Businesses - Sponsors and Providers

Study of Nutrition and Activity in Child Care Settings

Appendix D4a Meal Observation Form--Meals Served by Provider Final 11 3 15

Businesses - Sponsors and Providers

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D.4a Meal Observation Form – Meals Prepared by Provider

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Meal Observation Form-Meals Prepared by Provider

Date of observation: | | | / | | | / 2016

Month Day

Meal: (check one)

Meal START time: : £ am £ pm (check one)

*Time at which 75% of children have been seated

Meal END time: : £ am £ pm (check one)

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£ Meal ongoing (see decision log for details)

*Time at which 75% of children have left the table

0 £ Breakfast

1 £ Lunch

2 £ Dinner/Supper

3 £ Morning Snack

4 £ Afternoon Snack

5 £ Evening Snack

How were the initial portions of this meal served to children? (check ONLY one)

0 £ Family Style – serving dishes on community tables and children self-serve most food items

1 £ Serving dishes arrive in classroom and staff plate for children on individual dishes/trays at the table

2 £ Individual dishes/trays arrive in the classroom already portioned for children, staff pass them out

3 £ Other (please describe) ____________________________________________________________________________________________________

Meal Component:

Child 1 Description:

Child 2 Description:

Child 3 Description:

Reference Portion

Served

Additions/

Deletions

Reference Portion Remaining

(Plate Waste)

Reference Portion

Served

Additions/

Deletions

Reference Portion Remaining

(Plate Waste)

Reference Portion

Served

Additions/

Deletions

Reference Portion Remaining

(Plate Waste)

Condiments:*

Amount Served

Additions/

Deletions

Amount Remaining

Amount Served

Additions/

Deletions

Amount Remaining

Amount Served

Additions/

Deletions

Amount Remaining

(+) Additions to the meal include: 2^nd portions, items taken from another child (–) Deletions include: items dropped or spilled, items given to another child

*For items, such as condiments served at the table, in which you were not able to obtain a reference portion weight, please estimate the amount in tsp/Tbsp/cups.

Meal Observation Form-Meals Prepared by Provider, pg. 2

These X questions pertain to only the 3 children being observed during this meal/snack

These X questions pertain to ALL children participating in this meal/snack

During this meal/snack did the staff member sitting at the table with the 3 observed children eat the same food as the children?

0 £ No

1 £ Yes, complete meal

2 £ Yes, but only certain items

3 £ No staff sitting at this table

Were children seated at a table for the meal/snack?

0 £ No. If not, specify? _______________________________________

1 £ Yes

During this meal/snack did the staff member sitting at the table with the 3 observed children drink the same food as the children?

0 £ No

1 £ Yes

2 £ Did not observe staff drinking during this meal

During this meal, how many children in the classroom participated in the meal by eating the food provided by the center?

_________________

For the 3 observed children, did you observe staff encouraging them to eat any of the following meal components?

3a. Child 1: 0 £ No 1 £ Yes, fruits

2 £ Yes, vegetables

3 £ Yes, breads/grains

4 £ Yes, meats/beans/nuts (proteins)

5 £ Yes, dairy

3b. Child 2: 0 £ No 1 £ Yes, fruits

2 £ Yes, vegetables

3 £ Yes, breads/grains

4 £ Yes, meats/beans/nuts (proteins)

5 £ Yes, dairy

3c. Child 3: 0 £ No 1 £ Yes, fruits

2 £ Yes, vegetables

3 £ Yes, breads/grains

4 £ Yes, meats/beans/nuts (proteins)

5 £ Yes, dairy

For this meal or snack, were any food items brought in from home or elsewhere that were provided for the entire class?

0 £ No

1 £ Yes, single items

2 £ Yes, complete meals

6a. If yes, who brought in the food item(s)?

0 £ Teacher/other staff member

1 £ Parent/child

2 £ Other

6b. What foods/drinks were brought in? ____________________________

____________________________________________________________

Adapted from the NAP SACC Diet Observation Form and Environmental Policy Assessment Observation Form (EPAO), and the Early Childhood and Childcare Study Meal Intake Form.

Meal Observation Decision Log

_______________________________________________________________________________________________

Meal Observation Form, p. 1

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