TEFAP Outlet Monthly Report

Please note that this report is due by the 10th of each month. Do not leave information via CHFB voicemail. If you have any problems, please email or call Melissa Hoover.

Name of Outlet*

Month*

Households Served

Pantry Individuals Served

Soup Kitchen Head/Plate Count

Number of Pounds Donated

Number of Pounds Purchased

Dollar Amount Donated

Dollar Amount Purchased

Do you have Inventory of Unopened Cases Over 3 Months Old to Report for Your Freezer(s)? (If “Yes”, fill out below accordingly)*

Yes

Freezer 1 – Week 1

Freezer 1 – Week 2

Freezer 1 – Week 3

Freezer 1 – Week 4

Freezer 2 – Week 1

Freezer 2 – Week 2

Freezer 2 – Week 3

Freezer 2 – Week 4

Freezer 3 – Week 1

Freezer 3 – Week 2

Freezer 3 – Week 3

Freezer 3 – Week 4

Freezer 4 – Week 1

Freezer 4 – Week 2

Freezer 4 – Week 3

Freezer 4 – Week 4

Freezer 5 – Week 1

Freezer 5 – Week 2

Freezer 5 – Week 3

Freezer 5 – Week 4

Freezer 6 – Week 1

Freezer 6 – Week 2

Freezer 6 – Week 3

Freezer 6 – Week 4

Do you have Inventory of Unopened Cases Over 3 Months Old to Report for Your Refrigerator(s)? (If “Yes”, fill out below accordingly)*

Yes

Refrigerator 1 – Week 1

Refrigerator 1 – Week 2

Refrigerator 1 – Week 3

Refrigerator 1 – Week 4

Refrigerator 2 – Week 1

Refrigerator 2 – Week 2

Refrigerator 2 – Week 3

Refrigerator 2 – Week 4

Refrigerator 3 – Week 1

Refrigerator 3 – Week 2

Refrigerator 3 – Week 3

Refrigerator 3 – Week 4

Refrigerator 4 – Week 1

Refrigerator 4 – Week 2

Refrigerator 4 – Week 3

Refrigerator 4 – Week 4

Refrigerator 5 – Week 1

Refrigerator 5 – Week 2

Refrigerator 5 – Week 3

Refrigerator 5 – Week 4

Refrigerator 6 – Week 1

Refrigerator 6 – Week 2

Refrigerator 6 – Week 3

Refrigerator 6 – Week 4

By checking this box, you affirm that all the information reported above is correct and true to the best of your knowledge.*

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