Form Hrp-1027a - Usda/tefap Compliance Review
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3ARIZONA DEPARTMENT OF ECONOMIC SECURITY
HRP-1027A FORFF (11-17)
Page 1 of 3
Hunger Relief Program
USDA/TEFAP COMPLIANCE REVIEW
DISTRUBUTION SITE
REGIONAL FOOD BANK
DIRECTOR
CONTACT PERSON (Last, First, M.I.)
TELEPHONE NUMBER
FAX NUMBER
ADDRESS (No., Street)
CITY
STATE
ZIP CODE
Distribution Site
Congregate Feeding Site
SERVICE AREA
DAYS/HOURS OF OPERATION:
MON
TUES
WED
THURS
FRI
SAT
SUN
AM
PM
2. STORAGE
Are commodities stored in a secured area and away from other products that might cause contamination?
Yes
No
Comments:
Are commodities stored at a proper temperature for dry, cold, and frozen food?
Yes
No
COLD (Recommended Temperature Range 40 degrees or below Fahrenheit):
Temperature range during visit:
FROZEN (Recommended Temperature Range 0 or below degrees Fahrenheit):
Temperature range during visit:
Comments:
Are commodities stored at least 6 inches off the floor and away from walls?
Yes
No
Comments:
Are proper pest control measures being taken?
Yes
No
(e.g., regular visual inspections for infestation, regular visits by a pest control agency)
Comments:
Storage
Storage Room
Household
Household
Commercial
Commercial
Walk in
Walk in
Capacity
Size
Refrigerator
Freezer
Refrigerator
Freezer
Cooler
Freezer
Dimension
in feet
Number of
Units
What is the distribution site’s wish list for equipment?
Comments:
3. INVENTORY
Is a “first in – first out” inventory rotation system employed?
Yes
No
A food rotation system that organizes and rotates food cans on a first-in -first-out basis (FIFO)
Comments:
Are inventory receipts and distribution records up to date?
Yes
No
Comments:
Is inventory fully utilized without waste?
Yes
No
Comments:
Have there been any commodity losses? When? Why?
Yes
No
If Yes, did you notify RFB?
Comments:
Is inventory reconciled monthly?
Yes
No
Note: Review last month inventory report.
Comments:
See page 3 for USDA/ADA/LEP/EOE/GINA disclosures
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