State, Local and Tribal Agencies (Respondents)

OMB Control No: 0584-XXXX

Expiration Date: XX/XX/20XX

Appendix E9. Site Supervisor Survey

SECTION A. ABOUT THE SITE

A1. For how many summers, including this summer, has a Summer Meals Program operated at <SITE NAME>? An estimate is fine.

|___| Number of summers

Don’t know

A2. For how many weeks is <SITE NAME> scheduled to operate the summer meals program this summer 2018?

|___| Number of weeks

A3. On which day(s) of the week does <SITE NAME> typically operate the summer meals program this summer 2018?

SELECT ONE OR MORE.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

A4. During this summer 2018, what is the normal daily starting time (when children first begin arriving) at <SITE NAME>?

Please provide the earliest start time for any activity provided, not just for meals.

|___|___| : |___|___| AM/PM

A5. During this summer 2018, what is the normal daily closing time (when children leave) at <SITE NAME>?

|___|___| : |___|___| AM/PM

A6. Which children can go to the summer meals program at <SITE NAME> this summer 2018?

SELECT ONLY ONE.

All children and teens ages 18 and under in the area surrounding the site  GO TO QUESTION A7.

Only children and/or teens who are enrolled in the program at <SITE NAME>  GO TO QUESTION A6a.

Other (PLEASE SPECIFY_____________)  GO TO QUESTION A7.

A6a. Does <SITE NAME> enroll a particular group of childen and/or teens?

SELECT ONE OR MORE.

No, any child or teen 18 years of age or under may enroll

Yes, only children and/or teens of a certain age group may enroll

Yes, only children and/or teens who are interested in the activity or activities at <SITE NAME> may enroll

Other (PLEASE SPECIFY_____________)

A7. What is the average number of children at <SITE NAME> each day?

This includes both children who receive a summer meal or snack and those who do not. Your best estimate is fine.

|___| Average number of children each day

SECTION B: SITE SERVICES

B1. Does <SITE NAME> operate only to provide free meals to children in the summer?

Yes

No

B2. How often are activities offered for children at <SITE NAME> this summer?

SELECT ONLY ONE.

Every day the site is open

Most days the site is open

A few times over the summer

Other (PLEASE SPECIFY):

<SITE NAME> does not offer activities for children  GO TO QUESTION B4

B3. Which of the following activities are offered anytime at <SITE NAME> this summer?

SELECT ONE OR MORE.

Arts and crafts

Performing arts

Educational/instructional activities

Sports

Supervised free play

Supervised child care

Swimming

Off-site field trips

Religious activities

Cooking

Counseling, therapy, social skills development

Multicultural activities

Other (PLEASE SPECIFY):

B4. Does <SITE NAME> provide transportation for children to get to and from <SITE NAME>?

SELECT ONLY ONE.

Yes, transportation is provided for a fee

Yes, transportation is included in the program fee

Yes, free transportation is provided by <SITE NAME>

Yes, a voucher is provided for public transportation

No, transportation is not provided by <SITE NAME>  GO TO SECTION C

No, transportation is not needed for <SITE NAME>  GO TO QUESTION B4a

B4a. Why is transporation not needed for <SITE NAME>?

Children live near the site  GO TO SECTION C

Other (PLEASE SPECIFY)___________  GO TO SECTION C

B5. Does <SITE NAME> provide transportation for …?

SELECT ONLY ONE.

All children who go to the site

Children who live some distance away from the site

Those who request it

Other (PLEASE SPECIFY):

B6. What type of transportation is provided? (CHECK ALL THAT APPLY.)

Volunteers drive children in their own vehicles

Shuttle buses or vans transport children

Program is accessible through public transportation (e.g., on a bus route)

Other (PLEASE SPECIFY):

B7. On a typical day, how many children use transportation provided by <SITE NAME>, not including field trips?

SELECT ONLY ONE.

All or almost all children

Most children

Some children

Few or very few children

No children

SECTION C: SUMMER MEALS

C1. On which date did <SITE NAME> first begin serving meals for the summer meals program this summer 2018? Your best estimate is fine.

|___|___| / |___|___| MONTH/DAY

Don’t know/Not sure

C2. On which date did <SITE NAME> stop serving meals for the summer meals program this summer 2018? If meals are still being served, please enter the date on which you expect to stop serving meals this summer 2018.

