Form FDACS-01860 "Nslp Pre-operational Site Visit Form" - Florida

What Is Form FDACS-01860?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2013;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form FDACS-01860 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-01860 "Nslp Pre-operational Site Visit Form" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
NSLP PRE-OPERATIONAL SITE VISIT FORM
SCHOOL YEAR _____
ADAM H. PUTNAM
COMMISSIONER
Date of Site Visit:
Program Sponsor Specialist:
Prospective Sponsor Name:
Contact Person Name:
Title:
Phone Number:
Alternate Phone Number:
E-mail:
Street Address:
City:
Zip Code:
County:
Official Interviewed:
Title:
Official Interviewed:
Title:
Official Interviewed:
Title:
Prospective Sponsor Information:
1. Indicate the Prospective Sponsor Type:
Public School District
Private RCCI
Private Nonprofit School
Private RCCI and Private School
Charter School
Public RCCI and Private
Public RCCI
Other: __________________
2. What is the estimated student population? _________________ Grades: ______________________
a. Free =
_______
b. Reduced = _______
c. Meal services applying for:
Breakfast
Lunch
Snacks
3. If RCCI, indicate the student population type:
Residential
Residential and day students
NA
4. Has the official interviewed attended State Agency training?
Yes
No
5. If yes, has NSLP information been disseminated to other program staff?
Yes
No
Distribution: 1 – Original/Sponsor; 2 – Yellow/FDACS Staff
FDACS-01860 Rev. 03/13
Page 1 of 8
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
NSLP PRE-OPERATIONAL SITE VISIT FORM
SCHOOL YEAR _____
ADAM H. PUTNAM
COMMISSIONER
Date of Site Visit:
Program Sponsor Specialist:
Prospective Sponsor Name:
Contact Person Name:
Title:
Phone Number:
Alternate Phone Number:
E-mail:
Street Address:
City:
Zip Code:
County:
Official Interviewed:
Title:
Official Interviewed:
Title:
Official Interviewed:
Title:
Prospective Sponsor Information:
1. Indicate the Prospective Sponsor Type:
Public School District
Private RCCI
Private Nonprofit School
Private RCCI and Private School
Charter School
Public RCCI and Private
Public RCCI
Other: __________________
2. What is the estimated student population? _________________ Grades: ______________________
a. Free =
_______
b. Reduced = _______
c. Meal services applying for:
Breakfast
Lunch
Snacks
3. If RCCI, indicate the student population type:
Residential
Residential and day students
NA
4. Has the official interviewed attended State Agency training?
Yes
No
5. If yes, has NSLP information been disseminated to other program staff?
Yes
No
Distribution: 1 – Original/Sponsor; 2 – Yellow/FDACS Staff
FDACS-01860 Rev. 03/13
Page 1 of 8
Prospective Sponsor Name:
Date:
6. If yes, on what date was training conducted? __________ Is an agenda available for review? ______
Comments: _______________________________________________________________________
7. If no, describe the Prospective Sponsor’s training plans: ____________________________________
_________________________________________________________________________________
8. Does the Prospective Sponsor currently operate a food service program?
Yes
No
9. If yes, indicate the meal services that are provided:
Breakfast
Lunch
Snacks
10. Is the Prospective Sponsor on any other federally funded food service program?
Yes
No
11. If yes, name of program: ____________________ Length of time on program: ___________________
12. Has the Prospective Sponsor or individual ever been terminated from another federally funded food
program?
Yes
No
13. Have any of the Prospective Sponsor’s sites participated in the NSLP under another sponsorship?
Yes
No
14. If yes, which sites and under what sponsorship?____________________________________________
15. How many sites does the Prospective Sponsor wish to operate?
_________________________________________
PROGRAM ADMINISTRATION:
Eligibility:
16. Does the Prospective Sponsor currently collect Free and Reduced-Price Meal Applications or IDFs?
Applications
IDFs
None at this time
17. If forms are collected (apps, IDFs), are current IEGs being used?
Yes
No
18. If forms are collected (apps, IDFs), are the forms approved correctly?
Yes
No
19. Describe errors:
20. Who approves, or will approve and maintain applications, IDFs?
___________________________________________________________________________________
21. a. Does the Prospective Sponsor currently utilize Direct Certification?
Yes
No
NA
b. Will the Prospective Sponsor utilize Direct Certification once approved?
