SNMCS State, Local & Tribal Governments

H4. GROUP 2, 3—FSM A LA CARTE FOODS CHECKLIST INSTRUCTIONS
(BASIC AND EXPANDED MENU SURVEY)

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OMB Clearance Number: 0584-XXXX
Expiration Date: XX/XX/XXXX

Instructions for Completing the
A La Carte Foods Checklist
Purpose:

To identify foods and beverages your school offers on an a la carte
cart basis
at lunch and breakfast.

Location:

The A La Carte Foods Checklist (pink paper) is located behind the “A La
Carte” tab in the Menu Survey Folder.

Notes:
•

Complete the A La Carte Foods Checklist on the one day specified on the front of
the Menu Survey Folder. Be sure to complete the checklist even if your school
does not offer items on an a la carte basis, or if you sell only milk.

•

Be sure to look at the sample completed A La Carte Foods Checklist that is
provided.

How to Complete the A La Carte Foods Checklist
1. Write the name of your school and the date on the first page of the form.
2. Answer Question 1. If your school does not offer any foods or beverages on an a
la carte basis, check “No.” You are done. If you check “Yes,” please answer
Questions 2 through 4 and go on to the next page.
3. Place a check mark in the box next to each food and beverage that was available
for a la carte purchase on the specified day. This includes items that are sold
only a la carte as well as components of a reimbursable meal that may be
purchased a la carte. There are separate check boxes for lunch and breakfast.
4. Do not include foods and beverages sold in vending machines,
machines snack bars,
school stores, or food carts
carts.
5. If a food or beverage is usually or sometimes available a la carte, but was not
available on the specified day, do not check the box.
6. If your school had a la carte foods or beverages available on your specified day
that are not included in the checklist, please write in the names of these foods
and beverages under the appropriate category. Extra lines are available on the
last page of the checklist
checklist, if necessary.. Be sure to indicate whether each food or
beverage was offered at breakfast and/or lunch.

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