F02.04 FFVP Menu Survey (G2b)
2024–2025 National School Foods Study
F02.04 FFVP Menu Survey (G2b)
OMB: 0584-0698
Appendix F02.04. FFVP MEnu Survey (Group 2b)
OMB Control No: 0584-xxxx
This information is being collected to assist the Food and Nutrition Service in understanding school food purchasing practices, the nutritional quality of school meals and snacks, the cost to produce school meals, and student participation and dietary intakes. This is a mandatory collection and FNS will use the information to monitor program operations. This collection does not request any personally identifiable information under the Privacy Act of 1974. 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-[xxxx]. The time required to complete this information collection is estimated to average 0.50 hours 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. 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 Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22314 ATTN: PRA (0584-xxxx). Do not return the completed form to this address.
2024-2025
NATIONAL SCHOOL FOODS STUDY
FFVP
Menu Survey
DAY OF WEEK |
1 □ Monday |
2 □ Tuesday |
3 □ Wednesday |
4 □ Thursday |
5 □ Friday |
DATE: | | | / | | | / | 2 | 0 | 2 | 5 | MONTH DAY YEAR |
|
School ID: | | | | | | | |
School Name: |
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School Nutrition Manager: |
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Field Interviewer ID: | | | | | | |
Field Interviewer Name: |
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INSTRUCTIONS
Complete the four forms to record all food and beverage items available to students today: (1) reimbursable school breakfasts, (2) reimbursable lunches, (3) FFVP snacks, and (4) non-program items sold by food service and record the number of reimbursable meals and FFVP snacks served.
Form for Reimbursable Breakfasts |
If no breakfast was served today, check here £ |
OMB Number: 0584-xxxx
Expiration Date: xx/xx/20xx
A. |
B. |
C. |
D. |
E. |
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If served at Breakfast, check box and obtain portion size (include units) |
|
|
Check Box if Prepared from a Recipe |
|
Food Item |
Manufacturer/Brand Name and Product Code (If Applicable) |
Food Description |
|||
MILK |
|
|
|
|
|
White, fat free/skim |
£ |
fl oz. |
|
|
|
White, 1% |
£ |
fl oz. |
|
|
|
White, 2% |
£ |
fl oz. |
|
|
|
White, whole |
£ |
fl oz. |
|
|
|
Chocolate, fat free/skim |
£ |
fl oz. |
|
£ Reduced sugar |
|
Chocolate, 1% |
£ |
fl oz. |
|
£ Reduced sugar |
|
Chocolate, 2% |
£ |
fl oz. |
|
£ Reduced sugar |
|
Lactose free |
£ |
fl oz. |
|
£ Fat free/skim £ 1% £ 2% £ Whole £ Flavored £ Reduced sugar |
|
Other flavor Specify: __________________ |
£ |
fl oz. |
|
£ Fat free/skim £ 1% £ 2% £ Whole £ Reduced sugar |
|
Other flavor Specify: __________________ |
£ |
fl oz. |
|
£ Fat free/skim £ 1% £ 2% £ Whole £ Reduced sugar |
|
Other flavor Specify: __________________ |
£ |
fl oz. |
|
£ Fat free/skim £ 1% £ 2% £ Whole £ Reduced sugar |
|
Non-dairy milk alternative, Specify type: ___________________ |
£ |
fl oz. |
|
£ Fat free £ Light £ Reduced sugar £ Sweetened £ Unsweetened Specify flavor(s): ______________ |
|
|
£ |
fl oz. |
|
|
£ |
FRUIT |
|
|
|
|
|
Apple |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Applesauce, canned |
£ |
cup |
|
£ Sweetened £ Unsweetened |
|
Apricots |
£ |
cup |
|
£ Fresh £ Dried £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Banana |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Blueberries |
£ |
cup |
|
£ Fresh £ Frozen £ Sweetened £ Unsweetened |
|
