Meal Cancellation Report

1. Date of Closure(s): *
Start Date   End Date
2. Type of meals: *
3. Agency Name: *
  a. Site Name:*
4. Name of person reporting: *
First Name   Last Name
5. Phone: * ( ) - -
6. Email: *
7. Reason for cancellation: (check all that apply) *
    Inclement weather
    No road access
    Closure of production kitchen
    Closure of congregate site
    Driver availability
    Power outage
    Lack of water
    Health-related reason
    Site being used for other purpose, i.e. voting
    Other (please describe below):
8. Geographical areas affected: *
9. Methods by which customers/emergency contacts will be notified of service cancellation: *
    Phone call
        Client home
        Emergency contact
    Procedure in place with local closures (i.e. if schools are closed, so is meal delivery)
    Recorded phone message
10. Is staff available to answer the phone at the main number? *
11. What type of emergency meals are given (Per Nutrition Standard 21b)? *
12. Date of last distribution of emergency meals: *
13. Other related information:

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