Form 1 Lunch Personnel Protocol

The Healthy Communities Study: How Communities Shape Childrens Health (NHLBI)

HCS_SSA_ATTACH 16_LUNCH PERSONNEL PROTOCOL_SEPTEMBER 2011 FINAL for OMB

Food Service Personnel

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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



Shape1


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



  • YShape40 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

  • NShape41 o Yes


Chicken nuggets (breaded and fried chicken pieces)

  • NShape42 o Yes


Hamburgers

  • NShape43 o Yes


Entrée item (part of reimbursable meal)

Offered?

Number of types offered


Hot dogs/corn dogs

  • NShape44 o Yes


Nachos (with meat and/or cheese)

  • NShape45 o Yes


Pizza

  • NShape46 o Yes


Sandwiches (not burgers)

  • NShape47 o Yes


Wraps

  • NShape48 o Yes


Salads (meal/entrée sized)

  • NShape49 o Yes


Mexican-style




Burritos

  • NShape50 o Yes


Quesadillas

  • NShape51 o Yes


Tacos

  • NShape52 o Yes


Other hot entrées




Pasta with meat

  • NShape53 o Yes


Pasta with cheese

  • NShape54 o Yes


Soups, chilis, stews

  • NShape55 o Yes


Meat and potato

  • NShape56 o Yes


Meat and rice, Asian-style

  • NShape58 Shape57 o Yes


Other 1: ______________________________

  • NShape59 o Yes


Other 2: ______________________________

  • No Yes


Other 3: ______________________________

  • NShape60 o Yes


Other 4: ______________________________

  • NShape61 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.


  • NShape63

    Skip to B4

    Shape62 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.


  • NShape65

    Skip to B7

    Shape64 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


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


  1. 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


  1. 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)


  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



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