Momentum Senior Living / Dining Review Checklist

• Site conducted

  Select

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Instructions:
  -------------------------------------
  1. Answer "Yes", "No", "N/A" for the questions below.
  2. Add photos and notes by clicking on the paperclip icon.
  3. To add a Corrective Action click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.

DINING ROOM

• Hospitality Station Standard Met

  Yes

  No

  N/A

• Dining tables spaced appropriately

  Yes

  No

  N/A

• Sugar Caddies, S&P, Stocked

  Yes

  No

  N/A

• Tables Level & do not Wobble

  Yes

  No

  N/A

• Flowers Fresh w/clean water

  Yes

  No

  N/A

• Table Linens Clean & Wrinkle Free

  Yes

  No

  N/A

• Menus Clean & Accurate

  Yes

  No

  N/A

• Table Bases Dust Free

  Yes

  No

  N/A

• Chairs Clean & Free from scuffs

  Yes

  No

  N/A

• Baseboards/Walls Free from scuffs

  Yes

  No

  N/A

• Sitting Areas/Couches Free from Clutter

  Yes

  No

  N/A

• TV set to to appropriate channel

  Yes

  No

  N/A

• Music appropriate level

  Yes

  No

  N/A

• Control of Service Demonstrated

  Yes

  No

  N/A

• Steps of Service followed

  Yes

  No

  N/A

• Tables "pre-bussed"

  Yes

  No

  N/A

• Dining Room Re-set promptly

  Yes

  No

  N/A

• Dining Floors well maintained

  Yes

  No

  N/A

• Service areas organized and sanitized

  Yes

  No

  N/A

• Linens stored properly

  Yes

  No

  N/A

• Survey Box Observed

  Yes

  No

  N/A

• Window Blinds at 45 degree upward slant

  Yes

  No

  N/A

• Thermostat regulated to comfortable temp

  Yes

  No

  N/A

• Floorplan & Sidework assignments utilized

  Yes

  No

  N/A

• Menu posted in designated area

  Yes

  No

  N/A

• Resident Meal Log accurate

  Yes

  No

  N/A

• Room Service process in place

  Yes

  No

  N/A

• Walkers stored safely/not trip hazard

  Yes

  No

  N/A

UNIFORMS, APPEARANCE & HYGIENE

• Hair neat and restrained properly

  Yes

  No

  N/A

• Hair nets or hats observed in kitchen

  Yes

  No

  N/A

• Facial hair neat and trimmed

  Yes

  No

  N/A

• Jewelry kept to simple earring, ring, watch

  Yes

  No

  N/A

• Nails clean and trimmed short

  Yes

  No

  N/A

• Proper shoes worn

  Yes

  No

  N/A

• Correct uniform observed

  Yes

  No

  N/A

• Uniforms clean and presses

  Yes

  No

  N/A

• Name tags observed

  Yes

  No

  N/A

• Proper handwashing and use of gloves

  Yes

  No

  N/A

• Bandages used properly

  Yes

  No

  N/A

• Eating, drinking, smoking, gum chewing

  Yes

  No

  N/A

• Appropriate action when coughing/sneeze

  Yes

  No

  N/A

• Soap and Paper towels stocked

  Yes

  No

  N/A

• Handwashing signs posted at each sink

  Yes

  No

  N/A

SAFETY, SANITATION & CLEANLINESS

• ServSafe Certificates Posted on Wall

  Yes

  No

  N/A

• Health Dept. Grade & Permit Posted

  Yes

  No

  N/A

• Proper handwashing & Use of gloves

  Yes

  No

  N/A

• Sani Solution at work statoins

  Yes

  No

  N/A

• Cutting Boards stored properly

  Yes

  No

  N/A

• Air drying observed

  Yes

  No

  N/A

• Temp logs utilized & up to date

  Yes

  No

  N/A

• Overhead lights & Ceiling Tiles dust free

  Yes

  No

  N/A

• Cooler gaskets & handles free from mold

  Yes

  No

  N/A

• Ice machine filter up to date

  Yes

  No

  N/A

• Ice machine free from mold

  Yes

  No

  N/A

• Proper storage of ice scoop

  Yes

  No

  N/A

• Proper transport of ice observed

  Yes

  No

  N/A

• System in Place to transport food to rooms and remote areas safely

  Yes

  No

  N/A

• Food deliveries put away promptly

  Yes

  No

  N/A

• Food labeled and dated

  Yes

  No

  N/A

• Food stored 6 inches from floor

  Yes

  No

  N/A

• Food covered

  Yes

  No

  N/A

• Raw meat and eggs below RTE foods

  Yes

  No

  N/A

• Raw foods prepared away from RTE foods

  Yes

  No

  N/A

• Pasteurized Eggs used where required

  Yes

  No

  N/A

• Non-necessary staff restricted from kitchen

  Yes

  No

  N/A

• Eye washing station observed

  Yes

  No

  N/A

• First Aid kit observed

  Yes

  No

  N/A

• Thermometors present/calibrated

  Yes

  No

  N/A

• Chemicals stored in secure area

  Yes

  No

  N/A

• Coolers at 40 or below, freezer at 0 or below, cooked food held at 140 or above

