State and Local Burden - SA, SFA/LEA/Schools

Attachment N.6. Dietary Specifications Assessment Tool

This information is being collected from State agencies, school food authorities, schools. This is a
revision of a currently approved information collection. The Richard B. Russell National School
Lunch Act (NSLA) 42 U.S.C. § 1758, as amended, authorizes the National School Lunch Program
(NSLP). This information is required to administer and operate this program in accordance with
the NSLA. Under the Privacy Act of 1974, any personally identifying information obtained will
be kept private to the extent of the law. According to the Paperwork Reduction Act of 1995, an
agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control number for
this information collection is 0584-0006. The time required to complete this information
collection is estimated to average 47.5 hours of reporting burden per response. The burden
consists of the time it takes for the State agency to conduct the off-site portion of the review
which includes scheduling of the review and the completion of the Off-site Assessment, Resource
Management Risk Indicator, and Site Selection Tools. 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 (0584-0006).
Do not return the completed form to this address.

OMB #0584-0006
Expiration Date xx/xx/2019

Dietary Specification Assessment Tool Instructions
REVIEWER INSTRUCTIONS:
When utilizing the Dietary Specifications Assessment Tool, the SA will assess lunch and breakfast food service
practices to determine the risk for violations related to calories, saturated fat, sodium, and trans fat. The riskbased assessment tool requires both off-site and on-site review elements for lunch and breakfast. When
completing the tool, users should exercise their best judgment and select the most appropriate response
based on the menu documentation provided, interview of the SFA/site contact and on-site observation.
The reference time period is a typical week during the current school year.
Use the following scoring system:
•
1 - Always (every day or 5 days/week)
•
2 - Most items or most of the time (3-4 days/week)
•
3 - Some items or some of the time (1-2 days/week)
•
4 - Never (0 days/week)
Once all responses are selected, the assessment tool will automatically determine if the site is at risk for
dietary specification violations and places the targeted menu review site in one of two categories: high risk
or low risk. If the site is high risk, a nutrient analysis is required. If determined low risk, a nutrient analysis
may not be required. In all instances, a subsequent on-site visit is required to validate the level of risk and
provide the necessary technical assistance.

Page 1 of 2

For each question below, select the number that corresponds to the best description:
1 - Always (every day or 5 days/week)
2 - Most items or most of the time (3-4 days/week)
3 - Some items or some of the time (1-2 days/week)
4 - Never (0 days/week)

Dietary Specifications Assessment Tool

Off-site Review of
Documentation/SFA Interview to Determine Risk

School Name: [ENTER SCHOOL NAME HERE]

Lunch

Breakfast

On-site Observation
to Validate Risk

Lunch

Breakfast

1. Are specifications considered when purchasing menu items and condiments to limit the following?
a. Saturated fat
b.

Sodium

c.

Trans fat

2. Only low-fat (1 percent milk fat or less, unflavored) or fat-free (unflavored or flavored) milk is used for student consumption and in menu recipes.
3. Low-fat, fat-free milk products are used. This includes yogurt and cottage cheese.
4. Cheese (all varieties including reduced fat) is controlled by placing items in portion cups, portion controlled packaging or the use of appropriate serving size
utensils to limit portion size allowed per meal. This includes cheese offered on salad bars.
5. Are non-creditable cheese products offered as part of a reimbursable meal? (Non-creditable cheese includes: cheese sauce without a CN label or product
formulation statement, cheese product, imitation cheese and powdered cheese).
6. Reduced-fat, low fat, fat-free mayonnaise, sour cream, and/or salad dressings are offered instead of full-fat varieties.
7. Broths and/or soups with low or reduced sodium are used, rather than regular broths and soups.
8. Fresh, frozen, and/or low sodium or no sodium canned vegetables are offered, rather than reduced sodium or regular canned vegetables.
9. How often are bacon, bacon bits, pepperoni, chow mein noodles, pickles, olives, packaged crackers and/or croutons available to students?
10. How often are meats such as hot dogs, luncheon meats (e.g. ham, turkey) and/or sausage offered on the service line and/or salad bar? (All varieties including reduced and/or low sodium).
11. Canned fruits are packed in water, fruit juice, or light syrup. If only fresh fruit is offered, then select the "N/A" dropdown response.
12. Grain-based desserts such as doughnuts, pastries, cakes, and cookies are limited to 2 oz. eq. per week or less for LUNCH. If grain-based desserts are not
offered, then select the "N/A" dropdown response.
13. How often are "grain-based dessert" type items such as doughnuts, toaster pastries, cake, muffins, and cookies offered at BREAKFAST?
14. Other seasonings, such as herbs and spices, are substituted for salt.
15. Oil is used in recipes, rather than shortening, margarine, or butter.
16. Fat is drained from browned meats and poultry and/or fat is skimmed from broths, soups, stews, or gravies and/or skin is removed from poultry or skinless
poultry is used. If browned meats and poultry are not offered, then select the "N/A" dropdown response.
17. Is a deep fat fryer used on-site to prepare school meal items?
18. Is butter or margarine added to breads and/or vegetables prior to serving?
19. Standardized recipes are followed: all ingredients are weighed or measured with standardized weight or measuring utensils.
20. Meal pattern for appropriate age/grade groups are used for menu planning, including the meal patterns and serving sizes.
21. How often are extra, non-reimbursable food items (e.g. potato chips, ice cream, pudding and/or gelatin) offered on the menu? Items sold a la carte are
exempt.
22. Portion sizes for condiments (e.g. hot sauce, ketchup, mustard, salad dressing) are controlled by placing items in portion cups, portion controlled packaging
or the use of appropriate serving size utensils to limit portion size allowed per meal.

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

N/A

-- SELECT VALUE --

N/A

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

N/A

-- SELECT VALUE --

N/A

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

N/A

-- SELECT VALUE --

N/A

N/A

-- SELECT VALUE --

N/A

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

23. Students are offered butter or margarine:
a.

In the serving line.

b.

At a condiment station.

c.

If they ask for it.

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

24. Students are offered salt:
a.

In the serving line.

b.

At a condiment station.

c.

On meal tables.

d.

If they ask for it.

25. Larger portions and/or bonus items and/or seconds are offered (offering portion sizes that are inconsistent with the planned menu). Entrées sold a la
carte are exempt.

Indicate the Meals Evaluated:

Risk Level:

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

-- SELECT VALUE --

Low Risk
Perform On-site Review to Validate Information

Low Risk
No Nutrient Analysis Required

Page 2 of 2