Fruit cocktail |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Grapes |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Kiwi |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Mandarin oranges |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Orange |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Peaches |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Pears |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Pineapple |
£ |
cup |
|
£ Fresh £ Frozen £ Canned £ Heavy syrup £ Light syrup £ Extra light syrup £ Juice £ Water |
|
Raisins |
£ |
oz. |
|
|
|
Strawberries |
£ |
cup |
|
£ Fresh £ Frozen £ Sweetened £ Unsweetened |
£ |
|
£ |
|
|
|
£ |
JUICES |
|||||
Apple juice |
£ |
fl oz. |
|
£ Calcium added £ Reduced sugar |
|
Grape juice |
£ |
fl oz. |
|
£ Calcium added £ Reduced sugar |
|
Orange juice |
£ |
fl oz. |
|
£ Calcium added £ Reduced sugar |
|
Fruit juice blend |
£ |
fl oz. |
|
£ Calcium added £ Reduced sugar |
|
|
£ |
fl oz. |
|
£ Calcium added £ Reduced sugar |
£ |
COLD CEREAL |
|
|
|
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Apple Jacks |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Cheerios, plain |
£ |
oz. |
|
£ Whole grain-rich |
|
Cheerios, Apple Cinnamon |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Cheerios, Fruity |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Cheerios, Honey Nut |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Cinnamon Toast Crunch |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Cocoa Krispies |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Cocoa Puffs |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Froot Loops |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Frosted Flakes |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Frosted Mini Wheats |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Golden Grahams |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Granola |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Kix |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Lucky Charms |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Marshmallow Mateys |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Raisin Bran |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
Rice Chex |
£ |
oz. |
|
£ Whole grain-rich |
|
Rice Krispies |
£ |
oz. |
|
£ Whole grain-rich |
|
Trix |
£ |
oz. |
|
£ Whole grain-rich £ Reduced sugar |
|
|
£ |
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£ Whole grain-rich £ Reduced sugar |
£ |
|
£ |
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|
£ |
HOT CEREALS |
|
|
|
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|
Cream of Wheat |
£ |
cup |
|
£ Instant £ Quick £ Regular £ Whole grain-rich |
£ |
Grits |
£ |
cup |
|
£ Instant £ Quick £ Regular |
£ |
Oatmeal |
£ |
cup |
|
£ Instant £ Quick £ Regular |
£ |
|
£ |
|
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|
£ |
OTHER BREADS AND GRAINS OFFERED SEPARATELY |
|
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||
Bagel |
£ |
oz. |
|
£ Whole grain-rich Specify type: ___________________ |
|
Biscuit |
£ |
oz. |
|
£ Whole grain-rich £ Reduced fat |
£ |
Danish |
£ |
oz. |
|
£ Whole grain-rich £ Reduced fat £ Low fat £ Fruit £ Cheese |
|
Doughnut |
£ |
oz. |
|
£ Whole grain-rich £ Icing/glaze £ No Icing/glaze |
|
English muffin, plain |
£ |
oz. |
|
£ Whole grain-rich Specify type: ___________________ |
|
English muffin, buttered |
£ |
oz. |
|
£ Whole grain-rich £ Margarine £ Butter |
£ |
Granola/cereal bar |
£ |
oz. |
|
£ Whole grain-rich £ Low fat Specify type: ___________________ |
|
Muffin |
£ |
oz. |
|
£ Whole grain-rich £ Reduced fat Specify type: ___________________ |
£ |
Pancake |
£ |
oz. |
|
£ Whole grain-rich £ Reduced fat Specify type: ___________________ |
£ |
