOT exceed the Sodium restrictions? <1420 mg average / week Sodium (Sodium restrictions begin SY 2014/2015) Sat Fat Is each cycle menu average < 10% of total calories from Saturated Fat average / week? Dietary Specifications Daily Requirement Are all items on menu denoted as containing "ZERO" grams of Trans fat per serving on a daily basis? Trans Fat (Note: FDA allows products w/ less than.5gm / serving to count as zero. Excludes naturally occurring fats.) AFTERSCHOOL CARE PROGRAM (ARM, SECTION 10) Does the CE follow the correct meal pattern for reimbursement?

11 Child Nutrition Program Self Assessment Checklist Does the CE review the program within the first 4 weeks of the program? (Afterschool Care Program On Site Monitoring Checklist) Is the program reviewed a second time by the CE during the school year? If the site requires a corrective action plan, is the plan completed and reviewed within 45 calendar days of the original site visit? Does the CE conduct any outreach to increase participation? Were the snacks claimed according to the CE's eligibility? Does the CE have Food Production Records to show that a reimbursable snack is being provided to children? Do Snack Food Production Records show: planned numbers by age/grade group? separate planned numbers for adults / a la carte? accurate case numbers (Ex: 8 cs)? serving portions defined (EX: 144/1, 59 svg/cs, 25 svg / #)? accurate meal contributions (Ex: 2oz MMA, 2ozG, V or F)? 8. other required information (L.O. from w/ date, pounds, etc.)? 9. Does the program include an educational/enrichment activity? SEAMLESS SUMMER OPTION (ARM, SECTION 12) Is the CE participating in the Seamless Summer Option (SSO)? (if applicable) Does the CE follow the same menu planning system as served during the prior school year? Does the CE have Food Production Records to show that a reimbursable meal is being provided to children? Are the children 18 years old and under? Any child 18 years of age and under and those person over age 18 who meet the federal definition of mentally or physically disabled may receive meals under the SSO free of charge. Does the CE have a non discrimination poster "And Justice For All" displayed in a prominent place in the cafeteria area? (Dinning Area) Has the CE advertised the Seamless Summer Option? Has the CE reviewed each summer site for meal counting, claiming and meal patterns within the first 3 weeks of the program start? Does the CE practice Offer vs Serve? Is Offer vs Serve being implemented correctly? Are all CE Summer Seamless Option (SSO) sites open sites? (Open to public.) Has each non school feeding site had a health inspection to ensure that all foods served and prepared are following HACCP requirements, including, but not limited to handwashing requirements, receiving and holding temperatures, to ensure food safety? 10. ACCOMMODATING CHILDREN WITH SPECIAL DIETARY NEEDS (ARM, SECTION 13) Are students with medical or special dietary need provided access to program benefits as prescribed by regulations?

12 Child Nutrition Program Self Assessment Checklist Is a doctor's note on file if menu substitutions are being made to claim a reimbursable meal, for disabled students? MILK RULES Does the student meet the definition for Disability 504? * If yes, the CE must make substitutions as specified by a doctor ONLY. * If no, the CE may make substitutions as specified by a doctor or parent. * If making substitutions, they must meet standards. * The CE may NOT substitute juice or water for a milk, OFFER vs SERVE must be in place. Under Offer vs Serve, milk is not required to be on the plate of a student. If the student is offered a juice as a beverage (not the fruit), and NOT to replace the milk, then the juice cannot count as one of the 3 reimbursable items on the tray. IF juice is offered as a fruit, and the student elects the juice as his fruit, and opts not to take the milk, due to allergy or intolerance, then the juice CAN count as one of the 3 items to contribute toward a reimbursable meal. FINANCIAL (ARM, SECTION 14) Are records maintained for a period of five years (Public and Charter Schools) (Three years for Private and RCCI's) after the final claim for reimbursement for the fiscal year or until after resolution of any audits or reviews? Are records readily retrievable? Are records available for review? 8. Does the record keeping system separate program income by adult and student sales? Are program expenditures kept by food, labor and other? Was the remaining fund balance carried forward from last year to this year? School Nutrition Program Funds: Are the school food service account's net cash resources less than three month's operating expenditures? b. If not, is documentation on file explaining reasons for the excess? c. Was a plan to reduce or use surplus resources submitted to TDA? Is interest earned on invested school nutrition program revenues credited to the school food service account? Do all employees paid from the school food service account have direct responsibility to 9. the operation of the program? Do daily deposit slips balance with the bank's monthly statement for the non profit school 10. food service account? The district will need to produce a complete Chart of Accounts for the prior school year. Have month of review expenditures and revenues. Prior year's monthly balances. MEAL PRICING (ARM, SECTION 15) Are all serving areas where meals are claimed for reimbursement available to all students (free, reduced price, and full paying students)? Meals sold on all cash lines cannot be claimed for reimbursement.

