Title Page

  • Conducted on

  • Prepared by

  • Hospital/Floor/Ward:
  • Dining Host Full Name

  • Was the tray on top shelf of trolley delivered first?

  • Was the tray ticket removed from the meal tray before entering the patient's room?

  • Did the DH knock before entering the patient's room and enter with a smile, saying good morning/afternoon?

  • Did the DH introduce self by name and from food services announcing they had the patients B/L/D etc?

  • Did the DH verify patients full name and DOB against the tray ticket?

  • Did the DH circle the patient's gender on the tray ticket?

  • Did the DH return to the trolley to collect the correct meal tray to deliver to patient?

  • Was the nurse call bell pressed when required?

  • Did the DH present the tray and remove the meal lid?

  • Did the DH ask "May I assist you in opening any items on your tray?"

  • Were all the menu items on the tray?

  • When empty trolley returned to the kitchen, did the DH clear delivered trays on the tray tracker?

  • Evidence/other comments:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.