Appendix G4 Vending Machine Checklist

Appendix G4

VENDING MACHINE CHECKLIST

VENDING MACHINE CHECKLIST

School Name: _________________________________________________________

Observer Name: _________________________________________________________

Date: ______________________________ SFA ID: _______ School ID: _______

Grades: _______________

1. Please record the number of each type of vending machine available to students by location of machines.

Food Source	Location of Vending Machines
	In food service area	Adjacent to food service area (within 20 feet)	Elsewhere in school building	Outside of school building
a. Milk only
b. Water only
c. Milk with juice/water (no soft drinks)
d. Water with juice (no soft drinks)
e. Non-carbonated soft drinks with or without water/milk
f. Carbonated soft drinks with or without water
g. Snacks/candy/cookies
h. Entrees, non-refrigerated
i. Frozen foods
j. Combination (Specify ____________________________________)
k. Combination (Specify ____________________________________)
l. Combination (Specify ____________________________________)
m. Combination (Specify ____________________________________)
n. Other (Specify ____________________________________)
o. Other (Specify ____________________________________)
p. Other (Specify ____________________________________)
q. Other (Specify ____________________________________)

2. Place a check mark in the box corresponding to each food and/or beverage item sold in vending machines by location of machine.

Food Item	Availability of Food Item in Vending Machines
	In food service area	Adjacent to food service area (within 20 feet)	Elsewhere in school building	Outside of school building
A. Beverages
Carbonated Sweetened Soft Drink	1□	1□	1□	1□
Carbonated Diet Soft Drink	2□	2□	2□	2□
Juice (100% juice)	3□	3□	3□	3□
Juice Drinks (Cranberry Drink, Fruit Blends, Hi-C, Lemonade, Punch)	4□	4□	4□	4□
Iced Tea (sweetened)	5□	5□	5□	5□
Iced Tea (unsweetened)	6□	6□	6□	6□
Water (Spring Water, Flavored Water, Sparkling Water, Mineral Water, Seltzer Water)	7□	7□	7□	7□
Water (Water with Juice)	8□	8□	8□	8□
Coffee	9□	9□	9□	9□
Tea (hot)	10□	10□	10□	10□
Hot Chocolate	11□	11□	11□	11□
Yogurt Drinks	12□	12□	12□	12□
Energy and Sports Drinks (Gatorade, Powerade, Red Bull)	13□	13□	13□	13□
Other (Specify ___________________________)	14□	14□	14□	14□
B. Dairy
Whole Milk	15□	15□	15□	15□
Reduced Fat (2%) White Milk	16□	16□	16□	16□
Low Fat (1%) White Milk	17□	17□	17□	17□
Fat-Free White Milk	18□	18□	18□	18□
Fat-Free Flavored Milk	19□	19□	19□	19□
Yogurt	20□	20□	20□	20□
Cheese	21□	21□	21□	21□
Other (Specify ___________________________)	22□	22□	22□	22□
C. Baked Goods – Dessert
Cake-Type (Brownies, Cupcakes, Twinkies)	23□	23□	23□	23□
Cake-Type (Low-Fat/Reduced-Fat Brownies, Cupcakes, Twinkies)	24□	24□	24□	24□
Cookies	25□	25□	25□	25□
Cookies (Low-Fat/Reduced Fat)	26□	26□	26□	26□
Pastries (Pies, Turnovers)	27□	27□	27□	27□
Other (Specify ___________________________)	28□	28□	28□	28□
D. Bread or Grain Products
Regular Bread (Bread, Rolls, Bagels)	29□	29□	29□	29□
Whole Grain Bread (Bread, Rolls, Bagels)	30□	30□	30□	30□
Other Bread (Biscuits, Croissants, Hot Pretzels)	31□	31□	31□	31□
Muffins (Regular)	32□	32□	32□	32□
Muffins (Whole Grain)	33□	33□	33□	33□
Muffins (Low-Fat/Reduced-Fat)	34□	34□	34□	34□
Granola Bars	35□	35□	35□	35□
Granola Bars (Low-Fat/Reduced-Fat)	36□	36□	36□	36□
Pretzels (Regular, Sourdough)	37□	37□	37□	37□
Pretzels (Whole Grain)	38□	38□	38□	38□
Crackers/Cracker Sandwiches: Peanut Butter	39□	39□	39□	39□
Crackers/Cracker Sandwiches: Cheese	40□	40□	40□	40□
Cereal/Cereal Bars	41□	41□	41□	41□
Other (Specify ___________________________)	42□	42□	42□	42□

Food Item	Availability of Food Item in Vending Machines
	In food service area	Adjacent to food service area (within 20 feet)	Elsewhere in school building	Outside of school building
E. Frozen Desserts
Frozen Non-Diary (Fruit Bars, Jello Pops, Popsicles)	43□	43□	43□	43□
Ice Cream (Bars, Cups, Fudgesicles, Sundaes)	44□	44□	44□	44□
Low-Fat Frozen Desserts (Frozen Yogurt, Ice Milk, Sherbet)	45□	45□	45□	45□
Milkshakes	46□	46□	46□	46□
Smoothies	47□	47□	47□	47□
F. Fruit and Vegetables
Canned or Cooked Fruit	48□	48□	48□	48□
Fresh Fruit (whole, cut)	49□	49□	49□	49□
Fruit Salad (Fresh)	50□	50□	50□	50□
Fruit Salad (Canned in Water)	51□	51□	51□	51□
Fruit Salad (Canned in Light Syrup)	52□	52□	52□	52□
Dried Fruit	53□	53□	53□	53□
Other Fresh Fruit (Specify ___________________)	54□	54□	54□	54□
Vegetables, Side Salad	55□	55□	55□	55□
Vegetables, Raw	56□	56□	56□	56□
Other Fresh Vegetables (Specify ______________)	57□	57□	57□	57□
G. Snacks
Chips (Corn, Potato, Tortilla)	58□	58□	58□	58□
Chips (Lower-Fat/Reduced-Fat Corn, Potato, Tortilla)	59□	59□	59□	59□
Puffed Cheese (Regular)	60□	60□	60□	60□
Puffed Cheese (Lower-Fat/Reduced-Fat)	61□	61□	61□	61□
Nuts and Seeds (Almonds, Peanuts, Sunflower Seeds, Trail Mix)	62□	62□	62□	62□
Fruit Snacks (Roll-Up, Gummies)	63□	63□	63□	63□
Popcorn	64□	64□	64□	64□
Meat Snacks (Jerky, Pork Rinds)	65□	65□	65□	65□
Candy with Chocolate	66□	66□	66□	66□
Candy without Chocolate	67□	67□	67□	67□
Energy Bars (Balance Bars, Luna Bars, Power Bars, etc)	68□	68□	68□	68□
Other (Specify ___________________________)	69□	69□	69□	69□
H. Prepared / Pre-Prepared Entrees and Food
Hot Dogs	70□	70□	70□	70□
Hamburgers or Cheeseburgers	71□	71□	71□	71□
Veggie Burgers	72□	72□	72□	72□
Grilled Sandwiches	73□	73□	73□	73□
Cold Sandwiches	74□	74□	74□	74□
Burritos	75□	75□	75□	75□
Taco	76□	76□	76□	76□
Meal-Size Salad	77□	77□	77□	77□
Pizza (Slice)	78□	78□	78□	78□
Pizza (Bites)	79□	79□	79□	79□
Pasta	80□	80□	80□	80□
French Fries	81□	81□	81□	81□
Onion Rings	82□	82□	82□	82□
Mozzarella Sticks	83□	83□	83□	83□
Other (Specify ____________________________)	84□	84□	84□	84□

Food Item	Availability of Food Item in Vending Machines
	In food service area	Adjacent to food service area (within 20 feet)	Elsewhere in school building	Outside of school building
I. Other (Specify)
________________________________________	85□	85□	85□	85□
________________________________________	86□	86□	86□	86□
________________________________________	87□	87□	87□	87□
________________________________________	88□	88□	88□	88□
________________________________________	89□	89□	89□	89□
________________________________________	90□	90□	90□	90□