Form 16 Lunch Personnel Protocol

SSA Attachment 16

HEALTHY COMMUNITIES STUDY

HEALTHY COMMUNITIES STUDY

SCHOOL FOOD ENVIRONMENTAL ASSESSMENT PROTOCOL

FOR FOOD SERVICE PERSONNEL

The following document contains the school food environmental assessment protocol for the the food service personnel. In addition to the school food environmental assessment instruments provided in SSA Attachment 15, food service personnel in all 279 communities will be asked to participate in providing information on the school’s food environment.

Baseline observational assessments of the nutritional environment will be conducted in up to four randomly selected schools (two elementary and two middle schools) per community. A member of the school’s food service staff will complete a brief self-administered questionnaire , and, along with the Battelle community liaison, will observe the school’s lunch period and complete an observation form. These community and environmental assessments will be conducted in all 279 communities during the initial visit to the community, and again in the RIPA communities, three years later.

In addition, where the principal of the school has consented to be a key informant, a link to the food service staff questionnaire and lunch observation form will be sent to the principal during the follow-up period and with a request to forward the link to the appropriate food service person for completion.

HEALTHY COMMUNITIES STUDY SCHOOL FOOD ENVIRONMENTAL ASSESSMENT
Public reporting burden of this collection of information of the school food environment is 25 minutes, including the time for verbal consent, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to S. Sonia Arteaga, Ph.D., project officer at [email protected]

QUESTIONNAIRE FOR FOOD SERVICE PERSONNEL
	/ / mm dd yyyy
	Today’s Date		School ID
			Liaison ID (Observer)
	Initials of individual completing form		_____________________________ Position of individual completing form
1.	How many total lunches (including full price, reduced price, and free meals) were claimed for the school year 20__ __-20__ __ at this school?		# lunches
2.	How many total breakfasts (including full price, reduced price, and free meals) were claimed in 20__ __-20__ __ at this school?		# breakfasts
3.	How many students in this school were approved for free meals in 20__ __-20__ __?		# students
4.	How many students in this school were approved for reduced price meals in 20__ __-20__ __?		# students
5.	Is the campus open (students are allowed to leave) at lunch for: Please  only one.		All students Some students No students
6.	For how many years has this school participated in the following (write “0” if this school is not participating):
a	The federally funded Fresh Fruit and Vegetable program?		# years
b	The Department of Defense (DoD) Fresh program?		# years
c	The State Farm to School Program?		# years

d	USDA’s Team Nutrition Initiative		# years
e	Healthier US School Challenge		# years Bronze # years Silver # years Gold
f	Other state or Federal food or nutrition program: Name of program:_______________________		# years
7.	During the 20__ __-20__ __ school year, about what percent of reimbursable school lunch entrées at this school were prepared using the following methods?
a	Convenience prep [Pre-portioned, heat and serve items, i.e. frozen burrito]		%
b	Minimal prep [Food preparation primarily involving assembling and portioning, i.e. chef’s salad made with pre-cut and pre-cooked ingredients]		%
c	School-made/scratch prep [food preparation involving the use of raw ingredients, some degree of ingredient prep, and cooking when needed, i.e. spaghetti with scratch-prepared sauce]		%
	Total		100%
8.	Has the amount of scratch and minimal preparation cooking that has been done at this school been increasing or decreasing? Please  only one.		Increasing Decreasing
9.	Over how many years has this trend in scratch and minimal preparation cooking occurred?		# years

10.	To what degree have the following components of the local wellness policy (a district or school policy to encourage healthy eating and physical activity among students) been implemented at this school and for how many years have they been in place?
		Please  only one.
	Policy Component	Not at all (<10%)	To some extent (10-50%)			To a large extent (50-90%)	Completely (>90%)	Number of years in place
	Reimbursable school meal goals						

