Written Policies

Does staff have appropriate competencies/skill sets for food/nutrition services? Consider patient assessments, care plans, etc

^ Meal frequency?

Diet Manual; approved by medical staff/dietitian & current? Needs to have been published/revised within last 5 years PC.02.02.03 EP22

^ Diet ordering/patient tray delivery system? PC.02.02.03 EP7 and PC.02.01.03 EP1 for diet ordering

Do menu options meet patient needs & consider personal preference? PC.02.02.03 EP9

^ Nonroutine occurrences? e.g. parenteral nutrition, change in diet orders, early/late trays PC.01.02.01 EP3

Does the organization have a fulltime qualified dietitian or other qualified professional? If a dietitian or other qualified professional is not fulltime, interview staff to determine adequacy of the dietary director’s qualifications. HR.01.02.05 EP2

^ QAPI/IC program; integration of food/dietetic service?

^ Hygiene Practices for food service personnel? IC.02.01.01 EP1

Determine the relationship between the Dietary Director, & Lead Dietitian if the director is not a dietitian. Review the job descriptions— are their responsibilities clearly defined? CMS requirement for both roles to have necessary experience to serve population

^ Kitchen sanitation? IC.02.01.01 EP1

Did service director ensure the following policies/procedures CMS 482.28(a)(1) A0620: LD.04.01.05 EP3

^ Safe food handling? PC.02.02.03 EP6

ServSafe certification/license; if required, do the appropriate staff members have this? HR.01.01.01 EP3

^ Emergency food supplies? EM.02.02.03 EP3

Advanced: You can ask for recent health department inspection to provide baseline for whether issues are ongoing or isolated

^ Orientation, assignments, supervision & personnel performance? HR.01.04.01, HR.01.06.01, HR.01.07.01

^ Menu planning, purchasing, & essential record retention?


Are areas kept clean/sanitary? IC.02.01.01 EP1

Is the area free of any signs of pests? If there are pests, has the organization taken steps to address the issue?

Kitchen equipment; is it in safe operating condition? If there is an issue, does the staff have a plan to address it? Manufacturer’s recommended periodic maintenance schedule or an acceptable Alternate Equipment Management (AEM) program should be followed. EC.02.06.01 EP26

Is cookware/dishware stored in a clean, dry location? Food contact surfaces should be protected from splash, dust, other contamination, etc. typically being stored at least 18” from the floor. IC.02.01.01 EP1

Are dishes/utensils air dried to prevent crosscontamination? IC.02.01.01 EP1

Is all kitchen equipment regularly used? Unused equipment should not be stored in food service areas due to increased risk for pests

Are wet wiping cloths stored in an approved sanitizing solution & washed daily? IC.02.01.01 EP1

Is garbage/refuse properly disposed of? EC.02.02.01 EP19

Are food carts clean & in good repair? They should be sanitized after every meal. IC.02.01.01 EP1

Are sinks clear from items that can be contaminated from splashes? e.g. paperwrapped straws

Advanced: You can ask for a question regarding pest control services that have been accomplished

REFRIGERATOR PC.02.02.03 EP11 for food storage

Refrigerator temps; have they been monitored?

Is uncooked food (chicken or other meat) stored away from cooked food to prevent contamination? e.g. not stored over cooked food

Are frequency of temp checks & limits (41º or lower) maintained as per policy?

Is prepared food covered & labeled with expiration date?

Is there a process if the temp is inadequate? If possible, validate the process was followed

Are open containers labeled with expiration date?

Is there precooked food in the cooling process? Is the organization meeting requirements? Food should be cooled to 70º within 2 hours & to 41º within 4 & total cooling time should not exceed 6 hours. P

Are all items in date and not expired

Is the locking mechanism on the door in proper working condition?

^ Is there a process/mechanism in place to prevent staff from being locked in? Can the mechanism be accessed, & is it in working order? It shouldn’t be blocked or have any ice buildup

Is food stored away from soiled areas & rust?

Is food stored to allow for ventilation?

^ Is staff aware of how to use safety process/mechanism in emergency?

FREEZER PC.02.02.03 EP11 for food storage

Freezer temps; have they been monitored?

Is the freezer free of any ice buildup?

