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29565602644140School #2 to be reviewed (if applicable): ____________________________________________Grades: [ ]Pre-K [ ]K-5 [ ]6-8 [ ]9-12Offer vs. Serve: Yes / NoBreakfast Serving Time(s): ____________________ Lunch Serving Time(s): _______________________FFVP Serving Time:_________ Day(s) M T W TH F Afterschool Snack Time:________ Day(s) M T W TH F Serving location(s) for Breakfast:[ ]Cafeteria [ ]Classroom [ ]Grab and Go [ ] Breakfast After the Bell [ ]Other _____________Serving location(s) for Lunch: [ ]Cafeteria [ ]Classroom [ ]Other_____________ 00School #2 to be reviewed (if applicable): ____________________________________________Grades: [ ]Pre-K [ ]K-5 [ ]6-8 [ ]9-12Offer vs. Serve: Yes / NoBreakfast Serving Time(s): ____________________ Lunch Serving Time(s): _______________________FFVP Serving Time:_________ Day(s) M T W TH F Afterschool Snack Time:________ Day(s) M T W TH F Serving location(s) for Breakfast:[ ]Cafeteria [ ]Classroom [ ]Grab and Go [ ] Breakfast After the Bell [ ]Other _____________Serving location(s) for Lunch: [ ]Cafeteria [ ]Classroom [ ]Other_____________ 29587135271715Non-program Foods Available (check all that apply) [ ] Adult Meals [ ]A la Carte (e.g. milk only, smart snacks)[ ] Vending to other CN programs [ ]Catering (to internal or external groups/organizations) 00Non-program Foods Available (check all that apply) [ ] Adult Meals [ ]A la Carte (e.g. milk only, smart snacks)[ ] Vending to other CN programs [ ]Catering (to internal or external groups/organizations) -222885-40005School District:Review Period for Menu Documentation: Review Period for Resource Management Documentation:Please confirm with reviewer if Review Period is unknown00School District:Review Period for Menu Documentation: Review Period for Resource Management Documentation:Please confirm with reviewer if Review Period is unknown29654501160780Business Manager Name: Address: Email: Phone:00Business Manager Name: Address: Email: Phone:-2228852186305Location/Address of Free & Reduced-Price Meal Benefit Applications:00Location/Address of Free & Reduced-Price Meal Benefit Applications:-2228852647315School #1 to be reviewed:___________________________________________Grades: [ ]Pre-K [ ]K-5 [ ]6-8 [ ]9-12Offer vs. Serve: Yes / NoBreakfast Serving Time(s): ____________________ Lunch Serving Time(s): _______________________FFVP Serving Time:_________ Day(s) M T W TH F Afterschool Snack Time:________ Day(s) M T W TH F Serving location(s) for Breakfast:[ ]Cafeteria [ ]Classroom [ ]Grab and Go [ ] Breakfast After the Bell [ ]Other _____________Serving location(s) for Lunch: [ ]Cafeteria [ ]Classroom [ ]Other_____________ 00School #1 to be reviewed:___________________________________________Grades: [ ]Pre-K [ ]K-5 [ ]6-8 [ ]9-12Offer vs. Serve: Yes / NoBreakfast Serving Time(s): ____________________ Lunch Serving Time(s): _______________________FFVP Serving Time:_________ Day(s) M T W TH F Afterschool Snack Time:________ Day(s) M T W TH F Serving location(s) for Breakfast:[ ]Cafeteria [ ]Classroom [ ]Grab and Go [ ] Breakfast After the Bell [ ]Other _____________Serving location(s) for Lunch: [ ]Cafeteria [ ]Classroom [ ]Other_____________ -2228855271135Non-program Foods Available (check all that apply)[ ] Adult Meals [ ]A la Carte (e.g. milk only, smart snacks)[ ] Vending to other CN programs [ ]Catering (to internal or external groups/organizations) 020000Non-program Foods Available (check all that apply)[ ] Adult Meals [ ]A la Carte (e.g. milk only, smart snacks)[ ] Vending to other CN programs [ ]Catering (to internal or external groups/organizations) -2228851156335Food Service Contact Name: Address: Email: Phone:00Food Service Contact Name: Address: Email: Phone:638175-609600SY 2021 Administrative ReviewDistrict Information 00SY 2021 Administrative ReviewDistrict Information -2190756153785Farm to School - Check off each Farm to School area that applies to your district: [ ] Serve local foods in the school meals program (check all that apply) [ ] Milk [ ] Cheese and yogurt [ ] Fruits [ ] Vegetables [ ] Grains (such as oats, flour, rice)[ ] Meats (such as beef and poultry) [ ] Fish and seafood [ ] Other ________________[ ] Food and agriculture education in the classroom [ ] School gardens (engaging students and/or school cafeteria)[ ] Market/promote local foods in the school cafeteria 00Farm to School - Check off each Farm to School area that applies to your district: [ ] Serve local foods in the school meals program (check all that apply) [ ] Milk [ ] Cheese and yogurt [ ] Fruits [ ] Vegetables [ ] Grains (such as oats, flour, rice)[ ] Meats (such as beef and poultry) [ ] Fish and seafood [ ] Other ________________[ ] Food and agriculture education in the classroom [ ] School gardens (engaging students and/or school cafeteria)[ ] Market/promote local foods in the school cafeteria -95416159027SY 2020 Instructions for Completing the Administrative Review Pre-Visit Information Packet00SY 2020 Instructions for Completing the Administrative Review Pre-Visit Information Packet-95250686435The attached cover pages correspond to each section of the Administrative Review (AR) required by the U.S. Department of Agriculture’s (USDA) final rule, Administrative Reviews in the School Nutrition Programs (81 FR 50170). Each cover page has a table with a list of required documents for the AR. The left side of the table indicates documents that the School Food Authority (SFA) must provide to the Maine Department of Education (MDOE) Child Nutrition review team prior to the on-site visit. These must be submitted by the date requested in the “Administrative Review Pre-Visit Information” letter. The right side indicates documents that the SFA must have available on-site for the MDOE team to review. DIRECTIONSSend