"Daily Meal Count Form" - Connecticut

Daily Meal Count Form is a legal document that was released by the Connecticut State Department of Education - a government authority operating within Connecticut.

Form Details:

  • Released on February 1, 2018;
  • The latest edition currently provided by the Connecticut State Department of Education;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Education.

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Download "Daily Meal Count Form" - Connecticut

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Summer Food Service Program (SFSP)
DAILY MEAL COUNT
Site Name:
Meal Type (circle)
: Breakfast
Lunch
Snack Supper
Address:
Telephone:
Supervisor’s Name:
Delivery Time:
Date:
Signature of Site Supervisor:
+
=
Meals received/prepared ________
Meals available from previous day ________
_________ TOTAL MEALS AVAILABLE
[1]
First Meals Served to Children (cross off number as each child receives a meal):
1
2
3
4
5
6
7
8
9
10
11
12
13
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130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
Total First Meals
[2]
Second meals served to children:
+
1
2
3
4
5
6
7
8
9
10
Total Second Meals
[3]
Meals served to program adults:
+
1
2
3
4
5
6
7
8
9
10
Total Program Adult Meals
[4]
Meals served to non-program adults:
+
1
2
3
4
5
6
7
8
9
10
Total Non-Program Adult Meals
[5]
=
TOTAL MEALS SERVED
[6]
+
Total damaged/incomplete/other nonreimbursable meals
[7]
+
Total leftover meals
[8]
=
+
+
TOTAL (ADD [6]
[7]
[8])
[9]
Item [9] should be equal to item [1]
Number of additional children requesting a meal after all available meals were served:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Site Supervisor’s Comments:
Connecticut State Department of Education  Revised February 2018  Page 1 of 2
Summer Food Service Program (SFSP)
DAILY MEAL COUNT
Site Name:
Meal Type (circle)
: Breakfast
Lunch
Snack Supper
Address:
Telephone:
Supervisor’s Name:
Delivery Time:
Date:
Signature of Site Supervisor:
+
=
Meals received/prepared ________
Meals available from previous day ________
_________ TOTAL MEALS AVAILABLE
[1]
First Meals Served to Children (cross off number as each child receives a meal):
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
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89
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91
92
93
94
95
96
97
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100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
Total First Meals
[2]
Second meals served to children:
+
1
2
3
4
5
6
7
8
9
10
Total Second Meals
[3]
Meals served to program adults:
+
1
2
3
4
5
6
7
8
9
10
Total Program Adult Meals
[4]
Meals served to non-program adults:
+
1
2
3
4
5
6
7
8
9
10
Total Non-Program Adult Meals
[5]
=
TOTAL MEALS SERVED
[6]
+
Total damaged/incomplete/other nonreimbursable meals
[7]
+
Total leftover meals
[8]
=
+
+
TOTAL (ADD [6]
[7]
[8])
[9]
Item [9] should be equal to item [1]
Number of additional children requesting a meal after all available meals were served:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Site Supervisor’s Comments:
Connecticut State Department of Education  Revised February 2018  Page 1 of 2
SFSP DAILY MEAL COUNT, continued
Note: If the site serves more than 150 children, use this additional page and print the form two-sided. If the
site serves 150 children or less, use only page 1
Site Name:
Date:
First Meals Served to Children (cross off number as each child receives a meal):
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
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237
238
239
240
241
242
243
244
245
246
247
248
249
250
Total First Meals
[2]
Second meals served to children:
+
1
2
3
4
5
6
7
8
9
10
Total Second Meals
[3]
Meals served to program adults:
+
1
2
3
4
5
6
7
8
9
10
Total Program Adult Meals
[4]
Meals served to non-program adults:
+
1
2
3
4
5
6
7
8
9
10
Total Non-Program Adult Meals
[5]
=
TOTAL MEALS SERVED
[6]
+
Total damaged/incomplete/other nonreimbursable meals
[7]
+
Total leftover meals
[8]
=
+
+
TOTAL (ADD [6]
[7]
[8])
[9]
Item [9] should be equal to item [1] on the first page
Number of additional children requesting a meal after all available meals were served:
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Connecticut State Department of Education  Revised February 2018  Page 2 of 2
Summer Food Service Program (SFSP)
INSTRUCTIONS FOR DAILY MEAL COUNT FORM
Each site must take a point-of-service (POS) meal count every day. The POS is that point in the SFSP operation
where a determination can accurately be made that a reimbursable meal has been served to an eligible child.
1. Line 1 equals the total meals available, which equals the number of meals received or prepared plus the
number of meals available from the previous day.
2. Line 2 equals the total number of first meals served to children. Cross out each number as a child
receives a meal. Include any teenagers, ages 18 and under, paid or unpaid, who are helping out at the site.
Note: If the site serves more than 150 children, use page 2 and print the form two-sided. If the site serves
150 children or less, use only page 1
3. Line 3 equals the total number of second meals served to children. Note: Reimbursable meals are limited
to two percent of the total number of first meals served.
4. Line 4 equals the total number of meals served to Program adults. “Program adults” are adults who
work directly as part of the food service operation. This includes all adults who prepare meals, serve meals,
clean up or supervise the children. This does not include teenagers ages 18 and under who may perform
these tasks at the site. Meals for ages 18 and under are fully reimbursable, and are counted on Line 2.
5. Line 5 equals the total number of meals served to non-Program adults. “Non-Program adults” are
adults who are not directly involved in the operation of the food service, including any sponsor
administrative staff such as monitors or sponsor directors, or state or federal reviewers.
6. Line 6 equals the total number of meals served, which is the sum of Lines 2 through 5.
7. Line 7 equals the total number of meals that are unusable because they are damaged, incomplete or
otherwise nonreimbursable.
8. Line 8 equals the total number of leftover meals, which is calculated by subtracting Line 6 from Line 1.
9. Line 9 equals the sum of Lines 6, 7 and 8. It accounts for all meals and should equal Line 1.
10. Use the “Site Supervisor’s Comments” section to record the number of children requesting a first meal
after all available meals were served. This information is helpful in adjusting meal orders upward.
11. The site supervisor must sign and date at the top of the meal count form.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies,
offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color,
national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign
Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech
disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in
languages other than English.
To file a program complaint of discrimination, complete the
USDA Program Discrimination Complaint
Form, (AD-3027) found online at:
http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the
information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
(1) mail: U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410;
(2) fax: (202) 690-7442;
(3) email: program.intake@usda.gov.
This institution is an equal opportunity provider.
For more information on the SFSP, visit the Connecticut State Department of Education’s
SFSP
website.
This form is available at
http://portal.ct.gov/-/media/SDE/Nutrition/SFSP/MealCountDailySFSP.pdf.
Connecticut State Department of Education  Revised February 2018
Page of 3