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
    Flooding
    Lack of water
    Fire
    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: *
    Radio
    TV
    Flyer
    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? *
    Yes
    No
11. What type of emergency meals are given (Per Nutrition Standard 21b)? *
    Shelf-stable
    Frozen
12. Date of last distribution of emergency meals: *
Shelf-stable
Frozen
13. Other related information:
   

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