your documents electronically via email to your reviewer. Please follow the instructions at the top of each cover page.COVER PAGESSection 1 District InformationSection 2 Meal Access and Reimbursement Section 3 Meal PatternSection 4 Resource Management Section 5 Fresh Fruit and Vegetable ProgramSection 6 Afterschool Snack Service00The attached cover pages correspond to each section of the Administrative Review (AR) required by the U.S. Department of Agriculture’s (USDA) final rule, Administrative Reviews in the School Nutrition Programs (81 FR 50170). Each cover page has a table with a list of required documents for the AR. The left side of the table indicates documents that the School Food Authority (SFA) must provide to the Maine Department of Education (MDOE) Child Nutrition review team prior to the on-site visit. These must be submitted by the date requested in the “Administrative Review Pre-Visit Information” letter. The right side indicates documents that the SFA must have available on-site for the MDOE team to review. DIRECTIONSSend your documents electronically via email to your reviewer. Please follow the instructions at the top of each cover page.COVER PAGESSection 1 District InformationSection 2 Meal Access and Reimbursement Section 3 Meal PatternSection 4 Resource Management Section 5 Fresh Fruit and Vegetable ProgramSection 6 Afterschool Snack Service-55659455212Section 1: District Information 00Section 1: District Information -53340351155This is the district information cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “District Information” and label attachments accordingly and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.00This is the district information cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “District Information” and label attachments accordingly and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.30930571271601Have available on-site:00Have available on-site:-556591271600Send to MDOE in advance:0Send to MDOE in advance:-571501047749A copy of, or the web address for, the district’s charging /unpaid meal balance policyA copy of, or the web address for, the district’s wellness policy A copy of the district’s most recent assessment of the wellness policyA list of all district food service staff Including:NamePosition Work location Number of hours per week Training hours completed in current school year for all staffIf required training hours have not been met, provide a plan for staff to complete training 00A copy of, or the web address for, the district’s charging /unpaid meal balance policyA copy of, or the web address for, the district’s wellness policy A copy of the district’s most recent assessment of the wellness policyA list of all district food service staff Including:NamePosition Work location Number of hours per week Training hours completed in current school year for all staffIf required training hours have not been met, provide a plan for staff to complete training 30956251038225Current school year training documentation (including date, agenda, sign-in sheets) of Civil Rights training pertaining to the USDA Child Nutrition Programs for all staffProfessional standards training documentation and tracking form for all School Nutrition program staffCompleted On-site Monitoring Forms (found on our website) for all schools in the SFA completed before February 1st when applicable). Provide prior year if current year is unavailable.For school nutrition program directors hired on or after July 1, 2015 please provide the following documentation:Highest level of education achieved Education achievement certificates Years of school nutrition program experienceSanitation training receivedLocal educational agencies must take reasonable steps to ensure meaningful access to their programs and activities by persons with limited English proficiency00Current school year training documentation (including date, agenda, sign-in sheets) of Civil Rights training pertaining to the USDA Child Nutrition Programs for all staffProfessional standards training documentation and tracking form for all School Nutrition program staffCompleted On-site Monitoring Forms (found on our website) for all schools in the SFA completed before February 1st when applicable). Provide prior year if current year is unavailable.For school nutrition program directors hired on or after July 1, 2015 please provide the following documentation:Highest level of education achieved Education achievement certificates Years of school nutrition program experienceSanitation training receivedLocal educational agencies must take reasonable steps to ensure meaningful access to their programs and activities by persons with limited English proficiency-55659447262Section 2: Meal Access and Reimbursement 0Section 2: Meal Access and Reimbursement -55659325396This is the Meal Access and Reimbursement cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “Meal Access and Reimbursement” and label attachments accordingly, and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.Please make the documents listed in the left hand column available during the onsite review00This is the Meal Access and Reimbursement cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “Meal Access and Reimbursement” and label attachments accordingly, and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.Please make the documents listed in the left hand column available during the onsite review-556591271767Send to MDOE in advance:Send to MDOE in advance:3246120752475Have available on-site:Have available on-site:-57150752475Copies of sample letters sent from the SFA for the following:Direct Certification notification letterVerification notification letterDenial of benefits notification letterFor confidentiality reasons please blackout any student information before sending The Reviewer may work with you to obtain an encrypted Benefit Issuance Document (e.g., Student Master List used to maintain a student’s eligibility status) as the on-site review date approaches to assure the most recent updated information is available. For security reasons, please do not send the list until it has been requested. 