Form DACS-01835 "Nslp Rcci on-Site Review Form" - Florida

What Is Form DACS-01835?

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, 2012;
  • 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 DACS-01835 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 DACS-01835 "Nslp Rcci on-Site Review Form" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
Site review MUST be completed
by February 1 each year.
NSLP RCCI ON-SITE REVIEW FORM
ADAM H. PUTNAM
COMMISSIONER
Sponsors with only one site are exempt from this requirement.
Sponsor Name
Sponsor Number
Site Name
Monitor Name
Site Number
Date of On-site Review
INDIVIDUAL DETERMINATION FORMS
Are forms correctly approved?
YES
NO
MEAL COUNT SYSTEM
Are reimbursable meals correctly counted by category after the meal has
been served to the child?
YES
NO
Does the system correctly consolidate the daily meal count information for
the reporting period?
YES
NO
Does the system prevent overt identification of the eligible needy?
YES
NO
Are edit checks of each day’s meal count conducted?
YES
NO
Meal counts should not exceed the number of clients in attendance on a
daily basis. Is this true for meal counts at this location?
YES
NO
MENUS AND PRODUCTION RECORDS
Are menus and production records accurately maintained?
YES
NO
Do menus and production records document sufficient amounts of prepared
food to meet the meal pattern requirements?
YES
NO
CIVIL RIGHTS
Is “And Justice for All” poster displayed in a prominent place visible by the
clients?
YES
NO
Any NO answer requires corrective action and follow-up review within 45 calendar days.
Describe corrective action taken:
Date corrective action taken:
Date of follow-up review:
Monitor signature
“In accordance with Federal law, and US Department of Agriculture policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age, or disability. To file a complaint of discrimination write USDA, Director, Office of Adjudication, 1400
Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (Voice). Individuals who are hearing impaired
or have speech disabilities may contact USDA through the Federal Relay Service (800) 877-8339; or (800) 845-6136 (Spanish). USDA
is an equal opportunity provider and employer.”
DACS-01835 03/12
Florida Department of Agriculture and Consumer Services
Division of Food, Nutrition and Wellness
Site review MUST be completed
by February 1 each year.
NSLP RCCI ON-SITE REVIEW FORM
ADAM H. PUTNAM
COMMISSIONER
Sponsors with only one site are exempt from this requirement.
Sponsor Name
Sponsor Number
Site Name
Monitor Name
Site Number
Date of On-site Review
INDIVIDUAL DETERMINATION FORMS
Are forms correctly approved?
YES
NO
MEAL COUNT SYSTEM
Are reimbursable meals correctly counted by category after the meal has
been served to the child?
YES
NO
Does the system correctly consolidate the daily meal count information for
the reporting period?
YES
NO
Does the system prevent overt identification of the eligible needy?
YES
NO
Are edit checks of each day’s meal count conducted?
YES
NO
Meal counts should not exceed the number of clients in attendance on a
daily basis. Is this true for meal counts at this location?
YES
NO
MENUS AND PRODUCTION RECORDS
Are menus and production records accurately maintained?
YES
NO
Do menus and production records document sufficient amounts of prepared
food to meet the meal pattern requirements?
YES
NO
CIVIL RIGHTS
Is “And Justice for All” poster displayed in a prominent place visible by the
clients?
YES
NO
Any NO answer requires corrective action and follow-up review within 45 calendar days.
Describe corrective action taken:
Date corrective action taken:
Date of follow-up review:
Monitor signature
“In accordance with Federal law, and US Department of Agriculture policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age, or disability. To file a complaint of discrimination write USDA, Director, Office of Adjudication, 1400
Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (Voice). Individuals who are hearing impaired
or have speech disabilities may contact USDA through the Federal Relay Service (800) 877-8339; or (800) 845-6136 (Spanish). USDA
is an equal opportunity provider and employer.”
DACS-01835 03/12