"Corrective Action Plan Form - Child and Adult Care Food Program" - Arizona Download Pdf
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"Corrective Action Plan Form - Child and Adult Care Food Program" - Arizona

Corrective Action Plan Form - Child and Adult Care Food Program is a legal document that was released by the Arizona Department of Education - a government authority operating within Arizona.

Form Details:

  • Released on January 1, 2018;
  • The latest edition currently provided by the Arizona Department of Education;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;

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Arizona Department of Education
Child and Adult Care Food Program
2018 CORRECTIVE ACTION PLAN FORM
Instructions: Complete one form for each finding/deficiency identified. Read each
question thoroughly and answer clearly to ensure your Corrective Action Plan is approved.
CACFP Specialists Name:
CAP Form Due Date:
Sponsoring Organization Name:
Name of Site Reviewed (if different):
Review Date:
Total number of CAP-102A forms submitted to ADE (1 form per finding/deficiency):
A. FINDING/DEFICIENCY-
Write
the finding this form is correcting:
W hat did you change to fix the above problem?
B. CORRECTION –
List new processes or
procedures that are now being conducted to correct the finding (explain with a lot of
specific detail. Anyone should be able to read this and know exactly how your new steps
will correct the above problem):
Revised 01/2018
This institution is an equal opportunity provider.
Page 1 of 3
Arizona Department of Education
Child and Adult Care Food Program
2018 CORRECTIVE ACTION PLAN FORM
Instructions: Complete one form for each finding/deficiency identified. Read each
question thoroughly and answer clearly to ensure your Corrective Action Plan is approved.
CACFP Specialists Name:
CAP Form Due Date:
Sponsoring Organization Name:
Name of Site Reviewed (if different):
Review Date:
Total number of CAP-102A forms submitted to ADE (1 form per finding/deficiency):
A. FINDING/DEFICIENCY-
Write
the finding this form is correcting:
W hat did you change to fix the above problem?
B. CORRECTION –
List new processes or
procedures that are now being conducted to correct the finding (explain with a lot of
specific detail. Anyone should be able to read this and know exactly how your new steps
will correct the above problem):
Revised 01/2018
This institution is an equal opportunity provider.
Page 1 of 3
Arizona Department of Education
Child and Adult Care Food Program
2018 CORRECTIVE ACTION PLAN (CAP-102A)
Explain how you will monitor
C. CONSISTENCY -
the processes and/or procedures you
specified to ensure they are followed consistently to prevent a reccurrence:
D. RESPONSIBILITY –
Who -
list name, title, and responsibility of the individuals involved in
permanently correcting the finding/deficiency. Include those individuals responsible for
conducting the procedure to correct the finding/deficiency and those responsible for
ensuring that the procedure is conducted and permanently corrected.
E. IMPLEMENTATION –
W hen
will the process or procedure to correct the
W hen and How often
finding/deficiency begin?
will you monitor the corrective
procedures?
Revised 01/2018
Page 2 of 3
Arizona Department of Education
Child and Adult Care Food Program
2018 CORRECTIVE ACTION PLAN (CAP-102A)
F. TRAINING (if applicable) –
Create and attach
a staff training sign in attendance sheet
containing:
•
Date staff training was held (for responsible staff listed in D.)
•
Name(s) of trainer(s)
•
List of training materials used- including titles, page numbers and website links
•
A list of the processes and procedures being conducted to correct the
finding/deficiency
•
A confirmation statement indicating that by signing the attendance sheet; the
employee confirms that their job descriptions have been updated to reflect any new
CACFP responsibilities for the action steps and adequate training was provided to
successfully and permanently correct the finding/deficiency
Staff signatures
•
G. RESOURCES/SUPPORTING DOCUMENTATION (if applicable)–
List or attach
any
additional documentation to support the permanently corrected finding/deficiency, i.e.
handbooks, manuals, website links, ADE forms, training materials, eligibility determinations,
receipts, invoices, meal count documentation, specific policies and procedures, etc.:
_________________________
Date
Print Name of CACFP Authorized Signer
as printed on the Permanent Agreement
_________________________
Date
Signature of CACFP Authorized Signer
as signed on the Permanent Agreement
Revised 01/2018
Page 3 of 3
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