13 Are meals priced as a unit? If reimbursable premium meals are offered to the students, are free and reduced price meal recipients given the option of receiving the premium meal at no additional charge? Meal Pricing Is the reduced price breakfast $.30 or less? b. Is the reduced price lunch $.40 or less? c. Is the reduced price snack $.15 or less? Does the cost of an adult meal cover the cost of the meal? Are all NON CNP adult district staff, receiving a free meal from CN, essential to the operation of the CN Program? Provision 2 schools must use Method 2 to determine Adult Meal Prices. PROCUREMENT (ARM, SECTION 17) Did the CE use competitive procurement on purchases of $50,000 or more? Does the CE contract by a method other than cost plus percent of cost? Is the CE purchasing items as awarded? Is the CE receiving items awarded on bid? Is the CE checking invoices to ensure prices for items received are as awarded on bid? Is the CE competetively procuring produce and non awarded warehouse items? (3 bids are required for weekly produce and any purchase of warehouse items.) Are awarded CNP bids ONLY used for CNP purchases? For contracts that exceed $100,00, does the CE have copies of the companies' Clean Air and Water Act, Suspension/Debarment Certification Statement, Certification Regarding 8. Lobbying, and Disclosure of Lobbying Activities on file? HEALTH INSPECTIONS (ARM, SECTION 18) Has each serving site received two health inspections within the school year? School year is defined as (July 1 June 30). Has the CE contacted the health inspector to schedule the required health inspections? Requested one health inspection? (e mail, writing) b. Requested the second health inspection? (e mail, writing) Has the CE reported the dates and scores into the TX UNPS (Public and Charter Schools) or to TDA (Private Schools/RCCI's)? Has the CE posted its most recent food safety inspection report in a visible location where your customers can see it? (Dinning area NOT Managers office.) Has the school addressed all violations, via workorders or inservices or purchase of equipment? HACCP POLICY (ARM, SECTION 18) Has the CE developed a Hazard Analysis Critical Control Points (HACCP) Plan? Has the CE implemented the HACCP Plan? Are the standard operating procedures (SOP's) readily retrievable?

14 Has the CE reviewed or revised SOP's and documented with date revised on each SOP? Is there a written plan at each school food preparation and service site for applying HACCP principles? Are the temperature logs readily retrievable and currently filled out? Does each site maintain food preparation process charts? (Please have a copy available for review.) Is HACCP training conducted and documented with employee participation annually? 8. Is the policy, including all SOP's, updated/reviewed/revised annually (for new campuses or 9. service sites) and reflected with dates and/or signatures? OTHER OPERATIONAL ISSUES (ARM, SECTION 19) 8. Does the CE have a non discrimination poster "And Justice For All" displayed in a prominent place in the cafeteria area? (Dinning Area) Is the current non discrimination statement and information as to where a complaint may be filed included on program materials? Are forms available and procedures established to receive complaints alleging discrimination? Are complaints forwarded to the Texas Department of Agriculture (TDA)? Do children have access to ALL serving lines, eating periods, seating arrangements or eating areas regardless of race, color, national origin, sex, age, or disability? Are all meals claimed intended to be eaten on campus or school sponsored field trips? When preparing the monthly reimbursement claim, are the numbers of meals claimed by category for all schools consolidated correctly? Does the CE have a documented plan for student and parent involvement? (This can include student advisory councils, or printing the monthly menu.) Do all employees paid from child nutrition funds receive annual training on civil rights? Are the sign in sheets for annual Civil Rights training kept on file for review? Have all district staff that assist with Breakfast in the Classroom, weekend feeding and 1 Afterschool Care Program received Civil Rights training? 1 Are the sign in sheets for district staff Civil Rights training kept on file for review? COMPETITIVE FOODS / EXCLUSIVE BEVERAGE CONTRACTS (ARM, SECTION 20) Are Foods of Minimal Nutritional Value (FMNV carbonated beverages, pure sugar candies, pure water ices, and gums) not allowed to be provided to students at anytime, anywhere on school premesis by anyone until after the end of the last scheduled class?

