CACFP Agreement #____________

This institution is an equal opportunity provider.

CACFP-3696B (12/16) PAGE 1 OF 1

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.

Fresh Frozen Canned

3. Grains/Bread

OR

Meat/Meat Alternate

(only 3 times a week)

3.

3.

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.

Fresh Frozen Canned

3. Fruit or Vegetable 3.

3.

Fresh Frozen Canned

4. Grains/Bread 4.

4.

5. Meat/Meat Alternate 5.

5.

Other (not required)