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Required Forms / Information


General | Assessment Forms | Carryout Meals Policy & Fact Sheet | Dining Center Donation Signs | Donation Letters | Food Safety Cert Req | Meal Cost Tool | Surveys and Comment Cards | Vaccination Info | Waiting Lists/Fact Sheet Outlining Policy


Areas to Consider Before Decreasing Service or Eliminating Mealsites
C1-C2 Transfer of Funds Waiver Request Form

Fund Raising Memo from BADR
How Long to Keep Records Before You Shred Them
Meal Site Closing or Days of Service Change Form

Menu Approval Documentation Form
New or Relocated Dining Center Form

Nutrition Screen Form With Privacy Statement
Participant Eligibility at a Glance
Spanish Nutrition Risk Form

Test Tray Form

Waiver Request: Non-Elderly Participation Form

Assessment Forms

2016-2018 Nutrition Assessment Form
Congregate Assessment Form
HDM Reassessment Form
Initial HDM Assessment Form

New Congregate Registration Forms

Senior Dining Brochure Registration Form Version 1
Senior Dining Brochure Registration Form Version 2
Senior Dining Registration Form Half Sheet

Carryout Meals Policy & Fact Sheet

Burnett Carryout Food Safety Labels
Carry Out Policy and Procedure Template
Food Safety - Beyond the Plate: A Guide to Leftovers (Eau Claire County)
Food Safety-to-Go

Dining Center Donation Signs Samples

Clark County

Eau Claire County
Lac Courte Oreilles Tribe
Oneida County
Polk County
Waushara County

Donation Letters Samples

ADRC-CW Dining Site Advertisement
Barron County Donation Article
Barron County Meals on Wheels Statement
Grant County Donation Contribution
HDM Donation Brochure
Meals on Wheels Workgroup Donation Letter

Food Safety Certification Requirements Fact Sheet

Fact Sheet

Meal Cost Tool

Instructions and Definitions
Meal Cost Tool Training Presentation

Surveys and Comment Cards

2015 Mandatory Home-Delivered Meals Satisfaction Survey
2015 Mandatory Senior Dining Satisfaction Survey
Dining Experience Review for Congregate Meal Sites Template
Rate-A-Meal Comment Card for Regular Input Throughout the Year for HDMs and Congregate Sites

Vaccination Information

CDC Flyers and Brochures
Immunization for Older Adults
Jefferson County Flu Shots Poster
Pierce County Vaccine Locations

Waiting Lists Samples / Fact Sheet Outlining Policy

Eau Claire Waiting List Policy for Meals on Wheels
Jefferson County Waiting List Policy
Outagamie County "Holding" Time Frame Policy
Outagamie County Waiting List Policy