00Copies of sample letters sent from the SFA for the following:Direct Certification notification letterVerification notification letterDenial of benefits notification letterFor confidentiality reasons please blackout any student information before sending The Reviewer may work with you to obtain an encrypted Benefit Issuance Document (e.g., Student Master List used to maintain a student’s eligibility status) as the on-site review date approaches to assure the most recent updated information is available. For security reasons, please do not send the list until it has been requested. 3248025752475Selected student eligibility applications or documentation of eligibility (e.g., the Direct Certification List) All denied applicationsThe verification materials used in conducting verification including: Original household application for all verified households from current school year Verification notification letter to selected households for current school year Documentation of verified income and efforts to follow-up with unresponsive households Any notice of adverse actionDocumentation from the point-of-service demonstrating change in student eligibility status as a result of verification, if applicableMeal counts from reviewed school(s) by day for the review period broken down by free, reduced, and paid students00Selected student eligibility applications or documentation of eligibility (e.g., the Direct Certification List) All denied applicationsThe verification materials used in conducting verification including: Original household application for all verified households from current school year Verification notification letter to selected households for current school year Documentation of verified income and efforts to follow-up with unresponsive households Any notice of adverse actionDocumentation from the point-of-service demonstrating change in student eligibility status as a result of verification, if applicableMeal counts from reviewed school(s) by day for the review period broken down by free, reduced, and paid students-55659455212Section 3: Meal Pattern 00Section 3: Meal Pattern -55660349250This is the Meal Pattern cover page. Behind this page place the following documentation in the order listed below. If sending electronically please provide a folder for each reviewed school, with separate folders for breakfast and lunch, please order documents by day with corresponding production records, recipes, and labels.00This is the Meal Pattern cover page. Behind this page place the following documentation in the order listed below. If sending electronically please provide a folder for each reviewed school, with separate folders for breakfast and lunch, please order documents by day with corresponding production records, recipes, and labels.-55659850790Please provide 5 consecutive days of completed production records with corresponding recipes and labels from the review period for the breakfast and lunch program for the reviewed school(s).Include the menus for the breakfast and lunch programs during the review period. Below are instructions and an example of how this documentation should be organized.Example: Repeat this order under School 1 for breakfast. If applicable, create a separate folder for School 2 and repeat this process. Provide Nutrition Facts and ingredients lists for all grain and meat/meat alternate (M/MA) products as well as CN labels for any combination M/MA and gain products. Labels must be photocopies or photographs of the original, not printed labels from the manufacturer. Only one copy is needed for each product; if a product is served multiple times in a week, please attach the label with the first day it is served in the week. Repeat this order for breakfastCN labels must be photocopies or photographs of the original- not printed labels from the manufacturerMonthly menu for reviewed school(s) breakfast and lunchProduction records must be complete, listing all items offered to students including milk varieties and condiments. 00Please provide 5 consecutive days of completed production records with corresponding recipes and labels from the review period for the breakfast and lunch program for the reviewed school(s).Include the menus for the breakfast and lunch programs during the review period. Below are instructions and an example of how this documentation should be organized.Example: Repeat this order under School 1 for breakfast. If applicable, create a separate folder for School 2 and repeat this process. Provide Nutrition Facts and ingredients lists for all grain and meat/meat alternate (M/MA) products as well as CN labels for any combination M/MA and gain products. Labels must be photocopies or photographs of the original, not printed labels from the manufacturer. Only one copy is needed for each product; if a product is served multiple times in a week, please attach the label with the first day it is served in the week. Repeat this order for breakfastCN labels must be photocopies or photographs of the original- not printed labels from the manufacturerMonthly menu for reviewed school(s) breakfast and lunchProduction records must be complete, listing all items offered to students including milk varieties and condiments. -55880556260Send to MDOE in advance:00Send to MDOE in advance:-55245411480This is the Resource Management cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “Resource Management”, label attachments accordingly and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.00This is the Resource Management cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “Resource Management”, label attachments accordingly and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.