15 Child Nutrition Program Self Assessment Checklist If the Child Nutrition department is part of the exclusive beverage contract, is the department receiving their prorated share? Is a copy of the contract on file and available for review? If the Child Nutrition department is NOT part of the exclusive beverage contract, is the CNP department allowed to competitively procure ANY brand of product that does not support the district's exclusive beverage contract vendor brand? Please assess each TPSNP grade level on following pages. WELLNESS POLICY (ARM, SECTION 20) Has the CE developed a wellness policy? Has the CE implemented the wellness policy? Is the CE following the adopted wellness policy? Has the CE reviewed and/or revised the wellness policy? If yes, please have updated copy that is signed and dated. Are nutrition parameters specified in your wellness policy? (Please have copy.) Does CE have a copy of the board meeting minutes where approval or revision of the policy is on the agenda? (Please have a copy for review.) 8. Please describe to what degree the LWP is being implemented? What role does CNP play in LWP? SCHOOL MEALS INITIATIVE (SMI) (ARM, SECTION 24) Are the menus analyzed using USDA approved software? If the CE is using Nutrient Standard Menu Planning, have the meals been analyzed twice per year? Does the analysis show the nutrient standards are being met using weighted data? Previous SMI: Is a copy of the most current SMI available for review at the CE? b. Were improvement plans (CAP, Corrective Action Plans) implemented? Does the CE follow standardized recipes? (Please have examples of current standardized recipes to view.) Does each recipe have a HACCP process listed and CCP's noted? TEXAS PUBLIC SCHOOLS NUTRITION POLICY (ARM, SECTION 20) ELEMENTARY SCHOOLS (EC 6) Public and Charter Schools Only Is access and service prevented to FMNV & Competetive Foods at any time during the school day, anywhere on school campuses until the end of the last scheduled class?

16 Are fried potato products (including breakfast) served a maximum of once a week b. (excluding potato chips)? Do fried potato products weigh less than or equal to 3 ounces per serving (excluding c. potato chips)? Are students limited to purchasing no more than one fried potato product at a time? d. e. Has deep fat frying been eliminated as a method of preparation? f. Are chips limited to 5 ounces, and have no more than 5 grams of fat per bag? Are portion sizes for baked chips, crackers, popcorn, cereal, trail mix, nuts, seeds, dried g. fruit, jerky, and pretzels limited to 5 ounce portions? Are cookie/cereal bars no more than 2 ounces per portion, and do not exceed 30% of h. calories from total fat, or no more than 3 grams of total fat per 100 calories? Do they also not exceed 10% of calories from saturated fat, or no more than 1 gram of saturated fat per 100 calories? Do they also not exceed 10 grams of sugar per ounce? i. Are bakery items (pastries, muffins, bagels) no more than 3 ounces per portion? (This excludes items that count as two bread components at breakfast). Do bakery items not exceed 30% of calories from total fat, or no more than 3 grams of total fat per 100 calories? Do they also not exceed 10% of calories from saturated fat, or not more than 1 gram of saturated fat per 100 calories? Do they also not exceed 10 grams of sugar per ounce? j. Are frozen desserts and ice cream limited to a maximum portion size of 4 ounces? k. Is yogurt limited to a maximum portion of 8 ounces? Is milk, limited to a maximum portion size of 8 fluid ounces, skim plain or flavored or 1% l. unflavored? Are juices (100% fruit or vegetable) limited to a maximum portion size of 6 fluid ounces per serving, and limited to no more than 30 grams of total sugar per portion? m. Do frozen fruit slushes served contain 100% fruit juice and not exceed 6 ounces per n. portion? o. Have all vending machines been removed from accessibility by any student(s)? Only Competetive Foods allowed are unflavored, non carbonated water and 100% juice in containers no larger than 6oz. ELECTROLYTE REPLACEMENT DRINKS, i.e., Powerade or Gatorade are NOT ALLOWED. TEXAS PUBLIC SCHOOLS NUTRITION POLICY (ARM, SECTION 20) (CONTINUED) MIDDLE OR JUNIOR HIGH SCHOOLS (6 8) Public and Charter Schools Only Is access and service prevented to FMNV at any time during the school day, anywhere on school campuses until the end of the last scheduled class?

