Pre-Operational Visit Form Site Name Site Address Site Telephone Number Site Supervisor Type of Site (Check appropriate type) Recreation center School Church Park Residential Camp Play Street Playground Settlement House Healthcare Libraries Rual Development (RED)/Housing and Urban Development (HUD) Day Care Other Estimated Number of Children the site could serve Estimated Number of Needy Children in the area Estimated number of personnel needed to adequately control the food Service Are the present facilities adequate for an organized meal service? Yes No If answer is no, comments For the estimated number of children, does the site have: Shelter for inclement weather? Yes No Adequate storage for prepared or delivered food? Yes No Storage space for records at site? Yes No Adequate Refrigeration Yes No Access to a telephone Yes No Is this site for profit? Yes No What types of organized activities are possible or planned at this site? Improvements or corrective actions needed before site operates: Did the site have any deficiencies in the previous summer? Monitor's Signature Date Send