Form 9 School Lunch Observations
The Healthy Communities Study: How Communities Shape Childrens Health (NHLBI)
FINAL_HCS_SSA_ATTACH 15_SCHOOL LUNCH OBS_Jan 2013
Food Service Personnel
OMB: 0925-0649
SSA
ATTACHMENT 15
HEALTHY COMMUNITIES STUDY
HEALTHY COMMUNITIES STUDY
SCHOOL FOOD ENVIRONMENTAL ASSESSMENT PROTOCOL
SCHOOL LUNCH OBSERVATIONS
The following document contains the school food environmental assessment protocol for the school lunch observations. School lunch observations will be conducted in up to four schools (two elementary and two middle schools) per community from which the sample of children/families was recruited. The Battelle community liaison will observe the school’s lunch period and complete an observation form; a total of four questions regarding the lunch period will also be asked of a member of the school’s food service staff to supplement the observations.
LUNCH OBSERVATION FORM |
Public reporting burden for
this collection of information to respond to 4 questions of this
form is estimated to average 5 minutes, including the time for
reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and
reviewing the collection of information. An
agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a
currently valid OMB control number.
Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for
reducing this burden, to: NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA
(0925-0649). Do not return the completed form to this address.
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Today’s Date: |
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School ID |
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Observation Start Time: Observation End Time: |
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Liaison ID (Observer) |
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Get a copy of the month’s menu (if not able to obtain from school/district website prior to visit) |
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Already obtained 1 Collected today 2 Not available 3 |
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BEFORE THE LUNCH SHIFT
Competitive Foods Sold To Students On Campus |
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1. |
Number of Competitive Food Venues Operating at any time during the school day: |
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Location |
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(Record a number in each box – write zero if none.) |
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Venue Type |
Cafeteria 1 |
Hallway 2 |
Quad 3 |
Gym 4 |
Other 5 |
# |
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A la carte |
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_________ |
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Vending machine |
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_________ |
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Other 1: ______________ |
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_________ |
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Other 2: ______________ |
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_________ |
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Other 3: ______________ |
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_________ |
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To be asked of Food Staff on Site |
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2. How many minutes are the lunch period(s)? |
______ minutes |
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3. How many minutes, on average, would you estimate a student spends in line to get lunch? Do not count waiting for made or cooked-to-order items. |
______ minutes |
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4. During the lunch period how much time is set aside for eating vs. playing/recess?
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Not distinctly separated (Skip Question 5) 1
-OR- ______ minutes eating ______ minutes playing |
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5. Is play time/recess before or after when students eat lunch?
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Before 1 After 2 |
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DURING THE LUNCH SHIFT
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Food Observations |
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Reimbursable meal item |
Whole grain option ( > 50% WG) |
A la carte Venue |
Vending Machine |
Other Competitive Food Venue |
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Entrée/Mixed Dish Items |
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Burritos |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Chicken burgers |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Chicken pieces/ nuggets (breaded and fried) |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Hamburgers/Cheeseburger |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Hot dogs/Corn dogs |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Meat and potato |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Meat and rice/noodles/Asian-style |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Nacho chips with Salsa |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Nachos (with meat, beans, and/or cheese) |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Pasta with meat |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Pasta with cheese (no meat) / pasta salad |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Pizza |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Quesadillas |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Ramen-type soup / cup of noodles |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Sandwiches grilled/hot (not burgers) |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Sandwiches, cold |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Sandwich Bar |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Salad Bar |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Number of fresh fruits / vegetables: _____ |
