Pack Lunch Questionnaire

Allergen questionnaire for cold packed food

Please find attached ‘Pack lunch questionnaire’. The questionnaire is a tick list of certain types of foods which are allergens but are accepted in the setting. This form needs to be completed monthly as part of our Home prepared food policy and supports us to guarantee the children are able to have safe and enjoyable food consumptions. 

Food safety requirements for your child’s pack lunch box are to have an ice pack. This helps to keep children’s lunch boxes at a suitable temperature, until they are ready to be eaten.

A balanced lunchbox should contain a variety of nutritious foods from each of the five food groups –grains, fruits, vegetables, dairy and protein. Variety ensures children obtain a range of important nutrients, essential for growth and development, and keeps them alert throughout the day. Please find attached a healthy lunch box ideas to use when creating the packed lunches for the children as well as the lunch box rules for the setting.

In order for us to achieve this we are asking our parents not to provide the following list of highly allergen food:

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Crustaceans and shell fish (such as prawns, cray fish, mussels, clams, squid, etc.)

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Peanuts and nuts (such as almond, hazelnuts, walnut, cashew and peanut butter etc.)

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Sesame seeds and products.

    Child's Name:

    Date of Birth/Due Date:

    Setting:

    Please tick the box of allergen types which will present in the cold packed food you will be providing to your child:

    Milk and Products

    Eggs and Products

    Fish and Products

    Celery and Products

    Mustard and Products

    Cereals containing gluten (such as wheat, rye, barley, oats)

    Will your child be eating their packed lunch for?

    Dinner

    Tea

    Both

    If both please state in which order you would like staff members to give the food to your child

    I understand that to the best of my knowledge the above ingredients are within my child’s home prepared food. I agree to my child being given this food and I take full responsibility should my child become ill and it is thought this is as a result of digested food. I understand failure to provide a completed questionnaire or packed lunch will mean my child will be offered a Nursery meal which will be chargeable.

    Parents Name:

    Parent Email:

    Parent Contact Number:

    Date:

     

    Thank you for your support

    *Please be aware that we will not be able to provide the following:
    • Any food that requires reheating
    • Rice dishes brought from home
    • Any tin food that needs reheating (beans, spaghetti hoops)
    • Bread for toasting
    • Any food with nuts or made in a nut factory
    • Ice pack to keep the foods fresh and cool
    • Please note that these are required on a month to month basis. Please see Home Prepared Food Policy for more information
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