Site Visit Form (Partnership Coordinators)
Time:
Assessment Type:

FAEW Staff Contact Information

Partnership Coordinator
Partnership Coordinator
First Name
Last Name

Partner Contact Information

Partner
Partner
Organization Name
Partner Reference #
Address
Address
City
State/Province
Zip/Postal
Primary Contact
Primary Contact
First Name
Last Name

Partner Information

Partner Type:
Pantry Hours:
Only note hours of food distribution.
Monday Open
Monday Close
Tuesday Open
Tuesday Close
Wednesday Open
Wednesday Close
Thursday Open
Thursday Close
Friday Open
Friday Close
Saturday Open
Saturday Close
Sunday Open
Sunday Close
Is the Partner's signage and site hours clear and visible to participants?

Food Sourcing

Does this partner distribute TEFAP product?
Does this partner participate in Direct Connect?
If yes, is the partner in compliance?
Does this partner currently participate in Fresh Stop?
Does this partner participate in any other food bank programs?
Do all agency activities appear to be appropriate?

Client Demographics *See Primarius Statistics*

Does the partner have all statistic entries completed since last monitoring visit?

Service Territory

Partner Distribution

How is food distributed? Check boxes according to your partner type.
Food Pantries:
Meal Programs:
Meal Programs:
Does this partner operate a drive through model?
Does intake process treat clients with dignity in a polite, confidential manner?
Are clients required to attend church or classes or do anything in exchange for FAEW products?
Are clients required to donate time or funds to receive FAEW products?
Does the partner have eligibility requirements for providing food to clients?
Does this partner serve any particular vulnerable populations?
Does this partner keep client records for a minimum of two years?
Does this partner allow clients to access food multiple times per month?
Does this partner offer wraparound services?
Does this partner have paid staff?
Does the partner sub-distribute product to other FAEW agencies?
If yes, does the partner keep a log of items that have been sub-distributed?

Program Infrastructure & Capacity

Dry Storage:
Select the closest estimated description of the program's dry food storage space.

Food Safety, Storage & Inventory

Does the program have a contract with a licensed pest control firm?
Is there evidence of pests?
Ex: Insects, Webs, Droppings, Etc.
Does the program keep temperature logs on freezer and refridgeration units?
Does the program maintain a regular cleaning schedule?
Are food storage areas clean and odor free?
Do storage areas have adequate safeguards to prevent theft or other loss?
Ex: Locks, Limited Access, Etc.
Is food stored at least 4" away from walls to allow proper ventilation and air circulation?
Is food at least 6" off floor or stored on pallets, platforms, or shelves?
Does the program ensure older product is used before newer production? (FIFO/FEFO)
Does at least one person have the required food safety training completed?
Are FAEW products being used outside of approved distribution channels?
Are toxic items and chemicals stored away from food?
Ex: Bleach, Cleaning Supplies, Etc.
Does the program transport food further than 30 minutes?
If yes, are temperature control devices used to provide safe food transport?
Are reasonable accomodations available for handicapped clients?

Final Recommendations