Title Page
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Conducted on
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Prepared by
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Hospital/Floor/Ward:
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Dining Host Full Name
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Was the tray on top shelf of trolley delivered first?
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Was the tray ticket removed from the meal tray before entering the patient's room?
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Did the DH knock before entering the patient's room and enter with a smile, saying good morning/afternoon?
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Did the DH introduce self by name and from food services announcing they had the patients B/L/D etc?
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Did the DH verify patients full name and DOB against the tray ticket?
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Did the DH circle the patient's gender on the tray ticket?
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Did the DH return to the trolley to collect the correct meal tray to deliver to patient?
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Was the nurse call bell pressed when required?
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Did the DH present the tray and remove the meal lid?
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Did the DH ask "May I assist you in opening any items on your tray?"
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Were all the menu items on the tray?
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When empty trolley returned to the kitchen, did the DH clear delivered trays on the tray tracker?
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Evidence/other comments:
