Sponsor Site Monitoring Form For Centers

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Sponsor Site Monitoring Form for CENTERS
Date of visit: ________________
Time of visit: _____________
Unannounced? Yes OR No
1. Center Name ____________________________________________________
2. Address
____________________________________________________
____________________________________________________
3. List any problems found on prior visits:
_____________________________________
______________________________________
_____________________________________
______________________________________
4. License#: _________
Capacity:_____
Expiration date: _________
If expired- Renewal Process Verified?
Y
N
5. Days /Hours of Operation: ____________________________________________________
____________________
6 Health and Safety standards met if applicable? _________
7. “And Justice For All” flyer posted? Y
N
8. WIC information disseminated? Y
N
9. “Building for the Future” flyer posted /disseminated?
Y
N
10. Meals served: (circle all that apply)
B
AM
L
PM
S
E
11. Daily dated Menu posted?
Y
N
12. Meal Patterns meets USDA requirements?
Y
N
13. Meal Observed (circle/fill in meal observed)
Breakfast
Lunch / Supper
Supplement/Snack ( AM PM E )
______________
_______________
_______________
______________
_______________
_______________
______________
_______________
_______________
______________
_______________
_______________
_______________
14. Observed meal matches posted menu? Y
N
15. Meal served at time listed on Application? Y
N
16. Production reports completed before meal was prepared and served? Y
N
N/A
How did the cook know how much to prepare? _______________________________________________
______________________________________________________________________________________
Was there enough food prepared to meet the quantities needed for total children? Y
N
17. Infant Menu/Production Report posted and completed for Infants in care?
Y
N
NA
18. Complete IEF’s/ Enrollments up to date/on file for each child, including Race/Ethnicity?
Y
N
List any that are missing: ________________________
________________________
________________________
________________________
________________________
________________________
19. Medical statements on file for all food substitutions related to medical / special dietary needs?
Y
N
20. Are written parental requests on file for milk substitutions related to special dietary needs? Y
N
21. Was an accurate Point of Service meal count taken at this Center meal? ______________________________________
22. Number of children served at meal observed______ Number claimed_______ (if different)

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