4 Nutrition and Food Template.docx
DOCX document 18 KB Posted
- Attached to
- HCHV Federal contract opportunity
- Solicitation number
- 36C26123Q0196
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| S02 36C26123Q0196 0004.pdf | ||
| S02 36C26123Q0196 0003.pdf | ||
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| 3 Facilities Managment Template.docx | DOCX document | |
| ZIP CODE CATCHMENT LIST - EXCEL VERSION.xlsx | XLSX spreadsheet | |
| S02 36C26123Q0196 0002.pdf | ||
| S02 36C26123Q0196 0001.pdf | ||
| PERFORMANCE WORK STATEMENT.pdf | ||
| Attachment 1 - Wage Determination 1995-0573 Rev 52 12.27.22.pdf | ||
| S02 36C26123Q0196.pdf |
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Text version
NUTRITION AND FOOD SERVICES
HOMES PROJECT CODE:
SITE ADDRESS:
APPROPRIATE DISCIPLINE(S) SHOULD COMPLETE
THIS SECTION ATTACHING THEIR RESPECTIVE
REPORT FORMAT(S)
OPERATING STANDARDS ALL HCHV CRS PROVIDERS (ALL INSPECTIONS)
HOW DOES THE AGENCY PROVIDE FOR THE NUTRITIONAL NEEDS OF VETERANS IN THE PROGRAM, AT LEAST ONE ITEM MUST BE CHECKED, IF AN ITEM IS CHECKED THEN N/A MAY NOT BE SELECTED FOR ANY ITEMS IN THAT SECTION
__ CENTRALLY PREPARED NUTRITION AND FOOD SERVICES
___ INDIVIDUAL FOOD PREPARATION FACILITIES
| FOR CENTRALLY PREPARED NUTRITION AND FOOD SERVICES THE CONTRACT PROVIDER : |
| YES |
| NO |
| N/A |
| 30 |
| PROVIDES ONE WEEK OF MENUS FOR REVIEW |
| 31 |
| THE MENUS REPRESENT A NUTRITIONALLY ADEQUATE DIET |
| 32 |
| DEMONSTRATES THE ABILITY TO MEET SPECIAL DIETARY NEEDS (I.E. KOSHER, DIABETIC, ALLERGIES, MEDICALLY INDICATED) |
| 33 |
| PROVIDES THREE MEALS AND AN EVENING SNACK PER DAY, INCLUDING WEEKENDS |
| 34 |
| ENSURES ALL FOOD SERVICE PERSONNEL OBSERVE SAFE SANITATION PRACTICES |
| 35 |
| ENSURES REFRIGERATION AND DRY FOOD STORAGE AREAS ARE APPROPRIATELY MAINTAINED AND MONITORED |
| 36 |
| ENSURES ALL FOOD AREAS ARE CLEAN AND FREE OF LITTER |
| 37 |
| ENSURES CURRENT LICENSURES AND PERMITS ARE MAINTAINED IF REQUIRED BY LOCAL OR OTHER AUTHORITIES |
| 38 |
| ENSURES FACILITY FOOD PREPARATION AREAS ARE MAINTAINED IN A SANITARY CONDITION |
| FOR INDIVIDUAL FOOD PREPARATION THE CONTRACT PROVIDER ENSURES: |
| YES |
| NO |
| N/A |
| 39 |
| APPLIANCES ARE ADEQUATE TO SAFELY STORE AND PREPARE FOOD |
AND ARE IN GOOD WORKING CONDITION (I.E. STOVE, REFRIGERATOR, DISHWASHER)
| 40 |
| THAT ALL FOOD PREPARATION AREAS CONTAIN SUITABLE SPACE AND |
EQUIPMENT TO STORE, PREPARE, AND SERVE FOOD IN A SANITARY
MANNER INCLUDING PROVIDING APPROPRIATE CLEANING SUPPLIES AS NEEDED
| 41 |
| THE ABILITY TO MEET SPECIAL DIETARY NEEDS (e.g. KOSHER, DIABETIC, ALLERGIES, MEDICALLY INDICATED) |
| 42 |
| SUFFICIENT FOOD STORES ARE AVAILABLE TO ENSURE VETERANS RECEIVE THREE NUTRITIONALLY ADEQUATE MEALS PER DAY. |
| 43 |
| RESOURCE INFORMATION IS AVAILABLE TO EDUCATE VETERANS WITH |
SPECIAL DIETARY NEEDS (e.g. DIABETIC, ALLERGIES, MEDICALLY
INDICATED). MAY BE ACCOMPLISHED THROUGH NUTRITIONAL
EDUCATION PROVIDED DIRECTLY BY THE AGENCY OR A REFERRAL RESOURCE WITHIN THE COMMUNITY
| NUTRITION AND FOOD SERVICES |
| HOMES PROJECT CODE: |
INSPECTION DEFICIENCIES & CORRECTIVE ACTIONS
ANY CHECKLIST ITEMS WHERE “NO” WAS INDICATED MUST HAVE DOCUMENTATION PROVIDED
BELOW DETAILING THE SPECIFICS OF THE DEFICIENCY; CORRECTIVE ACTIONS TAKEN; AND THE DATE THE PROVIDER WAS IN COMPLIANCE. ANY DEFICIENCIES NOT CORRECTED AND
APPROPRIATELY DOCUMENTED WILL RESULT IN AN INCOMPLETE INSPECTION PACKAGE.
| YES |
| NO |
Deficiencies were present for items on this checklist during inspection (If Yes list deficiencies and confirm resolution below)
THESE ARE ITEMS THAT WOULD NOT CAUSE THE CONTRACT PROVIDER TO BE DEFICIENT IN ANY PROGRAM REQUIREMENTS BUT, MAY OFFER AN OPPORTUNITY FOR PROGRAM IMPROVEMENT.
| YES |
| NO |
| ALL APPROPRIATE CHECK LIST ITEMS HAVE BEEN ADDRESSED AND THE FACILITY IS APPROVED FOR PLACEMENT OF VETERANS |
| x |
| Nutrition/Food Management Inspection Team Members Signature |
| Facility Food Management Inspection |
Team Members Name ( Print) Date
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