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