-55245-2540Section 4: Resource Management 00Section 4: Resource Management -53340292100Provide the Income & Expense detail report for the school nutrition program from the Business office for the Resource Management Review Period*, including:Documentation of itemized program revenues (subsidies received, a la carte, meal sales and town appropriation if applicable)Documentation of itemized program expenses (food, labor and other costs)Documentation of any equipment purchases over $5,000 SY2020 Year-end balance sheet *The Resource Management Review Period is from the prior school year.00Provide the Income & Expense detail report for the school nutrition program from the Business office for the Resource Management Review Period*, including:Documentation of itemized program revenues (subsidies received, a la carte, meal sales and town appropriation if applicable)Documentation of itemized program expenses (food, labor and other costs)Documentation of any equipment purchases over $5,000 SY2020 Year-end balance sheet *The Resource Management Review Period is from the prior school year.-53340292100Send to MDOE in advance:0Send to MDOE in advance:3078480589280Documentation to verify the most recent claim for reimbursement, plus one additional month Copy of the internal control procedures used to ensure that only allowable costs are charged to the nonprofit school food service accountSupporting documentation for non- program Food RevenueExamples include:InvoicesDeposit SlipsBank Statements00Documentation to verify the most recent claim for reimbursement, plus one additional month Copy of the internal control procedures used to ensure that only allowable costs are charged to the nonprofit school food service accountSupporting documentation for non- program Food RevenueExamples include:InvoicesDeposit SlipsBank Statements3078480292100Have available on-site:00Have available on-site:-57150352426 Section 5: Fresh Fruit and Vegetable Program (FFVP) 00 Section 5: Fresh Fruit and Vegetable Program (FFVP) -556591565800FFVP menu for the review period if applicable 00FFVP menu for the review period if applicable 30930571565606Documentation needed to verify the claim for the review period:All supporting documentation for the above claim Invoices (anything claimed on your monthly report) o Fresh fruits and vegetables o Dips, paper, small equipment o Large equipment purchases (must be approved prior to purchase) Payroll records involving FFVP o Frontline staff o Administrative staffThe completed On-site monitoring forms for all schools operating FFVP completed prior to February 1st 00Documentation needed to verify the claim for the review period:All supporting documentation for the above claim Invoices (anything claimed on your monthly report) o Fresh fruits and vegetables o Dips, paper, small equipment o Large equipment purchases (must be approved prior to purchase) Payroll records involving FFVP o Frontline staff o Administrative staffThe completed On-site monitoring forms for all schools operating FFVP completed prior to February 1st -55660349250This is the Fresh Fruit and Vegetable cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “FFVP” and label attachments accordingly, and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.00This is the Fresh Fruit and Vegetable cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “FFVP” and label attachments accordingly, and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.30930571271601Have available on-site:00Have available on-site:-556591271600Send a copy to reviewer:0Send a copy to reviewer:-55659455212Section 6: Afterschool Snack Service00Section 6: Afterschool Snack Service-558801271270Afterschool Snack menu for the review periodProduction records for snacks served during the first week of the review period 00Afterschool Snack menu for the review periodProduction records for snacks served during the first week of the review period 30930571565606On-site monitoring forms for the two required visits at the selected site Documentation indicating that the approved afterschool program offers educational or enrichment activitiesDescription of the procedure used to ensure accurate counting and claiming of snacksAll documentation in support of the claim for reimbursementFor programs that are not area eligible, the roster of students receiving snacks for the first week of the review period00On-site monitoring forms for the two required visits at the selected site Documentation indicating that the approved afterschool program offers educational or enrichment activitiesDescription of the procedure used to ensure accurate counting and claiming of snacksAll documentation in support of the claim for reimbursementFor programs that are not area eligible, the roster of students receiving snacks for the first week of the review period-55660349250This is the Afterschool Snack cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “Afterschool Snack” and label attachments accordingly, and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.00This is the Afterschool Snack cover page. Behind this page place the following documentation in the order listed below. If you are sending documentation electronically, create a folder titled “Afterschool Snack” and label attachments accordingly, and send it to the MDOE reviewer. Please make the documents listed in the right hand column available during the on-site review.30930571271601Have available on-site:00Have available on-site:-556591271600Send a copy to reviewer:0Send a copy to reviewer: ................
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