Roll, cinnamon |
£ |
oz. |
|
£ Whole grain-rich £ Icing £ No Icing |
£ |
Toast, plain |
£ |
oz. |
|
£ Whole grain-rich Specify type: ___________________ |
|
Toast, buttered |
£ |
oz. |
|
£ Whole grain-rich Specify type: ___________________ £ Margarine £ Butter |
£ |
Toaster pastry |
£ |
oz. |
|
£ Whole grain-rich £ Low fat |
|
Waffles |
£ |
oz. |
|
£ Whole grain-rich £ Plain £ Fruit £ Chocolate chip £ Other:____________ |
£ |
Waffle sticks |
£ |
ea. |
|
£ Whole grain-rich £ Plain £ Fruit £ Chocolate chip £ Other:____________ Weight of each stick: _________oz. |
£ |
|
£ |
|
|
|
£ |
|
£ |
|
|
|
£ |
MEATS AND MEAT ALTERNATES OFFERED SEPARATELY |
|
|
|||
Bacon |
£ |
oz. |
|
£ Pork £ Turkey £ Vegetarian |
|
Eggs |
£ |
oz. |
|
£ Scrambled £ Hard boiled £ Fried |
£ |
Cheese |
£ |
oz. |
|
£ Reduced fat £ Reduced sodium |
|
Peanut butter or other nut/seed butter |
£ |
oz. |
|
£ Reduced fat £ Reduced sugar Specify type: ___________________ |
|
Sausage |
£ |
oz. |
|
£ Reduced sodium £ Beef or pork £ Chicken or turkey £ Vegetarian |
|
Yogurt |
£ |
oz. |
|
Specify type: £ Regular £ Greek (high protein) Specify fat: £ Whole £ Low fat £ Fat-free £ Light Specify flavors: _________________ |
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|
£ |
|
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|
£ |
|
£ |
|
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|
£ |
|
£ |
|
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|
£ |
COMBINATION ITEMS |
|
|
|
|
|
Breakfast burrito |
£ |
oz. |
|
£ Whole grain-rich £ Eggs £ Cheese £ Beans £ Potato £ Other:_______________ |
£ |
Egg sandwich |
£ |
1 sandwich |
|
£ Whole grain-rich £ Cheese £ Sausage £ Ham £ Bacon £ Other:____________ Specify bread type: ______________ |
£ |
French toast |
£ |
oz. |
|
£ Whole grain-rich £ Reduced fat |
£ |
French toast sticks |
£ |
ea. |
|
£ Whole grain-rich £ Reduced fat Weight of each stick: _________oz |
£ |
Grilled cheese |
£ |
1 sandwich |
|
£ Whole grain-rich £ Reduced fat |
£ |
Pancake on a stick |
£ |
oz. |
|
£ Whole grain-rich £ Beef or pork £ Chicken or turkey |
|
Pizza |
£ |
oz. |
|
£ Whole grain-rich £ Reduced fat £ Reduced sodium Specify toppings: _______________ |
£ |
Quesadilla |
£ |
oz. |
|
Specify type: |
£ |
|
£ |
|
|
|
£ |
CONDIMENTS |
|
|
|
|
|
Self-serve condiments or fixins’ bar |
£ |
|
Specify items:
|
£ |
|
Butter |
£ |
|
|
|
|
Cream cheese |
£ |
|
|
£ Regular £ Light £ Fat free |
|
Gravy |
£ |
|
|
£ Regular £ Light £ Fat free |
£ |
Honey |
£ |
|
|
|
|
Jelly |
£ |
|
|
£ Regular £ Sugar free £ Reduced sugar |
|
Ketchup |
£ |
|
|
£ Reduced sodium |
|
Margarine |
£ |
|
|
|
|
Salsa |
£ |
|
|
£ Low sodium |
£ |
Syrup |
£ |
|
|
£ Regular £ Reduced calorie £ Sugar free |
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£ |
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£ |
|
£ |
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£ |
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£ |
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£ |
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£ |
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£ |
|
£ |
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|
£ |
OTHER MENU ITEMS |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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£ |
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-
OMB Number: 0584-xxxx
Expiration Date: xx/xx/20xx
Form for Reimbursable Lunches
A
.B.
C.
D.
E.
Check Box if Prepared from a Recipe
Food Item
If served at Lunch, check box and obtain portion size
‘(include units)
Manufacturer/Brand Name and Product Code
(If Applicable)Food Description
MILK
White, fat free/skim
£
fl oz.
