Appendix G4
VENDING
MACHINE CHECKLIST
VENDING MACHINE CHECKLIST
School Name: _________________________________________________________
Observer Name: _________________________________________________________
Date: ______________________________ SFA ID: _______ School ID: _______
Grades: _______________
1. Please record the number of each type of vending machine available to students by location of machines.
Food Source |
Location of Vending Machines |
|||
In food service area |
Adjacent to food service area (within 20 feet) |
Elsewhere in school building |
Outside of school building |
|
a. Milk only |
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b. Water only |
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c. Milk with juice/water (no soft drinks) |
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d. Water with juice (no soft drinks) |
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e. Non-carbonated soft drinks with or without water/milk |
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f. Carbonated soft drinks with or without water |
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g. Snacks/candy/cookies |
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h. Entrees, non-refrigerated |
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i. Frozen foods |
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j. Combination (Specify ____________________________________) |
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k. Combination (Specify ____________________________________) |
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l. Combination (Specify ____________________________________) |
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m. Combination (Specify ____________________________________) |
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n. Other (Specify ____________________________________) |
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o. Other (Specify ____________________________________) |
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p. Other (Specify ____________________________________) |
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q. Other (Specify ____________________________________) |
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2. Place a check mark in the box corresponding to each food and/or beverage item sold in vending machines by location of machine.
Food Item |
Availability of Food Item in Vending Machines |
|||
In food service area |
Adjacent to food service area (within 20 feet) |
Elsewhere in school building |
Outside of school building |
|
A. Beverages |
|
|
|
|
Carbonated Sweetened Soft Drink |
1□ |
1□ |
1□ |
1□ |
Carbonated Diet Soft Drink |
2□ |
2□ |
2□ |
2□ |
Juice (100% juice) |
3□ |
3□ |
3□ |
3□ |
Juice Drinks (Cranberry Drink, Fruit Blends, Hi-C, Lemonade, Punch) |
4□ |
4□ |
4□ |
4□ |
Iced Tea (sweetened) |
5□ |
5□ |
5□ |
5□ |
Iced Tea (unsweetened) |
6□ |
6□ |
6□ |
6□ |
Water (Spring Water, Flavored Water, Sparkling Water, Mineral Water, Seltzer Water) |
7□ |
7□ |
7□ |
7□ |
Water (Water with Juice) |
8□ |
8□ |
8□ |
8□ |
Coffee |
9□ |
9□ |
9□ |
9□ |
Tea (hot) |
10□ |
10□ |
10□ |
10□ |
Hot Chocolate |
11□ |
11□ |
11□ |
11□ |
Yogurt Drinks |
12□ |
12□ |
12□ |
12□ |
Energy and Sports Drinks (Gatorade, Powerade, Red Bull) |
13□ |
13□ |
13□ |
13□ |
Other (Specify ___________________________) |
14□ |
14□ |
14□ |
14□ |
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|
|
|
B. Dairy |
|
|
|
|
Whole Milk |
15□ |
15□ |
15□ |
15□ |
Reduced Fat (2%) White Milk |
16□ |
16□ |
16□ |
16□ |
Low Fat (1%) White Milk |
17□ |
17□ |
17□ |
17□ |
Fat-Free White Milk |
18□ |
18□ |
18□ |
18□ |
Fat-Free Flavored Milk |
19□ |
19□ |
19□ |
19□ |
Yogurt |
20□ |
20□ |
20□ |
20□ |
Cheese |
21□ |
21□ |
21□ |
21□ |
Other (Specify ___________________________) |
22□ |
22□ |
22□ |
22□ |
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C. Baked Goods – Dessert |
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|
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Cake-Type (Brownies, Cupcakes, Twinkies) |
23□ |
23□ |
23□ |
23□ |
Cake-Type (Low-Fat/Reduced-Fat Brownies, Cupcakes, Twinkies) |
24□ |
24□ |
24□ |
24□ |
Cookies |
25□ |
25□ |
25□ |
25□ |
Cookies (Low-Fat/Reduced Fat) |
26□ |
26□ |
26□ |
26□ |
Pastries (Pies, Turnovers) |
27□ |
27□ |
27□ |
27□ |
Other (Specify ___________________________) |
28□ |
28□ |
28□ |
28□ |
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D. Bread or Grain Products |
