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Test Trays Audit
Test Trays Audit
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Created by Qualaris Staff
Critical Access Hospital
Dietician
Table of Contents
Audit Form
Audit Form
Test Trays Audit
Required
Observed Date
Meal
Breakfast
Lunch
Dinner
Test Trays Audit Checklist
Mark all as...
Was temperature OK during trayline?
Yes
No
N/A
Is temperature at delivery OK?
Yes
No
N/A
Is diet order correct?
Yes
No
N/A
Are portion sizes correct?
Yes
No
N/A
Is the appearance good?
Yes
No
N/A
Is the taste/smell good?
Yes
No
N/A
Are the substitutions appropriate?
Yes
No
N/A
Are tray and dinnerware neatly organized and clean?
Yes
No
N/A
Audit notes (optional)
Do not enter protected health information (PHI)