Yes
No
NA
Distribution: 1 – Original/Sponsor; 2 – Yellow/FDACS Staff
FDACS-01860 Rev. 03/13
Page 2 of 8
Prospective Sponsor Name:
Date:
Meal Service:
22. Do menus/production records indicate that all required components and portion sizes were served?
Yes
No
Not Available
23. When observing the lunch line, is there an accurate count by eligibility category at the point of service
(POS)?
Yes
No
NA
24. Does the system prevent overt identification?
Yes
No
NA
25. Are the Prospective Sponsor’s meal count procedures implemented as approved?
Yes
No
NA
26. If no, describe the Prospective Sponsor’s meal service procedure and POS:
27. Is the Food Based Traditional menu planning option is being used?
Yes
No
28. Is OVS being implemented?
Yes
No
NA
29. If yes, is OVS implemented correctly?
Yes
No
NA
30. Is an “And Justice for All” poster displayed?
Yes
No
NA
31. Is potable water available free of charge?
Yes
No
NA
Meal Counting and Claiming:
32. What system is used to count meals at the POS?
Rosters
Computerized
Other: _____________________________________
33. Who is responsible for the counting of the meal eligibility? _____________________________________
34. Is there a second party check of meals counted? Yes
No
NA
35. Are meals being counted at POS?
Yes
No
NA
36. Are Edit Checks being conducted?
Yes
No
NA
Facilities:
37. How are meals being prepared? (check all that are applicable)
On-site Self Prep
Self Prep Satellite
Vended by:
LEA
FSMC
Caterer/Vendor
38. Have the prospective sites been inspected by the local Health Department?
Yes
No
Distribution: 1 – Original/Sponsor; 2 – Yellow/FDACS Staff
FDACS-01860 Rev. 03/13
Page 3 of 8
Prospective Sponsor Name:
Date:
Facilities (continued):
39. If yes, were there any findings/deficiencies?
Yes
No
NA
40. If yes, did the Prospective Sponsor correct deficiencies?
Yes
No
NA
41. Is the most recent food safety inspection report (health inspection) posted in the food service area for
public viewing?
Yes
No
NA
42. Comments:
43. Complete the appropriate section:
Refer to the Self Prep (pages 5-6) or Vended (page 7) Facility Attachments
General:
44. Will the prototype On-Site Review form (document # 37a) be used for lunch service?
Yes
No
NA
45. Will the prototype On-Site Review form (document # 37b) be used for snack service?
Yes
No
NA
46. Does the Prospective Sponsor’s site personnel foresee any difficulties in implementing the NSLP?
Yes
No
47. If yes, list the concerns below:
Comments/Recommendations:
Distribution: 1 – Original/Sponsor; 2 – Yellow/FDACS Staff
FDACS-01860 Rev. 03/13
Page 4 of 8
Prospective Sponsor Name:
Date:
SELF-PREP FACILITY:
1. Is the prototype Production Record being used?
Yes
No
2. Is it complete?
Yes
No
3. If “No”, list missing information: _________________________________________________________
__________________________________________________________________________________
4. Does the Prospective Sponsor have an adequate procedure for documenting Production Records?
Yes
No
5. If “No,” explain: ______________________________________________________________________
6. Is a menu available?
Yes
No
7. Is the menu adequate?
Yes
No
8. If “No,” explain:______________________________________________________________________
___________________________________________________________________________________
9. Has the menu been approved by the State Agency for approval?
Yes
No
10. Is the prospective sponsor using the standardized recipes approved by the State Agency?
Yes
No
11. How and where does the Prospective Sponsor plan to purchase the food components?
___________________________________________________________________________________
12. How many self preparation sites (kitchens) does the Prospective Sponsor plan to operate? ___________
List each preparation site (kitchen) and describe the following:
1. Site Name: __________________________________________________________________________
Projected number of meals served: _______________________________________________________
List kitchen equipment: _________________________________________________________________
Describe sink (s): _____________________________________________________________________
Does the site have a current DOH operating permit?
Yes
No
Does the site a have current DOH inspection for review?
Yes
No
List any deficiencies found during DOH inspections: __________________________________________
Refrigeration Temperature: ______________________ Freezer Temperature: _____________________
Is kitchen adequate?
Yes
No
If “No,” please explain:
Distribution: 1 – Original/Sponsor; 2 – Yellow/FDACS Staff
FDACS-01860 Rev. 03/13
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