Your best estimate is fine.

|___|___| / |___|___| MONTH/DAY

Don’t know/Not sure

C3. What is the setting for <SITE NAME> during this summer 2018?

SELECT ONE OR MORE.

School

Church or other religious organization

Library

Playground/park

Recreation center or community center

Public housing project

Mobile feeding site/food truck

Homeless shelter

Day Camp

Residential Camp

Migrant Site

Museum

WIC Clinic

Hospital

Food bank

Government building

Indian Tribal Organization/building

College/University

Other (PLEASE SPECIFY):

C4. Please put a check mark in the box to indicate the meals served by <SITE NAME> during this summer 2018 and days of the weeks they are typically served.

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Breakfast
Morning Snack
Lunch
Afternoon Snack
Supper
Evening Snack

[PROGRAMMER: pre-populate C5 based on responses to C4.]

C5. On a typical day, what time does <SITE NAME> serve the following meals:

Please enter the start time and end time.

Your best estimate is fine.

<Meal1>?

Start Time: |___|___| : |___|___| AM/PM

End Time: |___|___| : |___|___| AM/PM

<Meal2>?

Start Time: |___|___| : |___|___| AM/PM

End Time: |___|___| : |___|___| AM/PM

<Meal3>?

Start Time: |___|___| : |___|___| AM/PM

End Time: |___|___| : |___|___| AM/PM

C6. During this summer 2018, does <SITE NAME> follow the same meal service schedule every week?

Yes

No

[PROGRAMMER: pre-populate C7 based on responses to C4.]

C7. On average across this summer 2018, how many meals and/or snacks are served to children each day and how long are children given to eat meals and snacks? Your best estimate is fine.

	Average number of meals/snacks served each day		Length of time (minutes) given to eat meal/snack
	Children 12 or younger	Children 13 to 18 years of age
Breakfast	______	______	______
Morning Snack	______	______	______
Lunch	______	______	______
Afternoon Snack	______	______	______
Supper	______	______	______

SECTION D: CHILDREN SERVED

[PROGRAMMER: TOTALS FOR EACH QUESTION IN SECTION D SHOULD EQUAL BUT NOT EXCEED 100%]

D1. On a typical day, about what percentage of the summer meals and snacks are served to. . .

Your best estimate is fine.

… Preschoolers? _____% Do not serve this age group

… Elementary age children (grades K-5)? _____% Do not serve this age group

… Middle school or junior high age children

(grades 6-8)? _____% Do not serve this age group

… High school age children (grades 9-12)? _____% Do not serve this age group

D2. On a typical day, about what percentage of summer meals and snacks are served by <SITE NAME> to…

Your best estimate is fine.

…Girls? _____ %

…Boys? _____ %

D3. On a typical day, about what percentage of children served summer meals and snacks at <SITE NAME> are …

Your best estimate is fine.

… American Indian or Alaska Native?              _____ %

… Asian?                                                          _____ %

… Black or African American?                          _____ %

…Hispanic or Latino?                                        _____ %

… Native Hawaiian or other Pacific Islander?   _____ %

… White?                                                          _____ %

… Some other race?                                         _____ %

SECTION E: MEAL SERVICE

E1. What type of meal service system does <SITE NAME> use for summer meals?

SELECT ONLY ONE.

Cafeteria-style meal service (site workers put food on platesfor children or children serve themselves such as a salad bar)

Pre-plated/pre-packaged meal service (meals are already assembled, either in whole or in part)

Family-style meal service (children serve themselves from common platters of food)

Other (PLEASE SPECIFY):

E2. How do you change portion sizes for children of different age groups at <SITE NAME>?

SELECT ONE OR MORE

Pre-plated/pre-packaged meals sized for different age groups

Different serving utensils to change portion sizes

Other (Please specify)____________________________________

We do not change portion sizes for different age groups

E3. For which of the following meals does <SITE NAME> use “offer versus serve”?

“Offer versus serve” allows children to decline some of the food offered in a reimbursable breakfast, lunch, or supper (excluding snacks).

SELECT ONE OR MORE.

Breakfast

Lunch

Supper

We do not use “offer versus serve” for any meals

E4. Where are meals and/or snacks typically served?