	Policy Component		Not at all (<10%)	To some extent (10-50%)			To a large extent (50-90%)	Completely (>90%)	Number of years in place
	Nutrition guidelines for all other foods sold (competitive foods) such as a la carte, school store, vending, etc.							
	Nutrition guidelines for foods that are not sold, but offered, such as at classroom parties and social events							
11.	To what extent have there been changes to the following within the last 10 years at this school: (Choose one response for each item and estimate when the changes started, if applicable.)
			Please  only one.
				If ’d, please fill in last column
			Did not change	Got worse			Somewhat improved	Improved a lot	Since __ years ago
	Meal offerings							
	Meal facilities							
	Competitive foods							
12.	Any additional comments or explanations:

HEALTHY COMMUNITIES STUDY LUNCH OBSERVATION FORM
SECTION A: REIMBURSABLE SCHOOL LUNCH FOODS AND BEVERAGES
	/ / mm dd yyyy
	Today’s Date			School ID
	: AM/PM Time			Liaison ID (Observer)
A1.	Get a copy of the month’s menu (if not able to obtain from school/district website prior to visit)				Already obtained Collected today Not available
THE FOLLOWING QUESTIONS SHOULD BE ANSWERED BASED ON OBSERVATIONS MADE DURING 25 MINUTE OBSERVATION (not the menu obtained).
A2.	Total # of different entrées offered			# entrées
A3.	Salad bar as entrée			Yes No
A4.	Salad bar as side dish			Yes No
A5.	Number of fresh fruits and vegetables in salad bar			# fruits and vegetables No salad bar offered
A6.	Sandwich bar			Yes No
A7.	Other entrée bar			Y es Describe: ___________________ ___________________ No

A8.	Indicate how many different entrée options are offered for each category listed in the table below. Include reimbursable meal items only (not a la carte).
	Entrée item (part of reimbursable meal)	Offered?				Number of types offered
	Fast food-style
	Chicken burgers	N o  Yes
	Chicken nuggets (breaded and fried chicken pieces)	N o  Yes
	Hamburgers	N o  Yes
	Entrée item (part of reimbursable meal)	Offered?				Number of types offered
	Hot dogs/corn dogs	N o  Yes
	Nachos (with meat and/or cheese)	N o  Yes
	Pizza	N o  Yes
	Sandwiches (not burgers)	N o  Yes
	Wraps	N o  Yes
	Salads (meal/entrée sized)	N o  Yes
	Mexican-style
	Burritos	N o  Yes
	Quesadillas	N o  Yes
	Tacos	N o  Yes
	Other hot entrées
	Pasta with meat	N o  Yes
	Pasta with cheese	N o  Yes
	Soups, chilis, stews	N o  Yes
	Meat and potato	N o  Yes
	Meat and rice, Asian-style	N o  Yes
	Other 1: ______________________________	N o  Yes
	Other 2: ______________________________	No  Yes
	Other 3: ______________________________	N o  Yes
	Other 4: ______________________________	N o  Yes
A9.	Indicate whether the following beverages are offered as part of a reimbursable meal at no extra charge:
	Milk - white, whole or 2%	Yes  No
	Milk - flavored, whole or 2%	Yes  No
	Milk - white, 1% or nonfat	Yes  No
	Milk - flavored, 1% or nonfat	Yes  No
	Juice (100%) + water, no added sweeteners	Yes  No
	Juice, sweetened	Yes  No
	Sports drinks	Yes  No