17 Is access to competitive foods restricted from 30 minutes before to 30 minutes after meal periods? (Including Vending Machines) All food, beverages & snack items must comply with the nutrition standards and portion b. size restriction in this policy. Are fried potato products (including breakfast) served a maximum of three times a week c. (excluding potato chips)? Are students limited to purchasing no more than one (3 ounce serving ) fried potato d. product at a time? e. Has deep fat frying been eliminated as a method of preparation? f. Are chips limited to 5 ounces, and have no more than 5 grams of fat per bag? Are portion sizes for baked chips, crackers, popcorn, cereal, trail mix, nuts, seeds, dried g. fruit, jerky, and pretzels limited to 5 ounce portions? Are cookie/cereal bars no more than 2 ounces per portion, and do not exceed 30% of h. calories from total fat, or no more than 3 grams of total fat per 100 calories? Do they also not exceed 10% of calories from saturated fat, or no more than 1 gram of saturated fat per 100 calories? i. Do they also not exceed 10 grams of sugar per ounce? Are bakery items (pastries, muffins, bagels) no more than 3 ounces per portion? (This excludes items that count as two bread components at breakfast). Do bakery items not exceed 30% of calories from total fat, or no more than 3 grams of total fat per 100 calories? Do they also not exceed 10% of calories from saturated fat, or not more than 1 gram of saturated fat per 100 calories? Do they also not exceed 10 grams of sugar per ounce? j. Are frozen desserts and ice cream limited to a maximum portion size of 4 ounces? k. Is yogurt limited to a maximum portion of 8 ounces? Is milk, limited to a maximum portion size of 8 fluid ounces, skim plain or flavored or 1% l. unflavored? Are beverages, other than milk or those restricted as FMNV, limited to a maximum portion m. size of 12 fluid ounces? Do frozen fruit slushes served contain 100% fruit juice and not exceed 8 ounces per n. portion? Have all vending machines been removed from accessibility to any students during lunch? o. Have all products in vending machines been checked to meet the portion chart and p. nutrition standards set forth in TPSNP? TEXAS PUBLIC SCHOOLS NUTRITION POLICY (ARM, SECTION 20) (CONTINUED) HIGH SCHOOLS (9 12) Public and Charter Schools Only Is access and service prevented to FMNV at any time during the school day, anywhere on school campuses until the end of the last scheduled class?