  Yes

  No

  N/A

• Hot water observed at hand sink

  Yes

  No

  N/A

• Knives and blades washed seperately

  Yes

  No

  N/A

• Dish and mop chemicals stocked

  Yes

  No

  N/A

• Scoops not stored in flour bins

  Yes

  No

  N/A

• Floor Drains clean

  Yes

  No

  N/A

• Pipes to sink & dish area clean/leak free

  Yes

  No

  N/A

• Floors free from water and trip hazards

  Yes

  No

  N/A

• Food covered, labeled & dated

  Yes

  No

  N/A

• Food Prep Sink Clean to sight & touch

  Yes

  No

  N/A

• 3 Sink set up: scrape→wash→rinse→ sanitize→air dry

  Yes

  No

  N/A

• 3 sink dish water free from grease/food

  Yes

  No

  N/A

• Sanitizer solution at proper dillution

  Yes

  No

  N/A

• Garbage Cans/lids clean

  Yes

  No

  N/A

• Dumpster/Loading Dock Area Clean

  Yes

  No

  N/A

• Brooms and Mops easy to access/in good order

  Yes

  No

  N/A

• No Rodent droppings found

  Yes

  No

  N/A

• Slicer Cleaned properly

  Yes

  No

  N/A

• Can opener clean & sanitized

  Yes

  No

  N/A

• Stove top clean/burner light/unobstructed

  Yes

  No

  N/A

• Griddle clean throughout service

  Yes

  No

  N/A

• Fryer oil clean, fryer free from build up

  Yes

  No

  N/A

• Hood vents cleaned

  Yes

  No

  N/A

• Documentation of hood cleaning

  Yes

  No

  N/A

• Equipment, walls, floors free from grease

  Yes

  No

  N/A

• Cooler Vents/Fans free from dust

  Yes

  No

  N/A

• Hold Holding Units are clean

  Yes

  No

  N/A

• Drawers and Racks are clean

  Yes

  No

  N/A

• Work surfaces clean to sight and touch

  Yes

  No

  N/A

• Coffee, Tea and Juice Machines Cleaned

  Yes

  No

  N/A

• Beverage area clean & Organized

  Yes

  No

  N/A

• Sick employees not present

  Yes

  No

  N/A

• Serving trays clean

  Yes

  No

  N/A

• Beverage pitchers free from stains

  Yes

  No

  N/A

• Clean Serving wares free from food/grease

  Yes

  No

  N/A

• Employee Restroom Clean & Stocked

  Yes

  No

  N/A

• Chlorine or Multi Quat Test Strips present

  Yes

  No

  N/A

• Dish Machine De-limed/no film/build up

  Yes

  No

  N/A

• Dish machine drains clear of food/trash

  Yes

  No

  N/A

OPERATIONS, FOOD QUALITY & SERVICE

• Kitchen on time with preparation of food

  Yes

  No

  N/A

• Food delivered to residents promptly

  Yes

  No

  N/A

• Dietary restrictions followed

  Yes

  No

  N/A

• Sugar Free Dessert (besides ice cream) avail

  Yes

  No

  N/A

• Soup of the Day available

  Yes

  No

  N/A

• Servers able to describe daily feature(s)

  Yes

  No

  N/A

• Non-dining dept. Driector assignements

  Yes

  No

  N/A

• Team members demonstrate training

  Yes

  No

  N/A

• Inventory Levels maintained properly

  Yes

  No

  N/A

• Menus followed/any changes approved

  Yes

  No

  N/A

• Culinary Council held monthly

  Yes

  No

  N/A

• "Taste Of" events held monthly

  Yes

  No

  N/A

• Quarterly Events held

  Yes

  No

  N/A

• Chef's features reflect thoughtful planning

  Yes

  No

  N/A

• Spend Down/Invoices Maintained

  Yes

  No

  N/A

• Food presentation in restaturant quality

  Yes

  No

  N/A

• Room service is delivered promptly

  Yes

  No

  N/A

• Employee Meals are prepared promptly

  Yes

  No

  N/A

• kitchen remains clean through service

  Yes

  No

  N/A

• Servers remain present in dining room

  Yes

  No

  N/A

• Dining Room is reset promptly

  Yes

  No

  N/A

Completion

• Completed by:

  Sign