White, 1%
£
fl oz.
White, 2%
£
fl oz.
White, whole
£
fl oz.
Chocolate, fat free/skim
£
fl oz.
£ Reduced sugar
Chocolate, 1%
£
fl oz.
£ Reduced sugar
Chocolate, 2%
£
fl oz.
£ Reduced sugar
Lactose free
£
fl oz.
£ Fat free/skim £ 1% £ 2%
£ Flavored £ Whole £ Reduced sugar
Other flavor
Specify: ____________________£
fl oz.
£ Fat free/skim £ 1% £ 2%
£ Whole £ Reduced sugar
Other flavor
Specify: ____________________£
fl oz.
£ Fat free/skim £ 1% £ 2%
£ Whole £ Reduced sugar
Other flavor
Specify: ____________________£
fl oz.
£ Fat free/skim £ 1% £ 2%
£ Whole £ Reduced sugar
Non-dairy milk alternative, Specify type:
___________________
£
fl oz.
£ Fat free £ Light
£ Reduced sugar
£ Sweetened £ Unsweetened
Specify flavor(s): ______________
£
fl oz.
£
FRUIT
Apple
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Applesauce, canned
£
cup
£ Sweetened £ Unsweetened
Apricots
£
cup
£ Fresh £ Dried £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Banana
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Blueberries
£
cup
£ Fresh £ Frozen
£ Sweetened £ Unsweetened
Fruit cocktail
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Grapes
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Kiwi
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Mandarin oranges
£
cup
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Orange
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Peaches
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Pears
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Pineapple
£
cup
£ Fresh £ Frozen £ Canned
£ Heavy syrup £ Light syrup
£ Extra light syrup £ Juice £ Water
Raisins
£
oz.
Strawberries
£
cup
£ Fresh £ Frozen
£ Sweetened £ Unsweetened
£
£
JUICES
Apple juice
£
fl oz.
£ Calcium added £ Reduced sugar
Grape juice
£
fl oz.
£ Calcium added £ Reduced sugar
Orange juice
£
fl oz.
£ Calcium added £ Reduced sugar
Fruit juice blend
£
fl oz.
£ Calcium added £ Reduced sugar
Frozen juice cup/bar
£
fl oz.
Specify flavor: ______________
£ Reduced sugar
£
fl oz.
£
VEGETABLES
Baked beans
£
cup
£ Vegetarian £ With meat
£
Beans, green
£
cup
From: £ Fresh £ Frozen £ Canned
£ Low sodium £ Served raw
£ Fat added, specify type:
_______________________
Broccoli
£
cup
From: £ Fresh £ Frozen £ Canned
£ Low sodium £ Served raw
£ Fat added, specify type:
_______________________
Carrots
£
cup
From: £ Fresh £ Frozen £ Canned
£ Low sodium £ Served raw
£ Fat added, specify type:
_______________________
Cauliflower
£
cup
From: £ Fresh £ Frozen £ Canned
£ Low sodium £ Served raw
£ Fat added, specify type:
_______________________
Celery, raw
£
cup
Corn, kernels
£
cup
£ Fresh £ Frozen
£ Canned £ Low sodium
£ Fat added, specify type:
_________________________
Cucumber, raw
£
cup
French fries
£
cup
£ Oven-baked £ Deep-fried
£ Reduced sodium
Lettuce and tomato (for sandwiches)
£
cup
Mixed vegetables
£
cup
From: £ Fresh £ Frozen £ Canned £ Low sodium £ Served raw
£ Fat added, specify type: _________________________£
Peas, green, cooked
£
cup
£ Fresh £ Frozen
£ Canned £ Low sodium