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Pre-made Salads (meal/entrée sized) |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Soups, Chilis, Stews with beans and/or meat, including minestrone |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Tacos |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Wraps |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Yogurt, Plain |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Yogurt, Flavored |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Other Entrée: ________ |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Other Entrée: ________ |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Other Entrée: ________ |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Other Entrée Bar: _______ |
Y / N : __ __ |
Y / N |
Y / N |
Y / N |
Y / N |
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Total grain products, 100% (100% whole wheat bread, pasta or tortillas, brown rice, corn tortillas) __ __ |
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Total grain products, not 100% __ __ |
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Beverages |
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Diet beverage |
Y / N |
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Y / N |
Y / N |
Y / N |
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Juice(100%) no added sweeteners |
Y / N |
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Y / N |
Y / N |
Y / N |
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Juice, sweetened |
Y / N |
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Y / N |
Y / N |
Y / N |
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Milk – white, whole or 2% |
Y / N |
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Y / N |
Y / N |
Y / N |
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Milk – flavored, whole or 2% |
Y / N |
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Y / N |
Y / N |
Y / N |
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Milk – white, 1% or nonfat |
Y / N |
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Y / N |
Y / N |
Y / N |
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Milk – flavored, 1% or nonfat |
Y / N |
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Y / N |
Y / N |
Y / N |
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Soda, regular |
Y / N |
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Y / N |
Y / N |
Y / N |
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Sport drinks |
Y / N |
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Y / N |
Y / N |
Y / N |
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Water, bottled, unsweetened |
Y / N |
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Y / N |
Y / N |
Y / N |
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Other sweetened beverages (any beverage with added caloric sweetener not already listed) |
Y / N |
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Y / N |
Y / N |
Y / N |
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Other beverage: ___________________ |
Y / N |
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Y / N |
Y / N |
Y / N |
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Other beverage: ___________________ |
Y / N |
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Y / N |
Y / N |
Y / N |
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Fruit |
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Fruit, dried |
Y / N : __ __ |
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Y / N |
Y / N |
Y / N |
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Fruit, fresh |
Y / N : __ __ |
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Y / N |
Y / N |
Y / N |
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Fruit, frozen, canned or cooked |
Y / N : __ __ |
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Y / N |
Y / N |
Y / N |
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Vegetables/Salad |
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Fried potatoes (including pre-fried, oven baked, French fries, tater tots, potato skins) |
Y / N : __ __ |
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Y / N |
Y / N |
Y / N |
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Salads, side (tossed, raw vegetables) |
Y / N : __ __ |
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Y / N |
Y / N |
Y / N |
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Vegetables, other fried |
Y / N : __ __ |
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Vegetables, fresh |
Y / N : __ __ |
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Y / N |
Y / N |
Y / N |
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Vegetables, processed, i.e. canned, frozen |
Y / N : __ __ |
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Y / N |
Y / N |
Y / N |
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Cereals/Desserts/Snacks |
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Candy/chocolate |
Y / N |
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Y / N |
Y / N |
Y / N |
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Cake |
Y / N |
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Cake type (brownies, cupcakes, Twinkies) |
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Y / N |
Y / N |
Y / N |
Y / N |
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Cake type (lower/reduced fat) |
Y / N |
Y / N |
Y / N |
Y / N |
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Cereal frosted or flavored |
Y / N |
Y / N |
Y / N |
Y / N |
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Cereal not frosted or flavored |
Y / N |
Y / N |
Y / N |
Y / N |
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Chips (corn, potato, puffed cheese, tortilla) |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Chips (lower/reduced fat, baked) |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Cookies |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Cookies (lower/reduced fat) |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Corn nuts |
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Y / N |
Y / N |
Y / N |
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Crackers, regular |
Y / N |
Y / N |
Y / N |
Y / N |
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Crackers / Pretzels (lower/reduced fat) |
Y / N |
Y / N |
Y / N |
Y / N |
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Frozen non-dairy (fruit bar, Jell-O Pops, Popsicles) |
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Y / N |
Y / N |
Y / N |
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Frozen desserts, Low fat (yogurt, sherbet, ice milk) |
Y / N |
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Y / N |
Y / N |
Y / N |
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Frozen desserts, other: ____ |
Y / N |
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Y / N |
Y / N |
Y / N |
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Fruit roll-up or fruit snacks with added sugar |
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Y / N |
Y / N |
Y / N |
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Granola bar/cereal bar/energy bar/snack bar |
Y / N |
Y / N |
Y / N |
Y / N |
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Ice Cream (bar, Fudgesicles, scoops, cups, sundaes, sandwiches) |
Y / N |
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Y / N |
Y / N |
Y / N |
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Meat snacks (jerky, salami, pork rinds) |
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Y / N |
Y / N |
Y / N |
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Milkshake |
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Y / N |
Y / N |
Y / N |
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Muffins |
Y / N |
Y / N |
Y / N |
Y / N |
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Muffins (low/reduced fat) |
Y / N |
Y / N |
Y / N |
Y / N |
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Nuts and seeds (almond, sunflower seeds) |
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Y / N |
Y / N |
Y / N |
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Pastries (donuts, pies, turnovers, toaster pastries) |
Y / N |
Y / N |
Y / N |
Y / N |
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Pastries (lower/reduced fat) |
Y / N |
Y / N |
Y / N |
Y / N |
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Pastries, other: ______ |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Popcorn, air popped or low fat |
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Y / N |
Y / N |
Y / N |
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Popcorn, butter or flavored |
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Y / N |
Y / N |
Y / N |
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Trail mix, without candy |
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Y / N |
Y / N |
Y / N |
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Trail mix, with candy |
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Y / N |
Y / N |
Y / N |
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Other dessert/snack:__________ |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Other dessert/snack:__________ |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Other foods: ________________ |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Other foods: ________________ |
Y / N |
Y / N |
Y / N |
Y / N |
Y / N |
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Other Observations
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1. |
In what forms is unsweetened water available free of charge in the dining or serving areas? Please all that apply. |
Water fountain 1 Pitcher 2 Bottles 3 Dispenser 4 Other 5 None 0 |
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2. |
Presence of indoor dining areas Please only one. |
None (no indoor dining areas provided)…SKIP TO Q. 6 0 Informal (students can eat inside but no seating AND tables provided for this purpose)…...SKIP TO Q. 5 1 Formal (indoor eating area with seating AND tables provided for this purpose) 2
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3. |
Size of formal indoor dining area |
Big enough to seat all students 1 Too small to seat all students 2
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4. |
Crowding in formal indoor dining area |
Too crowded 1 Not too crowded 2
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5. |
Indoor dining décor / ambiance: Please only one. |
Exceptional 1 Pleasant (clean, cheerful, inviting) 2 Acceptable (clean, well-kept, but sparse 3 Some areas of concern (dirty, dingy, needs repairs, very worn etc.) 4
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6. |
Presence of outdoor dining areas Please only one. |
None (no outdoor dining areas provided)…..SKIP TO Q. 10 0 Informal (students can eat outside but no seating AND tables provided for this purpose)…SKIP TO Q. 9 1 Formal (outdoor eating area with seating AND tables provided for this purpose) 2
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7. |
Size of formal outdoor dining area |
Big enough to seat all students 1 Too small to seat all students 2
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8. |
Crowding in formal outdoor dining area |
Too crowded 1 Not too crowded 2
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9. |
Outdoor dining décor / ambiance: Please only one. |
Exceptional 1 Pleasant (clean, cheerful, inviting) 2 Acceptable (clean, well-kept, but sparse) 3 Some areas of concern (dirty, dingy, needs repairs, very worn etc.) 4
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10. |
In their interactions with students, some staff were: Please all that apply. |
Engaging (smiling, interactive, encouraging) 1 Pleasant but not engaging 2 Neutral (interact enough to process the students’ meals) 3 Impolite, impatient, or negative with students 4 Unable to observe 5 |
LUNCH OBSERVATION FORM
Sources and References
UC Berkeley Atkins Center for Weight and Health (CWH) school nutrition environment observation forms (not published)
U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS). School Nutrition Dietary Assessment (SNDA) Study III, Pre-Visit Questionnaire and Menu Survey – Reimbursable Meals Form. Retrieved on November 14, 2010 from http://www.fns.usda.gov/oane/MENU/Published/CNP/cnp.htm
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | gregorioum |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |
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