Form 10.2.

MENU CHECK SHEET

Is the menu nutritionally adequate? YES NO

1. Includes at least one serving of a good vitamin C source daily? x
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List the daily vitamin C sources on the next page.

2. Includes at least one serving of a dark-green or deep-yellow

vegetable or fruit every other day? x
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List the vitamin A sources on the next page.

3. Includes at least four or more servings of fruits/vegetables daily? x

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4. Includes at least two cups of milk daily? x

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5. Includes daily, at least four to six ounces, cooked weight, of meat,

fish, poultry or substitute? x
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Includes ___3__ eggs per week

6. Includes at least four or more servings of whole-grain, enriched, or

restored bread daily? x
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Other factors:
7. Are the foods in season, available and within the budget? x
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8. Can foods be prepared with available equipment and personnel? x

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9. Is there a repetition of food items within the week? 

x

10. Is there variety in the food items served during the week? x
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11. Do flavors complement each other? x

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12. Do the foods offer contrasts in:

color?  x

texture? x 

temperature? x 
 size, shape or form? x
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lightness and heaviness? x

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preparation methods? x
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13. Are suitable garnishes and accompaniments used for interest? x

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14. Will foods appeal to the patients/residents/clients? x

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15. Will meal look appealing when served? x

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 SOURCES

Submit both pages of this check sheet with your meal plans.