£ Fat added, specify type: _________________________
Potatoes, whipped or mashed
£
cup
£ From fresh
£
Refried beans
£
cup
£ From dry £ Canned
£ Low sodium
£ Fat added, specify type:
_________________________£
Red peppers
£
cup
From: £ Fresh £ Frozen £ Canned
£ Low sodium £ Served raw
£ Fat added, specify type:
_______________________
Green peppers
£
cup
From: £ Fresh £ Frozen £ Canned
£ Low sodium £ Served raw
£ Fat added, specify type:
_______________________
Sweet potatoes
£
cup
£ Fresh £ Frozen
£ Canned £ Low sodium
£ Fat added, specify type:
_________________________£
Sweet potato fries or tots
£
cup
£ Oven-baked £ Deep-fried
£ Reduced sodium
Side salad bar
(non-entrée or small portion)
£
Specify items:
£
Side salad
£
cup
Specify items:
Tater tots or shapes
£
cup
£ Oven-baked £ Deep-fried
£ Reduced sodium
Tomato, raw
£
cup
£
Tomato soup
£
cup
£
£
£
£
£
SANDWICHES
Cheeseburger
£
1 sandwich
£ Whole grain-rich
£
Chicken filet or breast (not breaded)
£
1 sandwich
£ Whole grain-rich
£
Chicken patty (breaded)
£
1 sandwich
£ Whole grain-rich
£
Fish sandwich
£
1 sandwich
£ Whole grain-rich £ Breaded
£
Grilled cheese
£
1 sandwich
£ Whole grain-rich
£
Ham and cheese
£
1 sandwich
£ Whole grain-rich
£
Hamburger
£
1 sandwich
£ Whole grain-rich
£
Hot dog
£
1 sandwich
£ Whole grain-rich £ Beef or pork
£ Chicken or turkey £ Vegetarian£
Italian sub
£
1 sandwich
£ Whole grain-rich
£
Peanut butter (or other nut/seed butter) & jelly
£
1 sandwich
£ Whole grain-rich £ Reduced sugar
Specify type: ___________________
£
Rib, barbeque
£
1 sandwich
£ Whole grain-rich
£
Sloppy joe
£
1 sandwich
£ Whole grain-rich £ Beef £ Pork
£ Chicken or turkey £ Vegetarian£
Turkey
£
1 sandwich
£ Whole grain-rich
£
Tuna salad
£
1 sandwich
£ Whole grain-rich
£
Veggie burger
£
1 sandwich
£ Whole grain-rich
£
£
1 sandwich
£
£
1 sandwich
£
£
1 sandwich
£
£
1 sandwich
£
£
1 sandwich
£
ENTRÉE SALADS
Chef's salad
£
1 salad
£
Chicken Caesar salad
£
1 salad
£
Taco salad
£
1 salad
£
£
1 salad
£
£
1 salad
£
£
1 salad
£
£
1 salad
£
SELF-SERVE/MADE-TO-ORDER ENTRÉE BARS
Entrée salad bar
£
Specify items:
£
Potato bar
£
Specify items:
£
Nacho/taco bar
£
Specify items:
£
Sandwich/deli bar
£
Specify items:
£
Pasta/Italian bar
£
Specify items:
£
£
Specify items:
£
£
Specify items:
£
OTHER ENTREES AND MEAT/MEAT ALTERNATES
Beans or peas
(Specify type) ________________
£
cup
£ From dry £ Canned
£ Low sodium £ Fat added, specify type: _______________
£
Burrito
£
oz.
£ Whole grain-rich £ Bean £ Beef
£ Chicken £ Cheese£ Other:_______________
£
Cheese (string cheese or cubes)
£
oz.
£ Reduced fat £ Reduced sodium
Cheese breadstick or pizza stick
£
oz.
£ Whole grain-rich
£ Reduced fat £ Reduced sodium
Specify filling(s):
________________________
Chicken nuggets (breaded)
£
ea.
£ Whole grain-rich £ Oven-baked £ Deep-fried
Weight of each nugget: ________oz.
Chicken strips (not breaded)
£
oz.
Chicken patty (not sandwich)
£
oz.
£ Whole grain-rich £ Oven-baked £ Deep-fried
Chicken piece(s)
(Specify part)________________£
oz.
