Department of Family and Children Services The Emergency Food Assistance Program Sub-Recipient Agency Review

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Katrina Burns
5 years ago
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1 Name of Food Bank Servicing this Site: Date of Visit: Name of Site: Name of interviewer(s) Mailing Address of Site Name and Title of Person(s) interviewed: Street address (physical location) of site: Telephone#: Fax#: Program(s) available at this site: Congregate Feeding Food Pantry Other, Explain: 1. Does this site have a copy of its agreement/contract with the food bank? Yes No 2. How long has this site been receiving/using USDA Commodities? 3. What are your service hours/dates (for CF, include days of week and meal type each day)? 4. Are the USDA foods you receive sent to any other location/agency/pantry/church/etc. to be used in preparing meals or to be distributed to households? Yes No If yes, explain: If yes, how often can this other entity receive USDA foods from this site? 5. How does the general public know foods/meals are available here? 6. (CF Only) Who can eat meals here? Are they homeless/needy only? How do you know that the people are needy? Do others eat here such as staff or people who just walk in and you do not know their status regarding need? What percentages of people eating meals here do you estimate are needy? 7. (FP Only) How do you determine if a household is eligible to receive USDA foods in their bag?! 1

2 Ask to see the income scale they are using. Is the site using the most current income scale? Yes No 8. Are there limits to your service area (i.e., your neighborhood only, your city only your county only, etc.)? Yes No If yes, define limits: 9. Can you determine whether a household (or group, if question #3 is yes ) who receives USDA food from this site also receives USDA food from another location? Yes No 10. Are any documents required of a person requesting USDA food or meals containing USDA commodities (i.e., driver s license, proof residence, social security card, etc.)? Yes No If yes, list documents: Are these documents required of everyone requesting UDSA commodities/meals 11. How often can a household (other entity) receive USDA food here? 12. (FP Only) Are households allowed to pick up USDA foods for other households _ If yes, for how many households? 13. Do you have any type of home bound delivery system? Yes No If yes, explain: 14. (FP Only) How many households received bags or boxes which contained USDA food(s) in the last week/month? (Review records on file from Oct 1 and average) Per Week Per Month 15. Is the And Justice for All poster in a location where applicants or those eating meals can clearly see it? Yes No! 2

3 16. (FP Only) Once a client is approved to receive USDA food, do they have to re-apply at a later date? Yes No If yes, when or how often? Is the initial information received from a client ever updated? Yes No 17. (FP Only) Ask for a copy of the application form or eligibility record and determine if it contains: Name of household Address of household Total household size Total household income with frequency Signature of applicant or authorized designee Date of application 18. Ask to see completed application forms or eligibility records and document discrepancies and number of forms actually monitored for accuracy. 19. Are clients being served during this visit? If yes, is service provided to all regardless of race, color, national origin, sex, disability or age? 20. Are foods other than USDA being distributed/used? Yes No 21. Are USDA foods obtained from source(s) other than the Food Bank being distributed/ used? 22. (FP Only) How often can a household receive USDA foods from this site?! 3

4 23. (FP Only) Do you maintain a written record of the items and number of each item given to each household? If yes, ask for a copy of the distribution record and determine if it contains: Name of household Household size Date food was issued Signature of applicant or authorized designee Number of units per food type issued 24. (FP Only) How do you decide which USDA foods and how much of each USDA food you place in the box/bag? 25. What type of storage is available? Freezer Refrigerated Dry How Many? Walk-in Reach-in Chest type Upright 26. Do dry, refrigerated and freezer storage facilities appear adequate for the program? (Sufficient space available, freezers available when needed, proper temperature maintained, etc.)? 27. Are temperature logs available to show that inside freezer and cooler temperatures are checked and recorded daily? Yes No N/A Temperature range of dry storage Temperature range of cool storage 28. Is storage area Clean and orderly Safeguarded against theft and damage? Free of rodent or insect infestation? Date of last extermination! 4

5 Organized in a manner that facilitates accuracy and ease of USDA food inventory? Equipped with adequate shelving/pallets to allow storing off floor and away from walls? 29. Comments on storage conditions/practices: 30. Have there been any USDA commodity losses? 31. How are damaged or out-of-condition USDA food destroyed? 32. How are USDA commodities (as opposed to other foods) identified on production (menu) records and inventory records? 33. How long are records relating to USDA food kept? 34. Are any commodities out-of-condition? If yes, list: Are any commodities damaged? If yes, List: Have commodities been removed from their original cases? If yes, why and has identifying information such as pack date, contract number, etc. been transferred to individual unit(s)? List affected foods. 35. Are records maintained of USDA foods received by this site? Are client eligibility records maintained at this site? 36. How often is USDA food received by this site? 37. How much does Food Bank charge for USDA commodities? (Review invoices from Food Bank) 38. How many staff work regularly at the site? Volunteers?! 5

6 39. Is Civil Rights Training current for staff and regular volunteers-date? 40. Is a Civil Rights Training log available for regular volunteers? Yes No 41. Has this facility been reviewed/monitored by food bank personnel? (obtain copy) If yes, date of most recent review/monitoring visit If yes, was a written report left or mailed to site If yes, list discrepancies (if none, indicate no discrepancies) 42. Does this site report number of households (if FP) or individual (if CP) to Food Bank monthly? How are these numbers derived? Additional Comments: Agency Representative State Reviewer Date Date! 6

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