Menu Planning Form Instructions
Note:
Numbers correspond with numbers on sample
General Information:
1.
Ages:
Write the range of ages or grade level equivalent for
the children the site is serving. The age of the
children is important because it affects the amount
that is required to be served.
2.
Month/Year:
Include the month and year for which you are
completing the Menu Planning Form.
3.
Site:
Fill in the name of the site in the space given. For
agencies that only have one site, put the agency
name in the available space.
4.
B L SN:
Circle the appropriate letter to indicate the meal
served: B=Breakfast, L=Lunch, and SN=Snack.
5.
Date:
Include the specific date you are serving the meal.
Menu Items:
6.
M/MA:
M/MA stands for Meat/Meat Alternate. In this column, you
should indicate how the component contributes to the meal pattern in ounces.
For example, the meal pattern calls for 2 ounces of M/MA to be serviced as a
minimum for lunch for grades K-12. Resources such as your Food Buying Guide
will assist you in determining the serving size of items you prepare. For prepared
items you purchase (i.e. chicken nuggets-See lunch example #2), you should
have a Child Nutrition (CN) Label to determine the amount that should be served
to meet the meal pattern. In lunch example #2, a CN label might indicate that 8
chicken nuggets equals 2 ounces of meat/meat alternate. The baked beans in
the same example could be used to supplement the meat/meat alternate, if
needed, or as a fruit/vegetable serving. However, it may not be used as both
vegetable and meat in the same meal.
7.
F/V: F/V stands for Fruit/Vegetable. In this column, you should indicate
the contribution to the meal pattern in cups or portions of cups (1/4, ½). The
meal pattern for 7-12th grade calls for a minimum of 1¼ cup of fruit and/or
vegetable to be served. The 1¼ cup serving must be met by serving at least two
food items: 2 fruits, 2 vegetables, or 1 fruit/1 vegetable. However, you may serve
the quantity in any combination. Lunch example #1 shows three different fruits
and vegetable offered at different quantities.
Revised 08/2007
(Pre-K through Grade 4 requirement is 1 cup of fruit and/or vegetable.)
8.
G/B: G/B stands for Grains/Breads. In this column, you should indicate
how many grains/breads servings contributed to the meal pattern. You are
required to serve 12 G/B servings per week (based on five days) for grades 7-12.
(Pre-K through grade 4 requirement is 10 G/B servings.) For residential facilities
that operate 7 days a week, the weekly requirement increases to 17 for grades 712 and 14 for Pre-K through grade 4. Two of the bread servings, not more than
one per day, may be grain-based desserts. However, it is essential for you to
understand how to determine the Grains/Breads servings in the meals you serve.
In lunch example #1, the hamburger bun was determined to be 2 grains/breads
servings. In lunch example #2, one grains/breads serving was included in the
serving of chicken nuggets and 2¼ in the roll. Please note, however, the
information for prepared items can only be determined if the item has a CN label.
The grains/breads serving equivalents for USDA recipes is indicated on the
recipe.
The grains/breads chart (attached) shows the minimum serving size (by groups:
A-I) that must be served to meet meal pattern requirements. Grains/Breads
servings from food components such as cookies (lunch, example #1) or
pancakes (breakfast example) are categorized on the grains/breads chart in
different groups. The Nutrition Facts Label on the product package will indicate
the serving size and the weight of the food item. By using the information found
on the Nutrition Facts Label, calculate the serving size needed for the
grains/breads item you wish to serve.
9.
Milk: Milk is indicated in the column in ounces. The serving size is 8 fluid
ounces.
10.
Other: “Other” is anything else you served with the meal that is not part of
the meal pattern.
Portions:
11. Portion Size: The portion size should indicate what you planned on
serving to each child. In lunch example #1, the planned serving size was 1
hamburger, therefore, in the column there is a “1”. In lunch example #2, the
planned portion size for chicken nuggets was 8 nuggets.
12.
Portions Prepared: The portions prepared should indicate the actual
number of portions of each food item that has been prepared for this meal.
Revised 08/2007
For example: If 12 hamburgers with bun were prepared, the # of portions
prepared would be 12 hamburgers. If 3-16 oz. cans of peaches were prepared,
there would be 18-1/4 cup portions according to the Food Buying Guide.
13. Portions Taken: The portions served should indicate the actual number
of the planned portions you served. For example, under lunch example #1,
the planned portion size for salad was ½ cup. If you prepared 25 ½ servings and
5 were left over then portions taken were 20 (1/2 c).
This column should not be used to list the actual number of children
served. The meal count for children served must be documented at the
time of the meal service and is separate from the Menu Planning Form. The
number of portions served should include second helpings served as well as the
portions served to adults.
14.
Comments: Comments explain anything that happened to influence the
meal (i.e. substitutions, increased attendance, student preferences, meal counts,
etc.).