Are frequency of checks & temp limits maintained as per policy? Temps should ensure that food remains solid

Are items labeled appropriately with expiration dates? There should be no expired items

Is there a process if the temp is inadequate? If possible, validate the process was followed

If there is precooked food, is the cooling process sufficient? See refrigerator note above

Is food stored away from soiled areas & rust?

Is the locking mechanism on the door in proper working condition?

Is food stored to allow for ventilation?

^ Is there a process/mechanism in place to prevent staff from being locked in? Can the mechanism be accessed, & is it in working order? It shouldn’t be blocked or have any ice buildup

Is the freezer free from any signs of freezer burn/food discoloration?

Are raw foods stored properly? There should be no signs of them dripping on other foods

^ Is staff aware of how to use safety process/mechanism in emergency?


Are there any expired items? PC.02.02.03 EP11

Is the area clean, dry, & well ventilated? This will help with humidity & prevent growth of mold/bacteria. PC.02.02.03 EP11

Are canned goods properly sealed? PC.02.02.03 EP11

Is food stored away from sources of heat/light? This helps preserve shelf life. PC.02.02.03 EP11

Does the kitchen have food storage items/plans for disaster preparedness? A 96hour stockpile isn’t required for emergency operations. The kitchen should have a role in response to an event, & it should correspond with the organization’s Emergency Operations Plan. EM.02.02.03 EP3

Are food containers stored off the floor & away from walls to allow for adequate circulation? e.g. 6” above floor, protected from splashes PC.02.02.03 EP11


Advanced: Ask about ladle size & how to determine appropriate proportions

Foodborne illness; does the organization take prevention measures? Question if cases have occurred/been resolved. IC.01.03.01 EP1

Advanced: Conduct HAZMAT tracer for corrosive limeaway used for decalcifying automated dishwashers. Assess adequacy of eyewash station, PPE usage, SDS, staff knowledge, etc

Sick employees or those with open wounds; is there a procedure for them? PC.02.02.03 EP6 (not sure this can be associated)

Thawing food; is there a process? Validate the staff is following the process during observation. Food should not be thawing at room temperature & can be thawed under cold running water or the refrigerator. PC.02.02.03 EP6


Is the kitchen in good repair? e.g. lack of broken floor tiles, delamination, flaking walls, etc

Are the gaskets intact for kitchen entry/delivery doors to prevent entry from pests?

Do sprinkler heads have adequate 18” clearance? Ensure racks perpendicular to walls do not encroach 18” open space for sprinklers. NFPA 1012012:;;; NFPA 132010:;; LS.02.01.35 EP6

Eyewash station; if required, is it in good working order & located away from hazards?

^ Can staff access eyewash station within 10 seconds of hazardous material storage/usage area?

Evaluate sprinkler head obstructions in BOTH refrigerators & freezers. Be wary of surface mounted fluorescent light fixtures close to sprinkler heads as this does not follow the 18” rule. Refer to attachment for specific criteria

^ Has the eyewash inspection log been kept up to date?

Natural gas; does the organization use this?

Soda fountain machine; is the CO2 secured?

^ Is a gas valve accessible for emergency shutoff & do staff know its location/operation?

Are sewage/pipelines free from signs of water damage?

^ Is emergency shutoff valve properly labeled?

Deep fat fryer; is there a K fire extinguisher within 30’? NFPA 96–2011 10.10.1; NFPA 10–2010, 6.6.1; 6.6.2 LS.02.01.35 EP11

Evaluate the hood system

^ Is the hood clean with no grease buildup? NFPA 962011 11.6.2

Deep fat fryer; is it installed with at least a 16” space between the fryer & surface flames from adjacent cooking equipment? NFPA 96–2011

^ Are the steel filter baffles all installed with no gaps & are they in the proper direction? NFPA 962011;

K fire extinguisher placard identifying need to activate the fixed suppression (ansul) system before using the extinguisher? NFPA 962011 10.2.2 LS.02.01.35 EP11

^ Is grease producing equipment located properly under the hood? NFPA 962011 5.2

Suppression system; does staff know how to use it? Instructions for manual operations should be conspicuously posted & reviewed by staff. NFPA 962011 11.1.4

^ Are extinguishing heads pointed properly toward the cooking surface?

Electrical panels; are they clear from obstruction? There should be 36”

Compressed gas cylinders; are they properly secured? NFPA 992012 11.3;

Fire Evacuation & Relocation Plan; is the staff knowledgeable? NFPA 1012012: 18/19.7.1; 7.2

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.