	Soda, regular	Yes  No
	Other sweetened beverage (any beverage with added caloric sweetener not already listed above)	Yes  No
	Diet beverage	Yes  No
	Water, bottled, unsweetened	Yes  No
	Other beverage 1: _______________________	Yes  No
	Other beverage 2: _______________________	Yes  No
A10.	Please indicate the number of meal options that include the following:
		# meal options
	Grain product (100% whole wheat bread, pasta or tortillas, brown rice, corn tortillas)
	Grain product, not 100% whole grain
	Fruit, fresh
	Fruit, frozen, canned or dried
	Vegetable, French Fries
	Vegetable, other, fried
		# meal options
	Vegetable, fresh
	Vegetable, processed, i.e. canned, frozen
	Salad, side (tossed, raw vegetables)
A11.	Please indicate which desserts and snack items are offered as part of a reimbursable meal at no extra charge:
	Cake	Yes  No
	Cookie	Yes  No
	Other pastries	Yes  No
	Candy	Yes  No
	Ice Cream	Yes  No
	Low-fat frozen desserts	Yes  No
	Other frozen desserts	Yes  No
	Chips (corn, potato, puffed cheese, tortilla)	Yes  No
	Chips (lower/reduced fat, baked)	Yes  No
	Other 1: _______________________________	Yes  No
	Other 2: _______________________________	Yes  No
SECTION B: SCHOOL DINING FACILITIES
B1.	Presence of indoor dining areas Please  only one.			N Skip to B4 one (no indoor dining areas provided) Informal (students can eat inside but no seating AND tables provided for this purpose) Formal (indoor eating with seating AND tables provided for this purpose)
B2.	Size of indoor dining area Please  all that apply.			Big enough Too small Not enough seating Too crowded Not too crowded
B3.	Indoor dining décor / ambiance: Please  only one.			Exceptional Pleasant (clean, cheerful, inviting) Acceptable (clean, well-kept, but sparse) Some areas of concern (dirty, dingy, needs repairs, etc.)
B4.	Presence of outdoor dining areas Please  only one.			N Skip to B7 one (no outdoor dining areas provided) Informal (students can eat outside but no seating AND tables provided for this purpose) Formal (outdoor eating with seating AND tables provided for this purpose)
B5.	Size of outdoor dining area Please  all that apply.			Big enough Too small Not enough seating Too crowded Not too crowded
B6.	Outdoor dining décor / ambiance: Please  only one.			Exceptional Pleasant (clean, cheerful, inviting) Acceptable (clean, well-kept, but sparse) Some areas of concern (dirty, dingy, needs repairs, etc.)
B7.	In their interactions with students, most staff were: Please  only one.			Engaging (smiling, interactive, encouraging) Pleasant but not engaging Neutral (interact enough to process the students’ meals) Impolite, impatient, or negative with students Unable to observe
B8.	The longest meal service lines (during the time observed) consisted of approximately _____ students.			# of students
B9.	Meal service lines were observed over a span of ____ minutes.			minutes
B10.	Most students were served by ____:____ (not including stragglers)			: AM/PM Unable to observe
B11.	Time when meal period started			: AM/PM
	ended			: AM/PM

