CACFP Monitoring Checklist Form
Complete this monitoring checklist to document a CACFP site visit, meal observation, record review, and any corrective actions needed.
Monitoring Visit Details
Monitoring Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Site/Sponsor Name
*
Site Address or Location
*
Monitoring Type
*
Announced
Unannounced
Follow-up
Meal Service Observed
*
Breakfast
Lunch
Supper
Snack
Other
Checklist Review
Meal Pattern Compliance
*
Compliant
Minor Issue
Noncompliant
Food Safety and Sanitation Rating
*
1
2
3
4
5
Staffing and Supervision Adequacy
*
Inadequate
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Inadequate, 10 is Excellent
Attendance and Enrollment Records Reviewed
*
Yes
No
Meal Counts and Production Records Reviewed
*
Yes
No
Findings or Corrective Actions Needed
Reviewer Information
Reviewer Name
*
Reviewer Role / Title
*
Reviewer Signature
Submit
Submit
Should be Empty: