Monitor Survey

Burden Statement for Site Monitor Survey

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 4 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

SURVEY INSTRUMENTS

SURVEY 3: SITE MONITOR SURVEY

1. HOW LONG HAVE YOU BEEN A SITE MONITOR? ________ years

2. HOW MANY SPONSORS WERE YOU RESPONSIBLE FOR THIS SUMMER?

_____________ sponsors

3. HOW MANY SITES WERE YOU RESPONSIBLE FOR THIS SUMMER?

_____________ sites

4. HOW MANY SITES DID YOU MONITOR? (ASKED ONLY FOR THOSE YEARS THIS MONITOR WAS MONITORING SITES.)

___ 2004

___ 2005

___ 2006

5. ABOUT HOW LONG DID EACH MONITORING VISIT TAKE?

______ hours, ______ minutes

6. APPROXIMATELY HOW MANY OF YOUR SITE MONITOR VISITS WERE MADE TO FOLLOW-UP ON A PREVIOUSLY IDENTIFIED PROBLEM?

________%

(6A) APPROXIMATELY HOW MANY PROBLEMS WERE RESOLVED BY THE TIME THE FIRST FOLLOW-UP VISIT IS MADE?

_______%

7. APPROXIMATELY WHAT PERCENT OF YOUR SITE MONITORING VISITS WERE NOT ANNOUNCED AHEAD OF TIME?

________%

8. THE STATE COLLECTS DATA ON THE FOLLOWING POTENTIAL SFSP VIOLATIONS. PLEASE RANK THESE FROM 1 TO 7 TO SHOW HOW SERIOUS THE VIOLATION WAS COMPARED TO OTHER VIOLATIONS. BY “SERIOUS,” WE DO NOT MEAN THE NUMBER OF TIMES YOU ENCOUNTERED THIS VIOLATION, BUT RATHER THE SERIOUSNESS OF THE VIOLATION COMPARED TO OTHER VIOLATIONS. USE 1 FOR THE MOST SERIOUS VIOLATION AND 7 FOR THE LEAST SERIOUS VIOLATION.

___ Meals not utilized

___ Off-site consumption

___ Time violation

___ Meal pattern violation

___ Damaged/spoiled meals

___ Meals served to ineligible individuals

___ Other (Specify _____________________________)

9. DID NEW, 40% SITES HAVE THE SAME VIOLATIONS AS OTHER SITES?

___ Yes GO TO Q10.

___ No (If no, GO TO 9A)

(9A) PLEASE RANK VIOLATIONS AMONG NEW 40% SITES. BY “SERIOUS,” WE DO NOT MEAN THE NUMBER OF TIMES YOU ENCOUNTERED THIS VIOLATION, BUT RATHER THE SERIOUSNESS OF THE VIOLATION COMPARED TO OTHER VIOLATIONS. USE 1 FOR THE MOST SERIOUS VIOLATION AND 7 FOR THE LEAST SERIOUS VIOLATION.

___ Meals not utilized

___ Off-site consumption

___ Time violation

___ Meal pattern violation

___ Damaged/spoiled meals

___ Meals served to ineligible individuals

___ Other (Specify _____________________________)

10. WHAT TYPES OF SITES SEEMED TO HAVE THE MOST VIOLATIONS? ____________________________________________________________________________________________________________________________________________________________

11. PLEASE DESCRIBE THE MAJOR PROBLEMS YOU ENCOUNTERED DURING YOUR SITE MONITORING VISITS. “PROBLEMS” CAN INCLUDE FORMAL SFSP VIOLATIONS AND/OR OTHER DIFFICULTIES OR SITUATIONS THAT YOU ENCOUNTERED. _______________________________________________________

__________________________________________________________________________________________________________________________________________________________________

Date: _____/_____/2006

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