B12.

In what forms is unsweetened water available free of charge in the dining or serving areas? Please  all that apply.

Water fountain Pitcher Bottles Dispenser Other None

B13.

Other observations or clarifications:

SECTION C: COMPETITIVE FOODS SOLD TO STUDENTS ON CAMPUS

C1.

Number of Competitive Food Venues Operating at any time during the school day:

Location

(Record a number in each box – write zero if none.)

Venue Type

Cafeteria

Hallway

Quad

Gym

Other

#

A la carte

_________

Vending machine

_________

School store

_________

Other 1: ______________

_________

Other 2: ______________

_________

Other 3: ______________

_________

C2.

Competitive Foods Sold During the School Day– Type and location

Please  all that apply.

Beverages

A la carte

Vending machine

School store

Other

Diet beverage









Juice (100%) + water, no added sweeteners (including 100% juice smoothies)









Juice, sweetened









Milk, white, whole or 2%









Milk flavored, whole or 2%









Milk White, 1% or nonfat









Milk flavored, 1% or nonfat









Soda, regular









Sports drinks









Other sweetened beverage (beverage w/ added caloric sweetener not listed above)









	Please  all that apply.
	Water, no added sweeteners					
			* Check this box if there appears to be an option with >50% whole grain.
	Baked Goods - Dessert	Whole grain option	A la carte	Vending machine	School store	Other
	Cake type (brownies, cupcakes, Twinkies)					
	Cake type (lower/reduced fat)					
	Cookies					
	Cookies (lower/reduced fat)					
	Muffins					
	Muffins (lower/reduced fat)					
	Pastries (donuts, pies, turnovers, toaster pastries)					
	Pastries (lower/reduced fat)					
	Cereals	Whole grain option	A la carte	Vending machine	School store	Other
	Cereal frosted or flavored					
	Cereal not frosted or flavored					
	Frozen desserts		A la carte	Vending machine	School store	Other
	Frozen, non-dairy (fruit bars, Jell-O pops, Popsicles)					
	Ice cream (bars, Fudgesicles, scoops, cups, sundaes, sandwiches)					
	Low-fat frozen desserts (frozen yogurt, ice milk, sherbet)					
	Milkshake					
	Fruit		A la carte	Vending machine	School store	Other
	Canned or cooked fruit					
	Dried fruit					
	Fresh fruit					
	Meat/Meat Alternative Entrées/Mixed Dishes	Whole grain option	A la carte	Vending machine	School store	Other
	Burritos					
	Chicken burger					
	Chicken pieces/nuggets (breaded)					
	Hamburger/cheeseburger					
	Hot dog/corn dog					
			Please  all that apply.
			A la carte	Vending machine	School store	Other
	Meat with rice (Chinese-/Asian-style)					
	Nacho chips with salsa					
	Nacho chips (with meat, beans or cheese)					
	Pasta (spaghetti, macaroni and cheese, pasta salad)					
	Pizza					
	Ramen-type soup/cup of noodles					
	Salad, meal-sized (chef's, grilled chicken)					
	Sandwiches, cold					
	Sandwiches, grilled/hot					
	Soup/chilis/stews with beans or meat (chicken, clam chowder, minestrone)					
	Tacos					
	Wraps					
	Vegetables		A la carte	Vending machine	School store	Other
	Fried potatoes (including pre-fried, oven baked, French fries, tater tots, potato skins)					
	Salad - side (tossed, raw vegetables)					
	Vegetables (not fried)					
	Snacks	Whole grain option	A la carte	Vending machine	School store	Other
	Candy/chocolate					
	Chips (corn, potato, puffed cheese, tortilla)					
	Chips (lower/reduced fat/baked)					
	Corn nuts					
	Crackers,(regular)					
	Crackers (lower/reduced fat)/pretzels					
	Fruit roll-up or fruit snacks with added sugar					
	Granola bars/cereal bars/energy bars/other snack bars					
	Meat snacks (jerky, salami, pork rinds)					
	Nuts and seeds (almonds, sunflower seeds)					

			Please  all that apply.
			A la carte	Vending machine	School store	Other
	Popcorn, air-popped or low-fat					
	Popcorn, buttered or flavored					
	Trail mix, without candy					
	Trail mix with candy					
	Yogurt, flavored					
	Yogurt, plain					
	Other foods (specify):	Whole grain option	A la carte	Vending machine	School store	Other
	______________________					
	______________________					
	______________________					
	______________________					
	______________________					
	______________________					
	______________________					
	______________________					

SCHOOL FOOD ENVIRONMENTAL ASSESSMENT

Sources and References

SCHOOL FOOD ENVIRONMENT QUESTIONNAIRE FOR FOOD SERVICE PERSONNEL

1. U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS). School Nutrition Dietary Assessment (SNDA) Study III, Pre-Visit Questionnaire and Menu Survey – Reimbursable Meals Form. Retrieved on November 14, 2010 from http://www.fns.usda.gov/oane/MENU/Published/CNP/cnp.htm

2. USDA Team Nutrition School Wellness Policy Demonstration Project (SWDP), 2009. Questionnaire on Local Wellness Policy: School Level, 2^nd wave. Not published.

3. Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). School Health Policies and Practices Study (SHPPS). Retrieved on November 16, 2010 from http://www.cdc.gov/HealthyYouth/shpps/2006/questionnaires/index.htm

4. School Nutrition Association: http://docs.schoolnutrition.org/trendsetters/trendsets/blasts/trendSETS_Newsletter_june.htm, posted 7/9/2008, accessed 2/2011

LUNCH OBSERVATION FORM

1. UC Berkeley Atkins Center for Weight and Health (CWH) school nutrition environment observation forms (not published)

2. U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS). School Nutrition Dietary Assessment (SNDA) Study III, Pre-Visit Questionnaire and Menu Survey – Reimbursable Meals Form. Retrieved on November 14, 2010 from http://www.fns.usda.gov/oane/MENU/Published/CNP/cnp.htm

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