15.
Initials: The staff person who completes the Menu Planning Form for
breakfast, lunch or snack should put their initials in the space provided. This
information is helpful if someone has a question regarding the meal.
16.
Notes: Use this section for notes that may be helpful for the week or a
particular day or to convey information to staff. For example: on Tuesday, place
frozen ground beef in refrigerator (for thawing) for Chili preparation on Thursday.
“Be sure to leave menus for weekend staff”, etc.
Revised 08/2007
SAMPLE MENU PLANNING FORM
1.
Ages/Grades 11-17
4
B L SN
5
Date_ _______
(circle one) MENU ITEM
Hamburger on bun
French Fries
Salad
Peaches
Milk
2. Month/Year September 2007
6
7
M/MA F/V
oz
cups
2 oz
½
½
¼
8
G/B
serv
2
* Cookies
1
Date___________ M/MA F/V
MENU ITEM
oz
cups
2oz.
**Chicken nuggets
Baked Beans
½ c.
Corn
½ c.
Assorted Fresh Fruit
½ c.
Hot Roll
Milk
G/B
serv
1
B L SN
(circle one)
2¼
3. Site SAMPLE_______
9
10
11
12
Milk Other Portion # Portions
oz
Size
Prepared
1
12
½ c.
20
½ c.
25
¼ c.
18
8
8oz
10
2
12
13
14
15
#Portions
Comments Init
Taken
MBN
10
Lunch Example
15
20
#1
12
10
12
Milk
Portion # Portions
oz Other Size
Prepared
8
10
½ c.
15
½ c.
15
1
15
1
20
8oz.
8oz.
10
#Portions
Comments Init
Taken
MBN
10
Lunch Example
10
#2
10
12
15
10
Date___________ M/MA F/V
MENU ITEM
oz
cups
* Pancakes
Milk
Fruit (strawberries)
½ c.
G/B
serv
2
Milk
Portion # Portions
oz Other Size
Prepared
2
20
8oz.
8oz.
11
½ c.
20
#Portions
Comments Init
Taken
MBN
15
Breakfast
Example
11
15
(circle one)
Date___________ M/MA F/V
MENU ITEM
oz
cups
Yogurt
2oz.
1c.
*** Fruit Juice
G/B
serv
* Graham Crackers
2
Milk
Portion # Portions
oz Other Size
Prepared
8oz
12
1c.
15
4 crackers 10
#Portions
Comments Init
Taken
Snack Example MBN
10
10
10
B L SN
(circle one)
B L SN
M/MA-Meat/Meat Alternate
F/V-Fruit/Vegetable
G/B-Grain/Bread
Notes: 16
*
**
= Use Grain/Bread chart and product label to determine serving size.
= Requires Child Nutrition (CN) label to determine Meat/Meat Alternate (M/MA) serving size and Grains/Breads(G/B) serving for
prepared foods purchased.
*** = Juice must be 100% juice to contribute to meal pattern
Updated 08/2007
Ages/Grades________
B L SN
(circle one)
B L SN
(circle one)
B L SN
(circle one)
B L SN
(circle one)
MENU PLANNING FORM
Month/Year______________________
Site_________________________________
Date_____________ M/MA
MENU ITEM
oz
F/V
cups
G/B Milk
Portion # Portions #Portions
Prepared
Taken
serv oz Other Size
Comments
Init
Date_____________ M/MA
MENU ITEM
oz
F/V
cups
G/B Milk
Portion # Portions #Portions
Prepared
Taken
serv oz Other Size
Comments
Init
Date_____________ M/MA
MENU ITEM
oz
F/V
cups
G/B Milk
Portion # Portions #Portions
Prepared
Taken
serv oz Other Size
Comments
Init
Date_____________ M/MA
MENU ITEM
oz
F/V
cups
G/B Milk
Portion # Portions #Portions
Prepared
Taken
serv oz Other Size
Comments
Init
M/MA-Meat/Meat Alternate
Updated 08/2007
F/V-Fruit/Vegetable
G/B-Grain/Bread
Notes:
B L SN
(circle one)
B L SN
(circle one)
B L SN
(circle one)
Date_____________ M/MA
MENU ITEM
oz
F/V
cups
G/B Milk
Portion # Portions #Portions
Prepared
Taken
serv oz Other Size
Comments
Init
Date_____________ M/MA
MENU ITEM
oz
F/V
cups
G/B Milk
Portion # Portions #Portions
Prepared
Taken
serv oz Other Size
Comments
Init
Date_____________ M/MA
MENU ITEM
oz
F/V
cups
G/B Milk
Portion # Portions #Portions
Prepared
Taken
serv oz Other Size
Comments
Init
M/MA-Meat/Meat Alternate
Updated 08/2007
F/V-Fruit/Vegetable
G/B-Grain/Bread
Notes:
Updated 08/2007