BROWN BAG MONITORING _ EVALUATION TOOL

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					Exhibit G

BROWN BAG MONITORING & EVALUATION TOOL

PSA #: Evaluation Elements [Compliance Criteria/Standard Source] I. PROGRAM OPERATIONS A. Food Handling Core Elements: 1. Are all items inspected upon receipt? [California Retail Food Facilities Law 114003(a)] 2. Does the salvage and repackaging process prevent the contamination of usable foods? [CURFFL 114080 (a)] Are damaged and/or spoiled items culled for salvage or discarded? (Food service industry standard)

Completed By: Comments

Date:

Y

N

I*

3.

Recommended: 1. Is produce refrigerated upon receipt as needed? 2. Are dairy products refrigerated upon receipt? [Food service industry standard Brown Bag Network Program Manual-Part II (April 1997) VII.A.15] How are excess items handled after distribution at sites e.g., discarded or returned to storage? Is this documented? [BB Manual, VIIIF.2(b)]
CDA Revised 8.04

3.

*I - Needs improvement

Page 2 of 12

Evaluation Elements [Compliance Criteria/Standard Source] I. PROGRAM OPERATIONS (CONTINUED) B. Storage and Internal Control Core Elements: 1. Is storage capacity adequate for [AB 2800,9543(4)] a. Dry stores b. c. 2. Refrigerated items Frozen foods

Comments

Y

N

I*

Do refrigerators and freezers maintain required temperatures? [VIII.D.15 & 26)] Are food items stored 6 inches off floor, 18 inches from the ceiling and away from walls to allow for air circulation? [CURFFL - 114080(a)] Is access to storage areas to include refrigerators and freezers controlled? Who has access?

3.

4.

Recommended: 1. Are refrigerator and freezer temperatures checked each operational day? (Food service industry standard)[BB Manual VIII.D.19 &28] a. 2.
*

Are the temperatures recorded?

Are food stocks rotated as needed? (Food service industry standard) [BB Manual VIII.D.4] If storage capacity is inadequate, how is this addressed?
CDA Revised 8.04

3.

*I - Needs improvement

Page 3 of 12

Evaluation Elements [Compliance Criteria/Standard Source] I. PROGRAM OPERATIONS (CONTINUED) 4. Inventory records are up-to-date, e.g. reflecting receipts, and deliveries? (Food service industry standard) [BB Manual VIII.E.1]

Comments

Y

N

I*

C.

Food Distribution Core Elements: 1. How many food distribution sites are there? Are sites handicapped accessible?l[BB Manual VII.A.d]] 2. Are actions taken to establish sites in under served areas? [BB Manual, VII.A.1] How is food sent to distribution sites accounted for? [BB Manual VIII.F.2] When USDA commodities are distributed with Brown Bag items, are the two separately accounted for? [BB Manual II.C] Are actions taken to assure the quality, variety and nutritional balance of food distributed? (BB Manual VIII.B])

3.

4.

5.

Recommended: 1. Who determines the composition of the food bag to be distributed?

2.
*

Are there certain kinds of food which are difficult to obtain? (CDA 5)

*I - Needs improvement

CDA Revised 8.04

Page 4 of 12

Evaluation Elements [Compliance Criteria/Standard Source] I. PROGRAM OPERATIONS (CONTINUED) 4. What types of problems are encountered in obtaining foods, e.g. lack of vehicles, transportation costs, inadequate amounts of foods, accessibility to distant pick-up points.

Comments

Y

N

I*

D.

Sanitation and Safety Core Elements: 1. Is all equipment clean and in good repair? [CURFFL 114050] 2. Are non-foods, e.g. cleaning supplies and equipment stored separately from food items? [CURFFL 114025 (c)] Are all areas kept free of clutter and debris? [CURFFL 114040] Is garbage and other trash containing food waste placed in proper containers? (Leak proof with close fitting lid) [CURFFL 114035] Is there an adequate number of containers? 5. Are there signs of rodent or pest infestations? [CURFFL 114030] Is a professional pest control service used? (Food service industry standard) Is there adequate lighting? [CURFFL 114170]

3.

