Title Page
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Audit Title
Logistics
Logistics
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Avalon Site Number
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Site Administrator
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Physical Address
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Shipping Address
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Survey performed by
- Keith Murray
- Bill Sibbers
- David Lake
- Karen Goble
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Survey Performed on
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Number of Licensed beds
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Current Resident Population
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Dietary phone number(s) or extension(s)?
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Does site have retail sales?
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Daily dollar volume?
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Does site have a staff lounge?
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How many?
Culinary
Culinary
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Please take pictures of cooking equipment
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Obtain average meal counts by day
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Tray Service?
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Scratch Cooking?
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Is there a production system in place
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Please describe.
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Please take a picture of the menu
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Is catering provided
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Please describe
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Please take a picture of the menu
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General observations or comments/notes
Clinical
Clinical
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Is the RD full or part time?
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Day of week coverage
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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RD Name
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RD contact info
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Is there a tray card system
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What? Please describe
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Ratio of LTC to Rehab residents
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Average admissions per month?
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Last survey results for Dietary
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Survey Results
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Are there floor stock locations?
Floor Stock Location
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Please take pictures of the floor stock menu and area
Operational
Operational
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Who did you meet with? Names and titles.
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Business card pic(s)
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Is any equipment in need of repair?
Equipment
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Make?
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Model?
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What is the issue?
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Please take a picture or several. Include serial number plate or asset tag if possible.
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Are there any physical safety concerns?
Safety Concern
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Please describe concern and action required.
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Take pictures as applicable
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Are there any food safety concerns?
Safety Concern
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Please describe concern and action required.
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Take pictures as applicable
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Please take pictures of any posted licenses or permits. Health, business, etc.
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Please take pictures of dry storage area
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Please take pictures of refrigerated storage areas
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Please take pictures of frozen storage areas
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Ordering days and times
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Delivery day(s)
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Are there any other services being provided by dietary?
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Please describe.
IT
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How many employees will transition to Sodexo payroll?
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A time clock may not be required at this site.
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Please keep the following in mind when selecting a time clock location:
Location must meet ADA requirements. The top of the clock can be no less than 48 inches from the floor, and no more than 51 inches.
The clock requires 1 foot clearance on all sides.
The approach to the clock must remain clear.
The clock may require electrical power within 5 feet.
The clock will require a wired data connection. -
Please describe location for time clock
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Please take a picture of the selected area to show wall surface, electrical and/or data outlets, as well as clearance.
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Will cabling be required?
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Is Wi-fi available?
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Public or private?
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SSID?
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Pass phrase or key?
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Is there a telephone in the office space
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Phone number?
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Is there adequate space in the office for a computer?
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Is there an available data line?
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Additional cabling is required!
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Please take a picture of the port
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Proposed computer location
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Does the current manager have an Avalon computer?
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Can you access Sodexo sites on the Avalon computer?
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Which systems can you access?
- SodexoNet
- MySodexho
- eTime
- Market Connection
- Brio
- Food Management
HR
Human Resources
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Obtain employee information
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Obtain uniform sizing for employees
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Number of Full Time employees
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Number of Part Time employees
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Are the employees covered by a CBA?
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With whom?
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Is English the primary language for most employees?
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What language(s) are primary for employees?
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Please list any comments or conversational employee concerns