BREAKFAST
1. *MILK
2. ** GRAIN / BREAD (2)
3. FRUIT OR VEGETABLE
4. OTHER (OPTIONAL)
***Meat or meat alternate may be served in place of entire grain component at breakfast a maximum of 3 times per week.
LOUISIANA CHILD AND ADULT CARE FOOD PROGRAM
DAILY MENU WORKSHEET RECORD: ADULT DAY CARE
CACFP-
LUNCH
1. *MILK
2. ** GRAIN / BREAD (2)
3. MEAT OR MEAT ALTERNATE
4. VEGETABLE
5. VEGETABLE OR FRUIT
P.M. SNACK (CHOOSE 2)
1. *MILK
2. ** GRAIN / BREAD
3. FRUIT
4. VEGETABLE
5. MEAT OR MEAT ALTERNATE
*Yogurt may be served in place of milk one time per day for adults only. Yogurt must contain no more than 23 grams of sugar per 6oz.
**At least one serving of grains per day must be whole grain (WG) rich. Breakfast cereals must contain no more than 6 grams of sugar per dry ounce. For additional grains/bread or meat/meat alternates, consult the “meal Pattern Requirements” on the CNP website. Juice may not be served when milk is served as the only other component.
GENERAL INSTRUCTIONS:
Daily menu worksheet records must be dated and all components served must be indicated. Daily menu worksheet records must be maintained daily for each meal claimed for reimbursement.
Please indicate Reg Diets and Spec Diets’ plate count for each meal (minus any adult meals) at the bottom of worksheet.
SPONSOR: Complete with name of sponsor, facility, or center.
FACILITY: Complete with name of center, if same as institution, write same.
DATE: Write month, day and year meal was actually served.
(1) Meal pattern: All meals served must meet component requirements as indicated in meal pattern.
(2) Menu: Write the menu served to include all required components; for example, @ Breakfast: Spiced Applesauce Buttered Toast Milk
(3) Size of Serving: Indicate the amount of each component served for each adult; for example, @ Breakfast:
Applesauce 1/2 cup
Toast 2 oz Milk 1 cup
(4) Number to be served: Indicate the number of adults for which the meals are planned.
(5) Food items used: Describe food items as purchased: including all components used for each meal; for example, @ Breakfast:
Milk Canned Applesauce (C) Oz Bread
If food item served is a commodity item, please indicate by writing the letter (C) in parenthesis or writing the item in RED.
(6) Amounts used: Record the amount of all food used to prepare the meal, whether it is purchased food or leftovers. Indicate fresh fruits and vegetables in pounds; specify can, box, loaf or package sizes and yield of baked goods. Example:
Milk 1 Gallon or 16 cups or 16-1/2 pints
Canned Applesauce 1 #10 Can or 1-16 oz. can or 5 cups leftover
Oz Bread 1-24 oz. Loaf or 20 oz
(7) Number served: After each meal service, you must indicate the number of clients/program adults and food service staff actually served: Reg Diets - indicate number of clients/program adults served regular diets.
Spec Diets - indicate number of clients/program adults served special diets.
Adults - indicate number of food service staff.
Total - indicate total number of clients/program adults and food service staff.