4.

6.

*

7.

*I - Needs improvement

CDA Revised 8.04

Page 5 of 12

Evaluation Elements [Compliance Criteria/Standard Source] I. PROGRAM OPERATIONS (CONTINUED) 8. 9. Floors and drains routinely cleaned. [CURFFL 114050] What mechanisms used to prevent entry of flies, etc. through exterior doors? [CURFFL 114030 / 114040] Windows screened? [CURFFL 114030] 10. Do facilities where bags are assembled have a current health certificate (Health Department inspection)? [CURFFL 113920 & 113785] Are there adequate hand washing and bathroom facilities? [CURFFL 114105] Are NO SMOKING signs posted? (CURFFL 114021(b) Are fire extinguishers available? Is fire inspection current? [BB Manual VII.C.15]

Comments

Y

N

I*

11.

12. 13. 14.

Recommended: 1. What is the frequency of trash and garbage removal? (Food service industry standard) Is a cleaning schedule posted and followed?

2.

*

*I - Needs improvement

CDA Revised 8.04

Page 6 of 12

Evaluation Elements [Compliance Criteria/Standard Source] I. ADMINISTRATION A. General Information Core Elements: 1. How is the Brown Bag program promoted in the community? (BB Manual VI.A) 2. 3. What are the days and hours of operation? Are insurance policies current for: general liability, automobile liability, worker's compensation (Contract - Article XI)

Comments

Y

N

I*

Recommended: 1. What type of organization is sponsoring the agency? (Public/government entity or private, non-profit, Second Harvest) 2. Does the Brown Bag program own, or lease the storage facilities? What percentage of the host agency’s dry storage, refrigerator, freezer and salvage space is used in the Brown Bag program?

3.

B.

Program Management Core Elements: 1. Is there at least one low-income senior or representative on the Board of Directors? [AB2800 9543.c.3]

*

*I - Needs improvement

CDA Revised 8.04

Page 7 of 12

Evaluation Elements [Compliance Criteria/Standard Source] II. ADMINISTRATION (CONTINUED) 2. Who is responsible for the administration and operation of the Brown Bag Program? [BB Manual IV.A.2] Who is responsible for completion of the Program Activity Report (CDA 5)? [BB Manual IV.A.4(f)] Are the CDA 5s submitted monthly to the AAA? 4. How is data collected for the CDA 5? Is there valid documentation that supports the information reported on the CDA 5? [AB2800-9543 (c) (6)]

Comments

Y

N

I*

3.

Recommended: 1. Are there policies and procedures manual specific to the Brown Bag Program? 2. How does the number of seniors served and their demographics, e.g. minority, economic and social need compare with the projections of the contract? Is there an emergency plan? Are staff and volunteers knowledgeable of the plan? [BB Manual VII E.6] What are the program's current and future needs? What are the program's goals and objectives?

3.

4.

*

*I - Needs improvement

CDA Revised 8.04

Page 8 of 12

Evaluation Elements [Compliance Criteria/Standard Source] II. ADMINISTRATION (CONTINUED) C. Personnel Management Core Elements: 1. Paid staff a. How many paid staff are employed by the program, full-time vs. part-time? b. c. 2. Are there job descriptions for paid and volunteer staff? How is staff scheduled?

Comments

Y

N

I*

What are the qualifications for a distribution site manager? How are they selected? [BB Manual IV.A.6]

D.

Volunteers 1. How many volunteers work in the program? [BB Manual IV.B] How are responsibilities and duties assigned to the volunteers?[BB Manual IV.B.5] How are the volunteer hours scheduled, and verified? [BB ManualIV.B.7 & 12]

2.

3.

