HSCFDC Documentation/Monitoring System

Title of Form: / Food Production Records (multiple forms)
Related Policy: / Created to ensure snacks served to Head Start children meet the USDA Guidelines. Provide a check/balance system for staff in shopping & serving appropriate meals. Fulfill USDA requirement for maintaining production records.
Program Area: / 1304.23 Child Nutrition
Procedures
Filled Out By: / Planned by Nutrition Consultant. Completed by Teachers/TA.
Timeline: / Daily/weekly
Specific Directions: / 1)Nutrition Consultant plans a cycle menu for snacks that meet USDA requirements, taking into consideration the 3 to 5 year old child; nutrition; facility preparation/storage limitations; availability; economics and time constraints.
2)Teacher/TA shops for food based on cycle menu and records appropriate information on production records.
3)Daily number of children who eat/participate in the meal service are recorded on production record.
4)Nutrition Consultant monitors the production records.
This is used only in Centers where vendors do not provide the snacks or Breakfast.
Submitted To: / Central Office and Nutrition Consultant.
Timeline: / Monthly
Filed In:
Note: For duplicate or triplicate forms, please note where each copy of the form is filed. / 1)White – Teachers maintain in file for food service.
2)Yellow – Nutrition Consultant for review and then to Central Office to be maintained in USDA Files with copy of grocery receipt.

~HSCFDC Documentation/Monitoring System~

Breakfast Production Record
Week 1
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $1.55*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Cottage Cheese (1/4 cup)
Whole Grain Hot (1/4 cup)/
Cold Cereal (1/3 cup)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Egg (1/2)
Whole Grain Toast (1/2: 13g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Yogurt (1/4 cup)
Whole Grain Pancake (16g) / Waffle (16g)/French Toast (31g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Low-Fat Cheese (1/2 oz)/
Peanut Free Butter (1/2 Tbsp.)
Whole Grain English Muffin (1/2: 13g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Breakfast Production Record
Week 2
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $1.55*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Yogurt (1/4 cup)
Whole Grain Hot (1/4 cup)/
Cold Cereal (1/3 cup)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Egg (1/2)
Whole Grain Bagel (1/2: 13g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Cottage Cheese (1/4 cup)
Graham Crackers (2: 13 g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Low-Fat Cheese (1/2 oz)/
Peanut Free Butter (1/2 Tbsp.)
Whole Grain Tortilla (1/2: 13g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Breakfast Production Record
Week 3
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $1.55*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Cottage Cheese (1/4 cup)
Whole Grain Hot (1/4 cup)/
Cold Cereal (1/3 cup)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Egg (1/2)
Whole Grain Pita (1/2: 13 g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Yogurt (1/4 cup)
Whole Grain Pancake (16g) / Waffle (16g)/French Toast (31g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Low-Fat Cheese (1/2 oz)/
Peanut Free Butter (1/2 Tbsp.)
Whole Grain Toast (1/2:13g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Breakfast Production Record
Week 4
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $1.55*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Yogurt (1/4 cup)
Whole Grain Hot (1/4 cup)/
Cold Cereal (1/3 cup)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Egg (1/2)
Whole Grain Tortilla (1/2: 13g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Cottage Cheese (1/4 cup)
Whole Grain Granola Bar (1/2: 15g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Low-Fat Cheese (1/2 oz)/
Peanut Free Butter (1/2 Tbsp.)
Whole Grain Bagel (1/2: 13g)
Fruit (1/2 cup)
Skim Milk (3/4 cup)
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Snack Production Record
Week 1
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $0.74*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Cottage Cheese (1/4 cup)
Whole Grain Dry Cereal (2 Tbsp.)
Fruit (1/2 cup)
Water
Deli Turkey (1/2 oz)
Whole Grain Tortilla (1/2: 13g)
Vegetable (1/4 cup) & Dip
Milk (1/4 cup)
Yogurt (1/4 cup)
Graham Crackers (2: 13 g)
Fruit (1/2 cup)
Water
Low-Fat Cheese (1/2 oz)/
Peanut Free Butter (1/2 Tbsp.)
Whole Grain
English Muffin (1/2: 13g)
Fruit (1/2 cup)
Water
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Snack Production Record
Week 2
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $0.74*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Yogurt (1/4 cup)
Whole Grain Dry Cereal/ Granola (2 Tbsp.)
Fruit (1/2 cup)
Water
Hard Boiled Egg (1/2) or
String Cheese (1/2 oz)
Whole Grain Granola Bar (1: 31 g)
Vegetable (1/4 cup) & Dip
Water
Cottage Cheese (1/4 cup)
Whole Grain Crackers (2)
Fruit (1/2 cup)
Water
Low-Fat Cheese (1/2 oz)/
Peanut Free Butter (1/2 Tbsp.)
Whole Grain Tortilla (1/2: 13g)
Fruit (1/2 cup)
Water
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Snack Production Record
Week 3
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $0.74*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Cottage Cheese (1/4 cup)
Whole Grain Dry Cereal (2 Tbsp.)
Fruit (1/2 cup)
Water
Deli Turkey (1/2 oz)
Whole Grain Bread (1/2:13g)
Vegetable (1/4 cup) & Dip
Milk (1/4 cup)
Yogurt (1/4 cup)
Dry Cereal/Granola (2 Tbsp.)
Fruit (1/2 cup)
Water
Low-Fat Cheese (1/2 oz)/
Peanut Free Butter (1/2 Tbsp.)
Whole Grain Crackers (13g)
Fruit (1/2 cup)
Water
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Snack Production Record
Week 4
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $0.74*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Yogurt (1/4 cup)
Whole Grain Dry Cereal/ Granola (2 Tbsp.)
Fruit (1/2 cup)
Water
Hard Boiled Egg (1/2) or
String Cheese (1/2 oz)
Whole Grain Crackers (13g)
Vegetable (1/4 cup) & Dip
Water
Cottage Cheese (1/4 cup)
Whole Grain Granola Bar (1/2: 15g)
Fruit (1/2 cup)
Water
Low-Fat Cheese (1/2 oz)/
Peanut Free Butter (1/2 Tbsp.)
Whole Grain Bagel (1/2: 13g)
Fruit (1/2 cup)
Water
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Cluster Breakfast Production Record
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $0.74*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Protein (extra):
Grain:
Fruit:
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost
Cluster Breakfast Production Record
Center / * Original copy is maintained on file at each site.
* A copy of this form with a copy of the P.O. and grocery receipt is sent to the central office-nutrition consultant monthly.*
*This form can be completed in paper or electronic format. * / Identify items on hand by writing “On Hand” in Actual Purchases and/or Substitutions column. In the “$ Cost” column, write -0- to indicate no cost on this grocery receipt.
* Keep meal price per child below $0.74*
Date
mm/dd / #
Served / #
Enrolled / Menu / Amount
Prepared to meet requirements / Actual Purchased
and/or substitutions
(attach copy of P.O. and grocery receipt) / $
Cost
Protein (extra):
Grain:
Fruit:
Milk / Milk (gallons) for Weekly Requirement / Milk (gallons) Actually Purchased / $
Cost
Skim Milk
Special Diet Purchases / Menu Items / Amount
Prepared / Actual Purchased
and/or substitutions / $
Cost