School Nutrition Program (SNP) Self-Assessment Review Form

School Nutrition Program (SNP) Self-Assessment Review Form Contracting Entity (CE) Name: CE ID Number: Date: Application/Agreement, ARM, Section 2 Eligibility 1. Is the Reviewing Official the same person as stated on the CE application in TX-UNPS? 2. Is the Hearing Official stated in the notification letters to households the same person as stated on the CE application in Texas Unified Nutrition Programs Systems (TX-UNPS)? 3. Is the Hearing Official a person who is not involved in the determination, confirmation, and/or verification process? 4. Is the collection procedure in use at each serving site the same as the approved collection procedure stated in the policy statement for free and reduced-price meals (Attachment B)? 5. Is a copy of the policy statement for free and reduced-price meals available to each site in the CE? Medium of Exchange for Free, Reduced-price, and Paid Meals 6. Is the medium of exchange coded to prevent overt identification of children receiving free and reduced-price meals? 7. Is the medium of exchange available through prepayment or charging thus making free and reduced-price meals recipients appear as children who have prepaid or charged? 8. Is the medium of exchange distributed using a common location at a common time for all children to obtain their tickets or tokens? 9. Is the medium of exchange collected in a manner that ensures that the same procedures are used for free, reduced-price, and paid meal categories? Media Release 10. Did the CE send out a public release to the media and community/grass roots organizations that includes the letter to parents, application form, and the complete income eligibility guidelines? 11. Was a copy of the newspaper article or the fax letter of transmittal page, along with the media package, retained by the CE? Site Information 12. Has the CE updated the site application of all sites with their total enrollment, eligible children, percentages, and other information in TX- UNPS? Page 1 of 16

Eligibility, ARM, Section 4 Applications 1. Are the CE s free and reduced-price meals applications readily retrievable by site? 2. Were the current application, notice/letter to households and eligibility guidelines used by each CE site? 3. Does the CE provide categorical eligibility SNAP, TANF, FDPIR, foster, homeless, migrant, runaway, Head Start, and Early Head Start? Information Provided to Parents or Guardians 4. Are all households given a free and reduced-price meal application at the beginning of the school year with an explanation of eligibility requirements? 5. Are foreign language translations available or is a translator available? Review of Applications for Accuracy 6. Do all income applications include the name(s) of children (s) for whom application is made? 7. Do all income applications include the names of all household members? 8. Do all income applications include the signature of an adult household member? 9. Do all income applications include the last four digits of the social security number of the head of household or adult completing the form or an indication that he/she does not have one? 10. Do all income applications include the income of each household member, by source? 11. Do all income applications show the no income boxes checked for each household member that does not have income? SNAP/TANF Applications 12. Do all SNAP/TANF applications include name(s) of children? 13. Do all SNAP/TANF applications include valid SNAP/TANF identifiers? 14. Do all SNAP/TANF applications include the signature of an adult household member? 15. Is the CE using a multi-child or multi-use application? 16. Was the correct eligibility determination made for each application processed? 17. Are all children in each household receiving the same level of benefits? Direct Certification 18. Is the CE using Direct Certification (DC) procedures? 19. Is an original DC list kept on file at the CE? 20. Is the CE updating the second list as needed? 21. Is the CE updating the DC list quarterly? Page 2 of 16

22. Are benefits being issues for the entire year? 23. Is the CE maintaining each year s DC list for 5 years for public and charter schools? 24. Are Texas Department of Health and Human Service (HHSC) letters used for DC on file for 5 years for public and charter schools or 3 years for private and non-profit organizations? 25. Is the Notice of Predetermined Eligibility sent to the parent or guardian of each directly certified child? 26. Does the Notice of Predetermined Eligibility include the following information: a. Their children are eligible for free meals? b. No further application is required? c. Households should notify the CE if they do not want their children to receive free benefits? 27. Is the date that the notice is sent noted beside the name of the child on the DC list or elsewhere? Verification, ARM, Section 6 1. Based on the count taken of approved meal applications on file on October 1, were an adequate number of meals applications selected for verification? 2. Did the CE conduct the Error Prone method of verification? Reviewing for Accuracy 3. Were the applications reviewed for accuracy? 4. If the application was incorrectly approved, did the household receive an adverse action letter? 5. Was a new application pulled for verification? 6. Did the Confirming Official sign on the application? 7. Is the Confirming Official signature different from the Reviewing Official signature? Technology Based Verification System 8. Has the CE requested a waiver to review applications as part of the verification process? 9. Does the CE have the approved waiver letter on file? Verification Process 10. Was all required documentation obtained during the verification process? 11. Were four (4) consecutive weeks used to determine household s income? Page 3 of 16

12. Was a follow-up done on non-responsive households? 13. Was the follow-up notification documented and signed on the application? 14. Was the verification process completed by November 15? 15. Is the verification process documented on the application? 16. Is the information collected through the verification process documented on the CE s Verification Notification Summary Form? 1 17. Does the CE have a Verification Notification Summary Form completed and on file? 18. Is an individual verification form used for each application? 19. Are households whose benefits must be reduced or terminated given the required 10-day notification prior to the change? Counting and Claiming, ARM, Section 7 Counting 1. Is the count taken by category at the point-of-service? 2. If the cashier is at the beginning of the line, is there a monitor stationed at the end of line who removes any meal from the count that does not contain sufficient components in order to claim reimbursement? 3. In family-style meal service, does the supervising adult ensure the minimum required portions are available on the table including milk? 4. Is there a system in place to ensure that the second meals are not claimed for reimbursement? 5. Is there a trained substitute cashier or counter? 6. After viewing the collection procedure in operation, does it appear that it yields an accurate count by category? 7. Is the count by category that is taken on the line the same as that reported on the daily record? 8. Is the count by category comparable to the counts taken in that month or the previous month? 9. Does a report run from the point-of-sale show that meals were served and what levels of benefits are provided to participants? 10. Are the adult meals or a la carte sales recorded separately from the meals counted for children by category? 11. If there is more than one serving line, are the counts from all lines property consolidated? 1 Form available at http://www.squaremeals.org. Page 4 of 16

Master Roster/List 12. Is the master roster/list current? 13. Do the names on the list of eligible children match approved applications on file and the categorically eligible list (DC, foster, homeless, migrant, runaway, Head Start, and Early Head Start)? 14. If more than one master roster/list is used, are all lists the same? Updating Master Roster/List 15. Are changes due to withdrawals, transfers, etc., reflected on the list or on another tracking document dated and initialed by responsible person? 16. Is the count of eligible children updated on a daily basis or in a timely manner? 17. Are attendance-adjusted eligible children by category compared to daily meal counts for each school (Accuclaim edit check)? Accuracy in Counting 18. When the daily menu 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? 19. Are counts on the daily record of meals served that a. Reflect patterns of numbers? b. Repetition of numbers? c. Constant counts by category? d. Served count equal to delivered count? e. Identical counts for breakfast and lunch? f. One hundred (100) percent participation? g. Category counts exceeding the number of eligible children? 20. Are prepaid and charged meals counted on the day served, not the day the money is collected? 21. Are participants issued one original and a minimum of three replacement meal tickets? 22. Are special meal arrangements allowed before a child is charged for fourth replacement ticket? 23. Are all meals claimed intended to be eaten on campus or schoolsponsored field trips or events? 24. Is an onsite self-review of the lunch meal (or breakfast for breakfast only schools) counting and claiming procedure completed and documented prior to February 1, unless the CE has only one feeding site? 25. When preparing the monthly reimbursement claim, is the number of meals claimed by category for all sites correctly? Page 5 of 16

26. If corrective action was required after an onsite review, is a follow-up review conducted within 45 days to ensure that corrective action was taken? Breakfast and Lunch Programs, ARM, Sections 8, 8N, and 9 Food-Based Menu Planning 1. Is each of the required food components offered on every lunch menu? 2. Is each of the required food items offered on every breakfast menu? 3. Have all CE recipes been checked to ensure that they actually contribute the expected yield per serving? 2 Fruit and Vegetables Grains 4. Do CEs offer only 100% juice products? 5. Is full-strength fruit or vegetable juice contributing no more than onehalf (½) of the required serving size of fruit of vegetable component for lunch for the week? 6. Are the required number of grain servings offered each week? 7. Does the amount of grain servings per day meet the daily minimum for the age/grade group? 8. Does the number of grain servings per week meet the minimum and maximum for the age/grade group? Meat/Meat Alternate Milk 9. Are the required number of meat/meat alternate servings offered each week? 10. Does the amount of meat/meat alternate servings per day meet the daily minimum for the age/grade group? 11. Does the number of meat/meat alternate servings per week meet the minimum and maximum for the age/grade group? 12. Does the CE offer a variety of milk that is fat free and 1% low-fat milk? 13. Is the 1% low-fat milk unflavored? 14. Is the variety of milk offered on every reimbursable line throughout the entire serving period? 15. Is each child permitted to select from the fat free or 1% low-fat milk choices? 2 CEs will find information on recipes in the Food Buying Guide for Child Nutrition Programs which is available at http://www.squaremeals.org. Page 6 of 16

Menu Planning 16. Does the documentation show the appropriate age/grade groups? 17. Have the menus and nutrient standards been planned to reflect the correct age/grade grouping? 18. Do portion sizes of the serving menu appear to match portion sizes of the planned menu? 19. Is the menu meeting the required nutrient standards for calories, saturated and trans fat, and all other nutritional requirements 3 by age/grade groups for the week? 20. Are all items on the served menu included in and accounted for on the planned menu and nutrient assessment? 21. Does the planned menu and nutrient assessment meet the nutrition standards of the week? 22. When serving smoothies, does the CE adhere to current guidance on smoothie food content? 23. Are appropriate substitutions being made within the 2-week time frame? 24. Is the menu-planning pattern well-advertised to the participants? Nutrient Standard Menu Planning (Breakfast) 25. Did TDA review and approve the menu planning system prior to implementation? 4 26. If the CE uses the Nutrient Standard Menu Planning System for breakfast, are menus analyzed using USDA-approved software? 27. Is the CE serving the breakfast menu that has been analyzed by approved software? Serving 28. Are utensils that yield standard-sized servings used for portioning all menu items? 29. If using Enhanced Food Based Menu Planning System for breakfast does only one grain-based dessert for grades K 12 count as a grains serving? Water Availability 30. Is potable water available to children in the food service area during meal service at no charge to children? 31. Is the available potable water served plain with no flavoring or added food items? Reimbursable Meal 32. Does the cashier know the minimum number of food components that children may select for a reimbursable meal? 3 Sodium requirements are phased in from 2014 to 2023. 4 The review is required if the CE changed its menu planning system after May 2005. Page 7 of 16

33. Are all required components offered in sufficient amounts before the cashier counts the meal as reimbursable? 34. If the CE is operating under offer versus serve, is the child allowed to select her or his choice from the number of food items offered? 35. Do children grades 9 12 have offer versus serve available to all children (not applicable to RCCIs)? 36. Are children notified that extra sides taken will be charged? Promoting Participation 37. Does the CE conduct any activities to promote participation in the School Breakfast Program (SBP)? 38. Have all barriers to participation in the SBP been removed? 5 39. Has the CE set targets for growth in the SBP? 40. Has it met those targets to increase participation? Production 41. Is a CN Label or manufacturer s specification, with regard to the contribution of all purchased-prepared meat/meat alternate food items, on file? 6 42. Are purchased-prepared items documented the same as those received, prepared, and served in all of the CE s kitchens? 7 43. Are complete food production records maintained on all meals claimed for reimbursement including breakfasts, snacks, food bars, salad bars, and various other serving lines? 44. Do production records show accurate case numbers, serving portions, and other required information? 45. If breaded fruit and and/or vegetable products are used, is a CN Label or manufacturer s specification regarding their contribution to the meal pattern on file? Afterschool Care Program, ARM, Section 10 1. Does the CE follow the correct meal pattern? 2. Does the CE self-review the program within the first 4 weeks of the program? 3. Does the CE conduct a second self-review of the program before the end of the school year? 5 Such as bus schedules 6 Documentation is not required for products that are 100% meat and can be weighted in the cooked state (i.e., 100% beef patty). 7 Product labels attached to the back of food production records are an easy way to monitor the products actually used in each of the CEs kitchens. Page 8 of 16

4. Were the snacks claimed according to the site s eligibility? 5. Does the CE maintain daily participation records? 6. Does the CE maintain food production records that are up to date and accessible for review? 7. If the site requires a corrective action plan (CAP), is the plan completed and reviewed within 45 calendar days of the original site visit? 8. Does the CE conduct any outreach to increase participation? 9. Does the program include an educational enrichment activity? Seamless Summer Option, ARM, Section 12 1. Is the CE participating in the Seamless Summer Option? 2. Does the CE follow the NSLP or SBP menu planning pattern? 3. Does the CE have production records to show that a reimbursable meal has been provided to children? 4. Do the participating children meet the requirements for type of SSO site (i.e., camp, migrant, or open)? 5. Has the CE advertised the Seamless Summer Option? 6. Has the CE retained copies of media releases and out outreach documentation? 7. Has the CE self-assessed 8 each summer site for meal counting, claiming, and meal patterns during summer operation? Special Dietary Needs, Section 13 1. Are children with medical or special dietary needs provided access to program benefits as prescribed by regulations? 2. Is a doctor or medical authority note on file if menu substitutions are made to a reimbursable meal for a child with special dietary needs? 8 Form available at http://www.squaremeals.org. Page 9 of 16