SELECT ONLY ONE.

Indoors

Outdoors (except in bad weather)

Both indoors and outdoors

E5. Do you have any challenges with serving meals in a congregate setting at <SITE NAME>? By congregate we mean children must stay at the site to eat their meal.

Yes

No  GO TO QUESTION E7

E6. To what extent are each of the following factors a challenge or not a challenge in serving meals in a congregate setting at <SITE NAME>? By congregate we mean children must stay at the site to eat their meal.

	Not a challenge	Somewhat of a challenge	Challenge	Significant challenge	Not sure
Space for children to eat together
Shelter from the rain/heat
Attracting children to eat a meal onsite
Not offering meals to adults who are with children at <SITE NAME>
Safety of children while at <SITE NAME>
Other, please specify:

E7. How often are hot meals served each week?

A meal is considered a hot meal if at least one component (such as the entrée) is served heated.

Everyday

3 or more days each week

1 or 2 days each week

Never

E8. What role do the staff at <SITE NAME> have in menu planning?

SELECT ONLY ONE.

Site staff plan menus and submit to sponsor for review

Site staff do not plan menus but provide suggestions to the sponsor and/or meal vendor on suggested menus

Site staff do not have a role in menu planning

Other (PLEASE SPECIFY):

E9. Which of the following food safety procedures do staff at <SITE NAME> follow?

SELECT ONE OR MORE.

Staff who handle summer meals…

Wash hands before handling food

Wear gloves while handling food

Transport cold food in a refrigerated vehicle

Transport cold food in a cooler in a non-refrigerated vehicle

Serve perishable foods within 2 hours if they are kept out

Keep meals in a cooler or other cold storage until serving

Always use thermometers to check cooking temperatures

Always use thermometers to check food holding temperatures

Dispose of meals or foods that fail a quality check

Other (PLEASE SPECIFY):

E10. Does <SITE NAME> have a written Food Safety Plan for summer meals?

A Food Safety Plan has procedures to keep the food you serve safe. These may include procedures for hand-washing, sick employees, temperature control, and/or cross contamination.

Yes

No

Don’t know/Not sure

E11. Does <SITE NAME> have guidelines for accommodating children with food allergies or other special dietary needs?

Yes

No  GO TO SECTION F

Don’t know  GO TO SECTION F

E12. What guidelines does <SITE NAME> use accommodating children with food allergies or other special dietary needs?

SELECT ONE OR MORE.

Special sanitation procedures in the kitchen and/or dining area

Special training for staff

Signed statement from child’s physician or other healthcare professional is required before an accommodation is made

Staff inspect trays of children

Menus are adapted for children with allergies or special dietary needs

A team of parents, site/sponsor staff, health professionals and/or registered dietitians determines how best to address a child’s dietary needs

Accommodations are made on a case-by-case basis

Separate tables

Other (PLEASE SPECIFY):

SECTION F: OTHER FOODS OFFERED

F1. Can adults receive summer meals at <SITE NAME>?

SELECT ONLY ONE.

Yes, and adults must for them

Yes, and the adult meals are free

No, adult meals are not served at the site

F2. Are a la carte foods sold to children at <SITE NAME>?

A la carte foods are foods or beverages that are sold separately from the summer meal or snack, such as in a vending machine or a snack bar.

Yes

No  GO TO SECTION G

F3. Where are a la carte foods sold to children at <SITE NAME>?

SELECT ONE OR MORE.

In the meal service area

Away from the meal service area

In vending machines

In snack bars

Other (PLEASE SPECIFY):

F4. What types of a la carte foods are available to children?

SELECT ONE OR MORE.

Prepared entrees (e.g., sandwich, pizza, burritos)

Prepared non-entrée food (e.g., French fries, onion rings)

Fruits

Vegetables

Breads/grain products (e.g., bagels, pretzels, crackers)

Meats/meat alternates (e.g., nuts, nut butters, cheese, yogurt)

Baked goods/desserts (e.g., cookies, cakes, pastries)

Frozen desserts (e.g., ice cream, popsicles)

Snacks (e.g., chips, energy bars, jerky)

Candy

Milk

100% juice

Water

Beverages other than milk, 100% juice or water (e.g., sports drinks, juice drinks)

Other (PLEASE SPECIFY):

F5. Are extra foods provided free to children in addition to the summer meal?

