Menu Planning Worksheet Template

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M
S
D
H
ISSISSIPPI
TATE
EPARTMENT OF
EALTH
Menu Planning Worksheet
Week of _____________________________
Facility Name ____________________________________________________________
County ______________________
Hours of Operation ___________________
Mailing Address ___________________________________________________ Telephone No. _______________________
Contact Person ______________________________________________________
Phone # ______________________________________
Record all food and beverages served. List all servings sizes. Please print in ink. Refer to Appendix C in Regulations Governing Licensure of Child Care Facilities.
Meal Components
Monday
Tuesday
Wednesday
Thursday
Friday
Breakfast
Time Served _________
• Fruit
• Cereal or Bread Alternate
• Milk
• Other Foods
Time Served _________
Snack
(Select two out of four food groups)
• Meat or Alternate • Bread or Alternate
• Vegetables or
• Other Foods
Fruit, Juice
• Milk or Dairy Food
Lunch/Supper
Time Served _________
• Meat or Alternate
• Vegetables or Fruit (2 different vegetables
or 1 vegetable and 1 fruit)
• Bread or Alternate
• Milk
• Other Foods
Snack
Time Served _________
(Select two out of four food groups)
• Meat or Alternate • Bread or Alternate
• Vegetables or
• Other Foods
Fruit, Juice
• Milk or Dairy Food
Mississippi State Department of Health
Revised 7-8-10
Form 444

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