18 Is access prevented to competitive foods during meal periods in the areas where reimbursable meals are served and consumed? (Including Vending Machines) All food, beverages & snack items must comply with the nutrition standards and portion b. size restriction in this policy. Are students limited to purchasing no more than one (3 ounce serving ) fried potato c. product at a time? d. Has deep fat frying been eliminated as a method of preparation? e. Are chips limited to 5 ounces, and have no more than 5 grams of fat per bag? Are portion sizes for baked chips, crackers, popcorn, cereal, trail mix, nuts, seeds, dried f. fruit, jerky, and pretzels limited to 5 ounce portions? Are cookie/cereal bars no more than 2 ounces per portion, and do not exceed 30% of g. calories from total fat, or no more than 3 grams of total fat per 100 calories? Do they also not exceed 10% of calories from saturated fat, or no more than 1 gram of saturated fat per 100 calories? Do they also not exceed 10 grams of sugar per ounce? Are bakery items (pastries, muffins, bagels) no more than 3 ounces per portion? (This h. excludes items that count as two bread components at breakfast). Do bakery items not exceed 30% of calories from total fat, or no more than 3 grams of total fat per 100 calories? Do they also not exceed 10% of calories from saturated fat, or not more than 1 gram of saturated fat per 100 calories? Do they also not exceed 10 grams of sugar per ounce? i. Are frozen desserts and ice cream limited to a maximum portion size of 4 ounces? j. Is yogurt limited to a maximum portion of 8 ounces? Is milk, limited to a maximum portion size of 8 fluid ounces, skim plain or flavored or 1% k. unflavored? Are beverages, other than milk or those restricted as FMNV, limited to a maximum portion l. size of 12 fluid ounces? Do frozen fruit slushes served contain 100% fruit juice and not exceed 12 ounces per m. portion? Is each vending machine and each point of service free of carbonated beverages (including n. DIET SODAS)? Have all products in vending machines been checked to meet the portion chart and nutrition standards set forth in TPSNP, and removed from where reimbursable meals are o. served and consumed? TEXAS PUBLIC SCHOOLS NUTRITION POLICY (ARM, SECTION 20) (CONTINUED) ALL GRADE LEVELS Public and Charter Schools Only Do new exclusive beverage and snack contracts starting March 3, 2004 and contract renewals prohibit the sale of sugared, carbonated beverages? (including diet sodas)

19 Are all grade levels serving individual food items containing no more than 23 grams of fat, with an exception of one individual food item per week not to exceed 28 grams of fat? b. Are all grade levels limiting beverages to no more than 30 grams per 8 fluid ounce serving c. of total sugar? Are all grade levels offering fruits and vegetables daily on all points of service, packed in d. natural juice, water or light syrup, whenever possible? Is milk, at all grade levels, limited to a maximum portion size of 8 fluid ounces, skim plain e. or flavored or 1% unflavored? f. Is flavored skim milk limited to 30 grams of sugar or less per 8 ounce serving? g. Is the CE including a request of any products containing trans fats? h. Is the CE reducing the purchase of any products containing trans fats? i. Is the CE serving 100% fruit and/or vegetable juices? Does each campus in the district allow no more than 3 events per year where students may be given FMNV or candy items during the school day? (Events are determined by school officials and are not during meal times in the food service area or where j. reimbursable meals are served and consumed.) k. Are the 3 events documented on the school calendar? i. Is the event schedule readily retrievable? PROVISION 2 (ARM, SECTION 20) Does the CE have a copy of the current Provision 2 Attachment C Annualized Percentages? PROVISION 2 (ARM, SECTION 20) (CONTINUED) Did the CE send out a Public Media Release for Provision 2 to the media notifying the public that all meals (Breakfast and Lunch) will be provided at no charge to all students regardless of economic status? Was a copy of the newspaper article or the letter of transmittal page, along with the media package, kept as documentation? Is the district using their % eligibility by category (found at the bottom of the Provision 2 Attachment C Annualized Percentages Form )to determine how many students are eligible for Free and Reduced meals using current monthly enrollment? Is this updated each month, based on claim month's highest enrollment, and entered into TX UNPS's basic claim for Free and Reduced Eligibles? CE Child Nutrition Programs DO NOT have to pay for the Public Media Release to be published. CE must only show proof that a Public Media Release we sent to local news medias for publication. The actual medium can be a local news paper, school paper or newsletter. Are meals being served to all students at no charge? Are second meals served to students being charged? Did the CE download and print all monthly DC lists? Did the CE extend DC benefits to all enrolled members of the household**? **This increased DC number can be used to justify socioeconomic status when renewing your Provision 2 status every four (4) years.

20 Did the CE use the % eligibility by category to update their FREE & REDUCED eligibles on the District Verification Summary? Did the CE compare Attendance Adjusted Enrollment to Total Daily Meal Counts? 8. (Accuclaim Edit Check) 9. Did the CE use the correct On Site Review for Provision 2 Districts? Other Areas of Concern: