CACFP Agreement #____________
FOOD PRODUCTION RECORD –LUNCH-SNACK-SUPPER
Date____________________________________
MEAL PATTERN
FOOD ITEMS
SERVING SIZE
# SERVINGS
PREPARED
TYPE AND AMOUNTS USED
LUNCH – Must serve all 5 components
1. Milk
1.
1.
2. Vegetable
2.
2.
3. Fruit or Vegetable
3.
 Fresh
 Frozen
 Canned
 Fresh
 Frozen
 Canned
 Fresh
 Frozen
 Canned
 Fresh
 Frozen
 Canned
3.
4. Grains/Bread
4.
4.
5. Meat/Meat Alternate
5.
5.
Other (not required)
SNACK – Must serve 2 different components
Milk
Vegetable
Fruit
Grains/Bread
Meat/Meat Alternate
1.
1.
2.
2.
Other (not required)
SUPPER – Must serve all 5 components
1. Milk
1.
1.
2. Vegetable
2.
2.
3. Fruit or Vegetable
3.
3.
4. Grains/Bread
4.
4.
5. Meat/Meat Alternate
5.
5.
Other (not required)
This institution is an equal opportunity provider.
CACFP-3696C (12/16)
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