Title Page

  • Audit Title

Logistics

Logistics

  • Avalon Site Number

  • Site Administrator

  • Physical Address
  • Shipping Address
  • Survey performed by

  • Survey Performed on

  • Number of Licensed beds

  • Current Resident Population

  • Dietary phone number(s) or extension(s)?

  • Does site have retail sales?

  • Daily dollar volume?

  • Does site have a staff lounge?

  • How many?

Culinary

Culinary

  • Please take pictures of cooking equipment

  • Obtain average meal counts by day

  • Tray Service?

  • Scratch Cooking?

  • Is there a production system in place

  • Please describe.

  • Please take a picture of the menu

  • Is catering provided

  • Please describe

  • Please take a picture of the menu

  • General observations or comments/notes

Clinical

Clinical

  • Is the RD full or part time?

  • Day of week coverage

  • RD Name

  • RD contact info

  • Is there a tray card system

  • What? Please describe

  • Ratio of LTC to Rehab residents

  • Average admissions per month?

  • Last survey results for Dietary

  • Survey Results

  • Are there floor stock locations?

  • Floor Stock Location
  • Please take pictures of the floor stock menu and area

Operational

Operational

  • Who did you meet with? Names and titles.

  • Business card pic(s)

  • Is any equipment in need of repair?

  • Equipment
  • Make?

  • Model?

  • What is the issue?

  • Please take a picture or several. Include serial number plate or asset tag if possible.

  • Are there any physical safety concerns?

  • Safety Concern
  • Please describe concern and action required.

  • Take pictures as applicable

  • Are there any food safety concerns?

  • Safety Concern
  • Please describe concern and action required.

  • Take pictures as applicable

  • Please take pictures of any posted licenses or permits. Health, business, etc.

  • Please take pictures of dry storage area

  • Please take pictures of refrigerated storage areas

  • Please take pictures of frozen storage areas

  • Ordering days and times

  • Delivery day(s)

  • Are there any other services being provided by dietary?

  • Please describe.

IT

  • How many employees will transition to Sodexo payroll?

  • A time clock may not be required at this site.

  • 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

  • Please take a picture of the selected area to show wall surface, electrical and/or data outlets, as well as clearance.

  • Will cabling be required?

  • Is Wi-fi available?

  • Public or private?

  • SSID?

  • Pass phrase or key?

  • Is there a telephone in the office space

  • Phone number?

  • Is there adequate space in the office for a computer?

  • Is there an available data line?

  • Additional cabling is required!

  • Please take a picture of the port

  • Proposed computer location

  • Does the current manager have an Avalon computer?

  • Can you access Sodexo sites on the Avalon computer?

  • Which systems can you access?

HR

Human Resources

  • Obtain employee information

  • Obtain uniform sizing for employees

  • Number of Full Time employees

  • Number of Part Time employees

  • Are the employees covered by a CBA?

  • With whom?

  • Is English the primary language for most employees?

  • What language(s) are primary for employees?

  • Please list any comments or conversational employee concerns

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.