Extra foods are not a required part of meal but they are served at the same time as the meal to provide larger portions.

Yes

No  GO TO SECTION G

F6. What types of extra foods are provided free to children?

SELECT ONE OR MORE.

Prepared entrees (e.g., sandwich, pizza, burritos)

Prepared non-entrée food (e.g., French fries, onion rings)

Fruits

Vegetables

Breads/grain products (e.g., bagels, pretzels, crackers)

Meats/meat alternates (e.g., nuts, nut butters, cheese, yogurt)

Baked goods/desserts (e.g., cookies, cakes, pastries)

Frozen desserts (e.g., ice cream, popsicles)

Snacks (e.g., chips, energy bars, jerky)

Candy

Milk

100% juice

Water

Beverages other than milk, 100% juice or water (e.g., sports drinks, juice drinks)

Other (PLEASE SPECIFY):

SECTION G: SITE EQUIPMENT AND STORAGE FACILITIES

G1. Which of the following cooking equipment does <SITE NAME> have?

This equipment could be available to prepare summer meals, if needed.

SELECT ONE OR MORE.

Household Range with oven

Commercial Range with oven

Household microwave oven

Commercial microwave oven

Convection oven

Grill(s)

Other (PLEASE SPECIFY):

This site does not have cooking equipment

G2. What type of freezer food storage capacity does <SITE NAME> have?

This equipment could be available for summer meals, if needed.

SELECT ONE OR MORE.

Household freezer or domestic refrigerator/freezer

Small (single section) commercial reach-in freezer

Medium (double section) commercial reach-in freezer

Large (triple section) commercial reach-in freezer

Walk-in commercial freezer

Other (PLEASE SPECIFY):

This site does not have freezer food storage capacity

G3. What type of refrigerated food storage capacity does <SITE NAME> have?

This equipment could be available for summer meals, if needed.

SELECT ONE OR MORE.

Household refrigerator or domestic refrigerator/freezer

Small (single section) commercial reach-in refrigerator

Medium (double section) commercial reach-in refrigerator

Large (triple section) commercial reach-in refrigerator

Walk-in commercial refrigerator

Other (PLEASE SPECIFY):

This site does not have refrigerated food storage capacity

G4. Does <SITE NAME> have storage for dry and canned foods?

This storage could be available for summer meals, if needed.

SELECT ONLY ONE.

Yes

No

SECTION H: SCHOOL YEAR MEALS

H1. Which of the following meals or snacks does <SITE NAME> provide to children at times other than summer?

SELECT ONE OR MORE.

Breakfast

Morning Snack

Lunch

Afterschool Snack

Afterschool Supper

None  GO TO SECTION I

H2. What money helps pay for the meals or snacks you serve is the funding source for the meals or snacks served at times other than summer?

SELECT ONE OR MORE.

Federal funding (e.g., Child and Adult Care Food Program, National School Lunch Program)

State funding

Private funding

Other (PLEASE SPECIFY_____________)

Don’t know

SECTION I: OTHER INFORMATION

I1. Is there anything else you would like to tell us about the summer meals program at <SITE NAME>?

I2. How long have you worked at <SITE NAME>?

_____ Number of years or ______ Number of months

I3. What is your current job title or position?

I4. What is the highest level of school you have completed?

SELECT ONLY ONE.

Less than high school

High school graduate – high school diploma or the equivalent (for example, GED)

Some college but not degree

Associate degree

Bachelor’s degree (for example, BA, BS)

Advanced or post-graduate degree (for example, Master’s degree, MD, DDS, JD, PhD, EdD)

PROGRAMMER: Module below to be stored separately from the survey data above but with linking on ID possible.

SECTION J: FUTURE FOLLOWUP

J1. Would you be available for a follow-up telephone interview in the next month or so? The interview will take about an hour.

No

Yes. Please let us know your contact information.

WORK NUMBER:

CELL PHONE NUMBER:

EMAIL ADDRESS:

Thank you for participating in the Summer Meals Study.

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the 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: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 ATTN: PRA (0584-xxxx*). Do not return the completed form to this address.