Recommended: 1. How are the volunteers supervised? [BB Manual IV.B.6] 2.
*

How are volunteers recruited? [BB Manual IV.B.1] Is a "Volunteer Application" used?

*I - Needs improvement

3.

Is training provided paid and volunteer staff? a. What’s the type and frequency?

CDA Revised 8.04

Page 9 of 12

Evaluation Elements [Compliance Criteria/Standard Source] II. ADMINISTRATION (CONTINUED) E. Member Participant Information and Eligibility Core Eelements: 1. How many participants are there? How many participants receive home-deliveries? 2. Has the agency developed it's own participant application or is the example in the Brown Bag Manual used? [BB Manual V.B. 2] Is a membership card used? 3. How is eligibility, e.g. age, and income level verified? [BB Manual V.A.2] Is participation information kept confidential? [BB Manual V.B.7&8] How is a participant determined to be inactive? Is there a written policy? Are participants made aware of the policy? [BB Manual V.C.4] 6. Are procedures in place by which participation of members is accountable? [BB Manual V.B.7, AB2800-9543 (c)(6)]

Comments

Y

N

I*

4.

5.

*

*I - Needs improvement

CDA Revised 8.04

Page 10 of 12

Evaluation Elements [Compliance Criteria/Standard Source] II. ADMINISTRATION (CONTINUED) Recommended: 1. Are there people on a waiting list? How many? What actions are being taken to reduce the waiting list? 2. Are participants surveyed to determine their satisfaction with the program?

Comments

Y

N

I*

F.

Donations and Contributions Core Elements: 1. Does the service provider have a suggested contribution / donation? If so, what is it? (BB Manual VI.B.4]) 2. Are contributions donations voluntary? [BB Manual VI.B.2] Are they kept confidential? [BB Manual VI.] 3. How are donations accounted for? [BB Manual VI.B.6]

Recommended: 1. How much of the total program income received by the service provider comes from participant contributions / donations? G. Equipment and Vehicles Core Elements: 1. Are equipment inventory / accountability records maintained? [BB Manual X.5]
CDA Revised 8.04

*

*I - Needs improvement

Page 11 of 12

Evaluation Elements [Compliance Criteria/Standard Source] II. ADMINISTRATION (CONTINUED) 2. Is equipment purchased with Brown Bag funds identified?[BB Manual X.4]

Comments

Y

N

I*

Recommended: 1. How often is a physical inventory conducted? Does it include model and serial numbers, date of acquisition and cost, location and current condition? 2. How many vehicles does the program have? In what condition are the vehicles? Are maintenance records kept? 3. H. Are more vehicles needed?

Fiscal [AB2800-9543(c)(6)] Core Elements: 1. Does the AAA file of the Brown Bag Program budget agree with that of the service provider? 2. 3. 4. Has the budget been amended? What are the internal controls for accountability? How many people handle cash deposits and bank records? Who has authority to sign checks? Is there more than one signature?

5.
*

*I - Needs improvement

CDA Revised 8.04

Page 12 of 12

Evaluation Elements [Compliance Criteria/Standard Source] II. ADMINISTRATION (CONTINUED) 6. Does the program have its own accounting records for the posting of its transactions? If program funds are co-mingled, how are those transactions identified from other programs? Verify that all budgeted positions by classification and employee names agrees with payroll records.

Comments

Y

N

I*

7.

8.

9.

Randomly select expenditures reported on the CDA 192 and validate with supporting documentation. a. Ensure that Cash Match and In-Kind Match agree, and that the percentage is at least 25% for each. [AB2800-9543 (c)(1)] Ensure that prior expenditures for Grant Funds and Matching agrees between the CDA 192's.

b.

10. 11. 12.

Are indirect costs reported? What methods are used to determine? Is the total amount charged 8% or less than grant total? If the amount charged is greater than 8%, how are the excess indirect costs are absorbed?

13.
*

*I - Needs improvement

CDA Revised 8.04

Exhibit G

*I - Needs improvement

CDA Revised 8.04


				
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