£ Whole grain-rich £ Breaded £ With skin
£ Oven-baked £ Deep-fried£
Corndog
£
oz.
£ Whole grain-rich £ Beef or pork
£ Chicken or turkey
Egg rolls
£
ea.
£ Meatless £ Beef or pork
£ Chicken or turkeyWeight of each egg roll: _______oz.
£
Fish sticks or nuggets
£
ea.
£ Whole grain-rich £ Oven-baked £ Deep-fried
£ Breaded
Weight of each nugget/stick: _____oz.
Macaroni and cheese
£
cup
£ Whole grain-rich
£
Nachos
£
oz.
£ Whole grain-rich
£
Peanut butter or other nut/seed butter
£
oz.
£ Reduced fat £ Reduced sugar
Specify type:_______________
Pizza, cheese
£
oz.
£ Whole grain-rich £ Reduced fat £ Reduced sodium
£ Thick crust (deep-dish, bagel, French bread)
£
Pizza, pepperoni
£
oz.
£ Whole grain-rich £ Reduced fat £ Reduced sodium
£ Thick crust (deep-dish, bagel, French bread)
£
Pizza, sausage
£
oz.
£ Whole grain-rich £ Reduced fat £ Reduced sodium
£ Thick crust (deep-dish, bagel, French bread)
£
Pizza, vegetarian
£
oz.
£ Whole grain-rich £ Reduced fat £ Reduced sodium
£ Thick crust (deep-dish, bagel, French bread)
Specify toppings:____________£
Pizza pocket
£
oz.
£ Whole grain-rich £ Reduced fat £ Reduced sodium
Specify filling:_______________
£
Stir fry with rice or noodles
£
cup
£ Whole grain-rich
£
Spaghetti with sauce
£
cup
£ Whole grain-rich £ Meat sauce
£ Marinara sauce
£
Taco
£
oz.
£ Whole grain-rich £ Hard shell £ Soft tortilla
£ Bean £ Beef
£ Chicken £ Cheese£
Yogurt
£
oz.
Specify type: £ Regular
£ Greek (high protein)
Specify fat: £ Whole £ Low fat
£ Fat free £ Light
Specify flavors: _________________
£
£
£
£
BREADS AND GRAINS OFFERED SEPARATELY
Biscuit
£
oz.
£ Whole grain-rich £ Reduced fat
£
Bread, plain
£
oz.
£ Whole grain-rich
Specify type:_______________
Bread, buttered
£
oz.
£ Whole grain-rich
Specify type:_______________
£ Margarine £ Butter£
Breadstick
£
oz.
£ Whole grain-rich
Specify type:_______________£
Cornbread
£
oz.
£ Whole grain-rich
£
Crackers
£
oz.
£ Baked £ Reduced sodium
£ Whole grain-rich
Specify type:_______________
Croutons
£
oz.
£ Whole grain-rich
Rice
£
cup
£ White £ Brown £ Wild
£
Roll
£
oz.
£ Whole grain-rich
Specify type:_______________£
Pasta
£
cup
£ Whole grain-rich
Pretzels
£
oz.
£ Whole grain-rich
£ Soft £ Hard
£ Salted £ Unsalted£ Lightly salted
Tortilla chips
£
oz.
£ Whole grain-rich £ Reduced sodium
£
£
£
£
DESSERTS, DRINKS, AND OTHER SIDES OFFERED AS PART OF A REIMBURSABLE MEAL
Brownie
£
oz.
£ Icing/glaze £ No Icing/glaze
£ Reduced fat
£
Cake
£
oz.
£ Reduced fat
Specify type: _______________
£
Cookie
£
oz.
£ Reduced fat £ Low fat
Specify type: _______________
£
Fruit crisp or cobbler
£
oz.
Specify type: _______________
£
Fruit drink (not 100% juice)
£
fl oz.
Specify type: _______________
Fruit turnover
£
oz.
