CACFP Agreement #____________
FOOD PRODUCTION RECORD – BREAKFAST-SNACK-LUNCH
Date____________________________________
MEAL PATTERN
FOOD ITEMS
SERVING SIZE
# SERVINGS
PREPARED
TYPE AND AMOUNTS USED
BREAKFAST – Must serve all 3 components
1. Milk
1.
1.
2. Vegetable or Fruit
2.
2.
3. Grains/Bread
OR
Meat/Meat Alternate
(only 3 times a week)
3.
3.
 Fresh
 Frozen
 Canned
 Fresh
 Frozen
 Canned
 Fresh
 Frozen
 Canned
SNACK – Must serve 2 different components
Milk
Vegetable
Fruit
Grains/Bread
Meat/Meat Alternate
1.
1.
2.
2.
Other (not required)
LUNCH – 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-3696B (12/16)
PAGE 1 OF 1