SUMMER FOOD SERVICE PROGRAM PRE-OPERATIONAL SITE VISIT FORM - ISBE 67-16

Oct 10, 2026

Uploaded by Mia

This pre-operational visit form collects sponsor and site details for the Summer Food Service Program, including sponsor agreement number, site contact information, supervisor and monitor names, review date, and project start/end dates. It captures the meal service type, planned meal services and timing, meal preparation method (on-site, central kitchen, or vendor), child and staff estimates, and whether facilities and required SFSP training are in place. It also evaluates non-congregate meal readiness, supporting documentation requirements, and prior operational problems, ending with certification and signature fields.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Sponsor and Site Information

Meal Service Details

Facilities, Staffing, and Training

Non-Congregate Meal Requirements

Prior Operational Problems and Corrections

Certification and Signatures

SUMMER FOOD SERVICE PROGRAM PRE-OPERATIONAL SITE VISIT FORM 100 North First Street, W-270 Springfield, Illinois 62777-0001 NUTRITION DEPARTMENT Directions: Sponsors are required to complete this form for each new site, each site identified as having operational problems the prior year, and each existing site that is new to non-congregate meal service prior to operation. New sites are defined as ones that did not operate in the previous year or operated a different service model in the previous year (i.e. , operated congregate meal service in the previous year and now are operating non-congregate) . | SPONSOR NAME | AGREEMENT NUMBER | | | --- | --- | --- | | SITE NAME | SITE NUMBER | | | SITE ADDRESS (City, State, and ZIP Code) | SITE PHONE NUMBER (Include Area Code) | | | SITE SUPERVISOR | SITE MONITOR NAME (This must be different from site supervisor.) | | | DATE OF REVIEW | ARRIVAL TIME | DEPARTURE TIME | | PROJECT START DATE | PROJECT END DATE | | Type of Site: School Library Other (specify) : Church Park Residential Camp Recreation Center Playground Health Care Settlement House Mobile Site Qualification: Open Restricted Open Closed Enrolled Camp Migrant Site NYSP Other (specify) : | Meal Service Type:
Congregate Non-Congregate Home Delivery Non-Congregate Pick-up Conditional Non-Congregate Hybrid | | | --- | --- | | Planned Meal Service(s) :
Breakfast A. M. Snack Lunch Supper
Anticipated Meal Service Times: | P. M. Snack | | Meal Preparation:
On-site Central Kitchen (specifiy address) : | Vendor (specify) : | | Estimated number of children the site could serve: Estimated number of needy children in area:
Estimated number of personnel needed to adequately control the meal service: Are the present facilities adequate for an organized meal service? YES NO
If no, explain:
Has site staff received required SFSP training? YES NO Date of Training: | | ISBE 67-16 (2/26) This institution is an equal opportunity provider. PAGE 1 of 2 | For the estimated number of children, does the site have: | Yes | | No | | --- | --- | --- | --- | | 1. Shelter for inclement weather (if applicable)?
Name and Address of alternate site: | | | | | 2. Adequate storage for prepared or delivered food? | | | | | 3. Storage space for records at site? | | | | | 4. Adequate cooking facilities (if applicable)? | | | | | 5. Adequate refrigeration and freezer? | | | | | 6. Access to a telephone? | | | | | 7. Adequate tables and chairs for seating? | | | | | Additional questions for sites approved to serve non-congregate meals: | Yes | No | | --- | --- | --- | | 1. Does the site have adequate packaging for distributing off-site meals? | | | | 2. Does the distribution schedule align with information submitted on the site application in WINS? | | | | 3. For the Home Delivery Model, has parental consent been obtained for each household on the route? | | | | 4. For the Home Delivery Model, has the number of children living in the household been confirmed? | | | | 5. For the Home Delivery Model, do the parental consent forms contain the complete Non-Discrimination Statement? | | | | 6. For the Home Delivery Model, is each house verified to be in a rural area? | | | | 7. For the Pick-up Model, if parents/guardians are allowed to pick up meals on behalf of children in their household, has the number of children in the household been verified by the sponsor? | | | | 8. If more than one site is providing non-congregate meals, is the site following the documented procedures to ensure that duplicate meals are not distributed to the same child/household? | | | | 9. If distributing multiple days of meals or distributing food components in bulk, have menus and sample instructions been developed? | | | | Additional question regarding possible operational problems that happened previously: | Yes | | | No | | | | --- | --- | --- | --- | --- | --- | --- | | Did th

FAQs

What information must sponsors provide for a new or newly configured site?

Sponsors must complete sponsor and agreement details, site name/number/address/phone, supervisor and monitor names, review and schedule dates, and project start/end dates for the site.

How does the form define and collect non-congregate meal service information?

It records the meal service type (including non-congregate models) and asks additional questions about packaging, alignment of distribution schedules with WINS submissions, and requirements for home delivery or pick-up models.

What facility and training checks are required before site approval?

The form requires YES/NO confirmation that facilities are adequate for organized meal service, whether site staff received required SFSP training (including training date), and whether key resources such as storage, cooking equipment, refrigeration/freezer, tables/chairs, and telephone access are available.

Oct 10, 2026

Uploaded by Mia