Financial, ARM, Section 14 Retention 1. Are records maintained for the appropriate period of time? a. Five years for public or charter schools b. Three years for private schools or nonprofit organizations (RCCIs)? 2. Are records readily retrievable? 3. Are records available for review? 4. Does the record keeping system separate program income by adult and children sales? Fund Balance 5. Was the remaining fund balance carried forward from last year to this year? School Nutrition Program (SNP) funds: 6. Are the CE net cash resources less than three months of operating expenses? 7. If not less than three month s operating expenses, is documentation on file explaining reasons for excess? 8. Was a plan to reduce or use surplus resources submitted to TDA? 9. Is interest earned on invested school nutrition program revenues credited to the CE account? 10. Do all employees paid from the CE account have direct responsibility to the operation of programs? 11. Do daily deposit slips balance with the bank s monthly statement for the nonprofit CE account? 12. Does the CE have documentation, including tracking of and a line item transfer from the general fund to child nutrition, for all bad debts? 9 Meal Pricing, ARM Section 15 1. Are all serving areas where meals are claimed for reimbursement available to all children free, reduced-price, and paid? 2. Are meals priced as a unit? 3. If there are multiple service lines, are all children free, reduced-price, and paid offered the same reimbursable meal in every line? 4. If special meal items (such as brand name food items) are offered as part of the reimbursable meal, are all children free, reduced-price, and paid offered the same reimbursable meal at no extra charge? 9 Bad debts include outstanding charges and alternate meals. Page 10 of 16

5. Is the reduced-price breakfast price $.30 or less? 6. Is the reduced-price lunch price $.40 or less? 7. Is the reduced-price snack price $.15 or less? 8. Does the price of an adult meal cover the cost of the meal? Procurement, ARM Section 17 1. Did the CE use competitive procurement procedures on purchases of $25,000 or more? 2. Did the CE include all related charges 10 in determining if a competitive bid for a purchase of $50,000 or more is needed? 3. Does the CE contract by a method other than cost-plus-percent-ofcost? 4. Is the CE purchasing items as awarded and stipulated in contracts? 5. Is the CE receiving items awarded on bid? 6. For contracts that exceed $100,000 does the CE have copies on file of the company s a. Certification Regarding Lobbying? b. Disclosure of Lobbying Activities? Health Inspections, ARM Section 18 1. Has each serving site received two health inspections within the school year (July 1 June 30)? 2. Has the CE contacted the health inspector to schedule the first required health inspections? 3. Has the CE contacted the health inspector to schedule the second required health inspections? 4. Has the CE reported the previous school year s food safety inspections into TX-UNPS? 5. Has the CE posted each site s most recent food safety inspection report in a visible location? 10 Costs such as travel, meals, copying, or other add on charges in addition to a base fee Page 11 of 16

Hazardous Analysis Critical Control Points (HACCP) Policy, ARM, Section 18 1. Has the CE developed a HACCP policy? 2. Has the CE implemented its HACCP policy? 3. Are the standard operating procedures readily retrievable? 4. Is there a written plan at each CE preparation and service site for applying HACCP policy? 5. Are the temperature logs readily retrievable? 6. Does each site maintain food preparation process charts? 7. Is HACCP training conducted and documented with employee participation? Other Operational Issues, ARM, Section 19 1. Does the CE have a nondiscrimination poster And Justice for All displayed in a prominent place in the cafeteria area? 2. Are procedures established to receive complaints alleging discrimination? 3. Is the procedure for filing a complaint included in the posted nondiscrimination statement and information? 4. Are all complaints forwarded to the Texas Department of (TDA)? 5. 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? 6. Are the sign in sheets for annual Civil Rights training kept on file for review? 7. Does the CE have a documented plan for child and parent involvement in menu planning, enhancement of eating environment, program promotion, or related community support activities? Page 12 of 16

Competitive Foods/Exclusive Beverage Contracts, ARM, Section 20 1. Are Foods of Minimal Nutritional Value (FMNV) 11 being sold or consumed during meal times in the food service area where reimbursable meals are sold or consumed? 2. If the school nutrition department is part of the exclusive beverage contract, is the department receiving its prorated share? 3. Is a copy of the exclusive beverage contract on file and available for review? Texas Public School Nutrition Policy, ARM, Section 20 12 FMNV/Competitive Foods 1. Is access and service prevented to FMNV at any time during the school day, anywhere on the school campuses until the end of the last schedule class? 2. Is access to competitive food restricted from 30 minutes before to 30 minutes after meals periods for grades 6 8? 3. Do new exclusive beverage and snack contract starting March 3, 2004 and contract renewals after March 3, 2004 prohibit the sale of sugared, carbonated beverages in containers larger than 12 ounces? 4. Does each site in the CE a. Allow no more than 3 events per year where children may be given FMNV or candy items during the school day? 13 Meal Planning b. Document the 3 events on the school calendar? c. Have a system for readily retrieving event schedules? 5. Is the CE including a request for trans fat information on all product specifications? 6. Is the CE reducing the purchase of any products containing trans fat? Potato Products 7. Are children limited to purchasing no more than one fried potato product at a time? 8. Are portion sizes for baked chips, crackers, popcorn, cereal, trail mix, jerky, and pretzels limited to 1.5 ounces? 9. Are chips limited to 1.5 ounces and no more than 7.5 grams of fat per serving or bag? 11 Such as carbonated beverages, pure sugar candies, pure water ices, or gums 12 Applies to public and charter schools only 13 Events are determined by school officials and are not during meal times in the food service area. Page 13 of 16

Fried Potato Products 10. Does the CE serve fried potato products a maximum of 1 time a week for grades pre-school (EE) 6 for both breakfast and lunch? 11. Does the CE serve fried potato products a maximum of 3 times a week for grades 6 8 for both breakfast and lunch? 12. Does the CE served portion of fried potato products that weigh less than or equal to 3 ounces for grades EE 6? Fried Food 13. Has deep fat frying been eliminated as a method of preparation? Cookie and Cereal Bars 14. Do cookie and cereal bars meet the following requirements: a. No more than 2 ounces per portion? Bakery Items b. No more than 30% of calories from total fat c. No more than 3 grams of total fat per 100 calories? d. No more than 10% of calories from saturated fat e. No more than 1 gram of saturated fat per 100 calories? f. No more than 10 grams of sugar per ounce? 15. Do bakery items meet the following requirements: a. No more than 3 ounces per portion? Desserts b. No more than 30% of calories from total fat c. No more than 3 grams of total fat per 100 calories? d. No more than 10% of calories from saturated fat e. No more than 1 gram of saturated fat per 100 calories? f. No more than 10 grams of sugar per ounce? 16. Are frozen desserts and ice cream 14 limited to a maximum portion size of 4 ounces? 17. Is yogurt limited to a maximum portion of 8 ounces? Beverages 18. Are beverages, other than milk or those restricted as FMNV, limited to a maximum portion size of 12 ounces for grades 6 8? 14 Ice cream and puddings cannot be counted as one of the five food components for a reimbursable meal; however, if offered as a part of the reimbursable meal, these items must be included in the weekly nutrient standards and do count toward the maximum limits on calories, saturated fat, sodium, and trans fat. Page 14 of 16

Wellness Policy, Section 20 1. Has the CE developed a wellness policy? 2. Has the CE implemented the wellness policy? 3. Is the CE following the adopted wellness policy? Page 15 of 16

Directions: School Nutrition Program (SNP) Self-Assessment Review Form Purpose This form is intended to be used periodically throughout the year to help the CE self-assess its program operations. The questions on this form are aligned to key sections of the Administrator s Reference Manual (ARM); however, it does not address all guidance provided in the ARM. Directions for Completing Form General Information Contracting Entity (CE) Name: Record the name of the CE in the designated space. CE ID Number: Record the CE ID Number in the designated space. Frequency Required Form Format Record Retention Use This Form Optional, for best practice use several times per year This form or a similar form Form kept onsite and made available on request. State Board of Education policies require public and charter schools to maintain records for a period of five years. Private schools and RCCIs maintain records for three years. Date: Record the date the self-assessment review was completed. Self-Assessment Questions Practice in Place: Consider each question carefully and check the appropriate response to reflect the practices the CE has in place. Retained Rating: Check the appropriate response to reflect the CEs practice to retain supporting record or documentation in an easily accessible location. Record any notes or comments about specific issues of need or progress related to the question in the section. Page 16 of 16