£ Reduced fat £ Low fat
Specify type: _______________
£
Gelatin (Jell-O)
£
cup
£ With fruit
£ With whipped topping£
Potato chips
£
oz.
£ Reduced fat £ Reduced sodium £ Baked
Specify flavor: _______________
£
£
£
£
SALAD DRESSINGS
Caesar dressing
£
£ Regular £ Light £ Reduced calorie
£ Fat free£
French dressing
£
£ Regular £ Light £ Reduced calorie
£ Fat free£
Honey mustard dressing
£
£ Regular £ Light £ Reduced calorie
£ Fat free£
Italian dressing
£
£ Regular £ Light £ Reduced calorie
£ Fat free£
Ranch dressing
£
£ Regular £ Light £ Reduced calorie
£ Fat free£
£
£ Regular £ Light £ Reduced calorie
£ Fat free£
£
£ Regular £ Light £ Reduced calorie
£ Fat free£
CONDIMENTS
Self-serve condiments or fixins’ bar
£
Specify items:
Barbeque sauce
£
Butter
£
Cream cheese
£
£ Regular £ Light £ Fat free
Gravy
£
£ Regular £ Fat free
£
Honey
£
Hot sauce
£
Jalapeno peppers
£
Jelly
£
£ Regular £ Sugar free
£ Reduced sugar
Ketchup
£
£ Reduced sodium
Margarine
£
Mayonnaise
£
£ Regular £ Light £ Reduced calorie
£ Fat free
Mustard
£
Pickles, slices
£
Ranch dip
£
£ Regular £ Light £ Fat free
£
Relish
£
Salsa
£
£ Low sodium
£
Sour cream
£
£ Regular £ Light £ Fat free
Syrup
£
£ Regular £ Reduced calorie
£ Sugar free
Tartar sauce
£
£ Regular £ Reduced fat
£
£
£
OTHER MENU ITEMS
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
NOTES:
Form for FFVP Snacks |
If no FFVP snacks were served today, check here £ |
A. Food Item |
B.
If
served at AM
snack,
check box and obtain portion size |
C.
If
served at PM
snack,
check box and obtain portion size |
D. Food Description |
||
FRUITS LIST CONDIMENTS, DIPS, AND SALAD DRESSINGS UNDER LATER SECTION |
|||||
Apples |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Apricots |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Bananas |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Blackberries or raspberries |
£ |
cup |
£ |
cup |
|
Blueberries |
£ |
cup |
£ |
cup |
|
Cantaloupe or honeydew |
£ |
cup |
£ |
cup |
|
Cherries |
£ |
cup |
£ |
cup |
|
Grapefruit |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Grapes |
£ |
cup |
£ |
cup |
|
Kiwis |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Mandarin oranges or clementines |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Mangoes |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Nectarines |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Oranges |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Peaches |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Pears |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
FRUITS, continued LIST CONDIMENTS, DIPS, AND SALAD DRESSINGS UNDER LATER SECTION |
|||||
Pineapple |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Plums |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Strawberries |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Tangerines |
£ |
cup |
£ |
cup |
£ Whole £ Sliced/ Cut Up |
Watermelon |
£ |
cup |
£ |
cup |
|
Mixed fruit |
£ |
cup |
£ |
cup |
Specify fruits: |
Other (specify): |
£ |
cup |
£ |
cup |
|
Other (specify): |
£ |
cup |
£ |
cup |
|
Other (specify): |
£ |
cup |
£ |
cup |
|
Other (specify): |
£ |
cup |
£ |
cup |
|
VEGETABLES LIST CONDIMENTS, DIPS, AND SALAD DRESSINGS UNDER LATER SECTION |
|||||
Beans, green or string |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Beans, other (specify): |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Broccoli |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Carrots |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Cauliflower |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Celery |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Cucumber |
£ |
cup |
£ |
cup |
|