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Regular Bread (Bread, Rolls, Bagels) |
29□ |
29□ |
29□ |
29□ |
Whole Grain Bread (Bread, Rolls, Bagels) |
30□ |
30□ |
30□ |
30□ |
Other Bread (Biscuits, Croissants, Hot Pretzels) |
31□ |
31□ |
31□ |
31□ |
Muffins (Regular) |
32□ |
32□ |
32□ |
32□ |
Muffins (Whole Grain) |
33□ |
33□ |
33□ |
33□ |
Muffins (Low-Fat/Reduced-Fat) |
34□ |
34□ |
34□ |
34□ |
Granola Bars |
35□ |
35□ |
35□ |
35□ |
Granola Bars (Low-Fat/Reduced-Fat) |
36□ |
36□ |
36□ |
36□ |
Pretzels (Regular, Sourdough) |
37□ |
37□ |
37□ |
37□ |
Pretzels (Whole Grain) |
38□ |
38□ |
38□ |
38□ |
Crackers/Cracker Sandwiches: Peanut Butter |
39□ |
39□ |
39□ |
39□ |
Crackers/Cracker Sandwiches: Cheese |
40□ |
40□ |
40□ |
40□ |
Cereal/Cereal Bars |
41□ |
41□ |
41□ |
41□ |
Other (Specify ___________________________) |
42□ |
42□ |
42□ |
42□ |
Food Item |
Availability of Food Item in Vending Machines |
|||
In food service area |
Adjacent to food service area (within 20 feet) |
Elsewhere in school building |
Outside of school building |
|
E. Frozen Desserts |
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|
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Frozen Non-Diary (Fruit Bars, Jello Pops, Popsicles) |
43□ |
43□ |
43□ |
43□ |
Ice Cream (Bars, Cups, Fudgesicles, Sundaes) |
44□ |
44□ |
44□ |
44□ |
Low-Fat Frozen Desserts (Frozen Yogurt, Ice Milk, Sherbet) |
45□ |
45□ |
45□ |
45□ |
Milkshakes |
46□ |
46□ |
46□ |
46□ |
Smoothies |
47□ |
47□ |
47□ |
47□ |
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F. Fruit and Vegetables |
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|
48□ |
48□ |
48□ |
48□ |
|
Fresh Fruit (whole, cut) |
49□ |
49□ |
49□ |
49□ |
Fruit Salad (Fresh) |
50□ |
50□ |
50□ |
50□ |
Fruit Salad (Canned in Water) |
51□ |
51□ |
51□ |
51□ |
Fruit Salad (Canned in Light Syrup) |
52□ |
52□ |
52□ |
52□ |
Dried Fruit |
53□ |
53□ |
53□ |
53□ |
Other Fresh Fruit (Specify ___________________) |
54□ |
54□ |
54□ |
54□ |
Vegetables, Side Salad |
55□ |
55□ |
55□ |
55□ |
Vegetables, Raw |
56□ |
56□ |
56□ |
56□ |
Other Fresh Vegetables (Specify ______________) |
57□ |
57□ |
57□ |
57□ |
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G. Snacks |
|
|
|
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Chips (Corn, Potato, Tortilla) |
58□ |
58□ |
58□ |
58□ |
Chips (Lower-Fat/Reduced-Fat Corn, Potato, Tortilla) |
59□ |
59□ |
59□ |
59□ |
Puffed Cheese (Regular) |
60□ |
60□ |
60□ |
60□ |
Puffed Cheese (Lower-Fat/Reduced-Fat) |
61□ |
61□ |
61□ |
61□ |
Nuts and Seeds (Almonds, Peanuts, Sunflower Seeds, Trail Mix) |
62□ |
62□ |
62□ |
62□ |
Fruit Snacks (Roll-Up, Gummies) |
63□ |
63□ |
63□ |
63□ |
Popcorn |
64□ |
64□ |
64□ |
64□ |
Meat Snacks (Jerky, Pork Rinds) |
65□ |
65□ |
65□ |
65□ |
Candy with Chocolate |
66□ |
66□ |
66□ |
66□ |
Candy without Chocolate |
67□ |
67□ |
67□ |
67□ |
Energy Bars (Balance Bars, Luna Bars, Power Bars, etc) |
68□ |
68□ |
68□ |
68□ |
Other (Specify ___________________________) |
69□ |
69□ |
69□ |
69□ |
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H. Prepared / Pre-Prepared Entrees and Food |
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Hot Dogs |
70□ |
70□ |
70□ |
70□ |
Hamburgers or Cheeseburgers |
71□ |
71□ |
71□ |
71□ |
Veggie Burgers |
72□ |
72□ |
72□ |
72□ |
Grilled Sandwiches |
73□ |
73□ |
73□ |
73□ |
Cold Sandwiches |
74□ |
74□ |
74□ |
74□ |
Burritos |
75□ |
75□ |
75□ |
75□ |
Taco |
76□ |
76□ |
76□ |
76□ |
Meal-Size Salad |
77□ |
77□ |
77□ |
77□ |
Pizza (Slice) |
78□ |
78□ |
78□ |
78□ |
Pizza (Bites) |
79□ |
79□ |
79□ |
79□ |
Pasta |
80□ |
80□ |
80□ |
80□ |
French Fries |
81□ |
81□ |
81□ |
81□ |
Onion Rings |
82□ |
82□ |
82□ |
82□ |
Mozzarella Sticks |
83□ |
83□ |
83□ |
83□ |
Other (Specify ____________________________) |
84□ |
84□ |
84□ |
84□ |
Food Item |
Availability of Food Item in Vending Machines |
|||
In food service area |
Adjacent to food service area (within 20 feet) |
Elsewhere in school building |
Outside of school building |
|
I. Other (Specify) |
|
|
|
|
________________________________________ |
85□ |
85□ |
85□ |
85□ |
________________________________________ |
86□ |
86□ |
86□ |
86□ |
________________________________________ |
87□ |
87□ |
87□ |
87□ |
________________________________________ |
88□ |
88□ |
88□ |
88□ |
________________________________________ |
89□ |
89□ |
89□ |
89□ |
________________________________________ |
90□ |
90□ |
90□ |
90□ |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Kim Standing |
File Modified | 0000-00-00 |
File Created | 2021-01-29 |