Corn |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
VEGETABLES, continued LIST CONDIMENTS, DIPS, AND SALAD DRESSINGS UNDER LATER SECTION |
|||||
Jicama |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Mixed vegetables |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Peas, green |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Snap peas |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Snow peas |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Peppers, green |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Peppers, orange, red, or yellow |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Sweet potatoes |
£ |
cup |
£ |
cup |
£
Fresh/cooked £ Fat added, (specify type) |
Tomatoes |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Side salad |
£ |
cup |
£ |
cup |
Specify vegetables: |
White potatoes |
£ |
cup |
£ |
cup |
£ From fresh £ Oven-baked £ Deep-fried £ Fat added, (specify type) |
Yellow summer squash |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
Zucchini |
£ |
cup |
£ |
cup |
£ Fresh/raw £ Fresh/cooked £ Fat added, specify type: ________________ |
VEGETABLES, continued LIST CONDIMENTS, DIPS, AND SALAD DRESSINGS UNDER LATER SECTION |
|||||
Other (specify): |
£ |
cup |
£ |
cup |
|
Other (specify): |
£ |
cup |
£ |
cup |
|
Other (specify): |
£ |
cup |
£ |
cup |
|
Other (specify): |
£ |
cup |
£ |
cup |
|
CONDIMENTS, DIPS AND SALAD DRESSINGS |
|||||
|
£ |
|
£ |
|
£ Reg £ Reduced fat £ Low fat £ Fat-free |
|
£ |
|
£ |
|
£ Reg £ Reduced fat £ Low fat £ Fat-free |
|
£ |
|
£ |
|
£ Reg £ Reduced fat £ Low fat £ Fat-free |
|
£ |
|
£ |
|
£ Reg £ Reduced fat £ Low fat £ Fat-free |
|
£ |
|
£ |
|
£ Reg £ Reduced fat £ Low fat £ Fat-free |
|
£ |
|
£ |
|
£ Reg £ Reduced fat £ Low fat £ Fat-free |
|
£ |
|
£ |
|
£ Reg £ Reduced fat £ Low fat £ Fat-free |
NOTES:
Form for Non-Program Foods Sold by Food Service |
If no non-program foods were served today, check here £ |
Where Sold: o Serving line breakfast o Serving line lunch o Snack bar Vending Machine Food Cart School Store o Food Truck Other (specify):_____________
A. Food Item |
B. Portion Size (Include Units) |
C. Food Description |
1. |
|
|
2. |
|
|
3. |
|
|
4. |
|
|
5. |
|
|
6. |
|
|
7. |
|
|
8. |
|
|
9. |
|
|
10. |
|
|
11. |
|
|
12. |
|
|
13. |
|
|
14. |
|
|
Meal Counts Form for Breakfast, Lunch, and FFVP Snacks
Record the total number of reimbursable breakfasts and lunches and FFVP snacks served in the school for the day you are on site. Remind the School Nutrition Manager to not include meals for which the school does not claim reimbursement, for example, second lunches sold to student on an à la carte basis.
-
A.
B.
C.
Total Number of Reimbursable Breakfasts Served
Total Number of Reimbursable Lunches Served
Total Number of FFVP Snacks Served
| | , | | | |
| | , | | | |
| | , | | | |
1a. Was the number of Reimbursable Breakfasts served today much higher, much lower, or about the same as usual?
1 □ Much higher
2 □ Much lower
3 □ About the same
If much higher or lower than usual, please explain:
1b. Was the number of Reimbursable Lunches served today much higher, much lower, or about the same as usual?
1 □ Much higher
2 □ Much lower
3 □ About the same
If much higher or lower than usual, please explain:
1c. Was the number of FFVP Snacks served today much higher, much lower, or about the same as usual?
1 □ Much higher
2 □ Much lower
3 □ About the same
If much higher or lower than usual, please explain:
MEAL COUNTS NOTES:
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | FFVP SCHOOL REIMBURSABLE FOODS FORM |
| Subject | FORM |
| Author | MATHEMATICA STAFF |
| File Modified | 0000-00-00 |
| File Created | 2024-08-04 |
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