Patient/Resident Tray Assessment

Date:
Floor:
Diet:
Temperature & Scoring Guide
Section 2: Soups, Cereals & Hot Beverages: > 150F/ 66C = 3 145F/ 63C - 149F/ 65C = 2 140F/ 60C - 144F/ 62C = 1 < 140F/ 60C = 0
Hot Entrees, Eggs, Starches & Vegetables: > 130F/ 55C = 3 125F/ 52C - 129F/ 54C = 2 120F/ 49C - 124F/ 51C = 1 < 120F/ 49C = 0
Fruits & Desserts: < 50F/ 10C = 3 51F/ 11C - 55F/ 13C = 2 56F/ 14C - 60F/ 16C = 1 > 60F/ 16C = 0
Salads & Potentially Hazardous Cold Foods: < 45F/ 7C = 3 46F/ 8C - 50F/ 10C = 2 51F/ 11C - 55F/ 13C = 1 > 55F/ 13C = 0
Milk, Dairy Products & Cold Beverages: < 41F/ 5C = 3 42F/ 6C - 46F/ 8C = 2 47F/ 9C - 51F/ 11C = 1 > 51F/ 11C = 0
Sections 4, 5 & 6: N/A Fully acceptable/full bodied = 2 Needs improvement/some flavor = 1 Unacceptable = 0
Sections 3, 7 & 8: N/A N/A Correct/no substitutions = 1 Incorrect/sub = 0
Number on the right side of each box indicates the possible total score for that category
Hot Foods & Beverages Cold Foods & Beverages
Menu Type Soup/Cereal Entre Starch Vegetable Hot Beverage Salad Fruit Dessert Milk/Dairy Cold Beverage
Product / Item Chicken Soup Baked Ziti Broccoli Tea Peaches 2% Milk Iced Tea
Standard Temperature 150F / 66C 130F / 55C 130F / 55C 130F / 55C 150F / 66C 45F / 7C 50F / 10C 50F / 10C 41F / 5C 41F / 5C
Temp of Food on Tray 155 140 130 160 30 50 45
2. Actual Temperature 3 / 3 3 / 3 / 3 3 / 3 3 / 3 / 3 / 3 3 / 3 1 / 3 3 / 3 19
3. Portion Size 1 / 1 1 / 1 / 1 1 / 1 1 / 1 / 1 / 1 1 / 1 1 / 1 1 / 1 7
4. Food Appearance 2 / 2 2 / 2 / 2 2 / 2 2 / 2 / 2 / 2 2 / 2 1 / 2 2 / 2 13
5. Quality & Preparation 2 / 2 2 / 2 / 2 2 / 2 2 / 2 / 2 / 2 1 / 2 0 / 2 2 / 2 11
6. Taste & Aroma 2 / 2 2 / 2 / 2 2 / 2 2 / 2 / 2 / 2 2 / 2 2 / 2 2 / 2 14
7. Missing Items or Subs / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1
8. Tray Completeness Garnish 1 / 1 Napkin 1 / 1 Flatware 1 / 1 Plate Cover 1 / 1 Bread 1 / 1
and Cleanliness
Dishes 1 / 1 Condiments 1 / 1 Glassware 1 / 1 Tray 1 / 1 Butter 1 / 1 10
Overall Quality: Excellent:______ (96% - 100%) Satisfactory:___X___ (90% - 95%) Unsatisfactory:______ (< 90%) Totals: 74
1. Time floor tray assembly begins:___________________3. Time cart arrives at unit (or test area)_________________5. Time test tray is delivered to patient:_______________________ 12:30
2. Time cart leaves kitchen__________________________ 4. Time tray passing begins:_______________________6. Elapsed time (e-b):_______________________________________ 12:10 20 min.
Comment/Problem List:
A score of less than 90% requires a corrective action plan
Any individual area with a score of less than 80% requires a corrective action plan Evaluation Team Signatures:
Any hot food item < 120F/ 49C yields an unacceptable tray
Any cold potentially hazardous food item > 55F/ 13C yields an unacceptable tray
*Serving temperatures for patient/resident trays (hot food hot, cold food cold - for palatability and
quality purposes only) are not to be confused with the regulatory requirements for holding

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temperatures (hot food -- 140F/60C or above; cold food -- 40F/4C or below)
TRAY ASSESSMENT - April 2010 (EAO) SODEXO HEALTH CARE SERVICES
Patient/Resident Tray Assessment
__________
__________
__________
Temperature & Scoring Guide
< 140F/ 60C = 0
< 120F/ 49C = 0
> 60F/ 16C = 0
> 55F/ 13C = 0
> 51F/ 11C = 0
Unacceptable = 0
Incorrect/sub = 0
21 90.5%
7 100.0%
14 92.9%
14 78.6%
14 100.0%
0 ####
10 0.0%
10 100.0%
80 92.5%

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SODEXO HEALTH CARE SERVICES
TO CALCULATE THE SCORE OF A PATIENT/RESIDENT TRAY ASSESSMENT: FACTORS TO CONSIDER IN EVALUATION OF TRAY:
1 1
2
2
3
3 4 Appearance of Food - consider:
a. color combination
b. consistency of food
4 c. arrangement of food on plate and the tray in general
d. garnish
5 Quality and preparation - consider: recipe compliance & degree of doneness
5 6 Taste and aroma - consider:
a. seasoning as appropriate to diet modification
b. odor
c. texture
6 d. moisture content
7
8
Target Area Corrective Action Resposibility Target Date Re-audit date
TRAY ASSESSMENT - April 2010 (EAO)
by 100 to identify percent.
Add up all scored points for Areas 2-6 and place scores in appropriate
Temperature standards. (See below)
to the cold food temperature standards for Milk, Cold Bev., and Potentially Hazardous Cold Forms, per form. Serving
Score the Assessment using the "As Served Standards" printed in the box
of this form.
right of the form. Minimum standard on tray - as per form.
Portion size - follow portion sizes as outlined in Standards Manual or indicated by diet modification.
CORECTIVE ACTION PLAN
number by its corresponding "Points Possible" number and multiply
Separately add up scores for "Scored Points" and "Points Possible"
Staple a copy of the menu from which Assessment was scored to this form.
Missing items/substitutions - has substitution been approved?
tray and diet modification.
Tray completeness and cleanliness - all dishes and flatware clean, dry and appropriate to tray and
diet modification.
vertically, and record at lower box in the Scoring Columns.
Patient/Resident Tray Assessment
Fill in the "% Achievement" column by dividing each "Scored Points" f
a. Cold foods such as protein salads, custards, crme pies, etc. are considered potentially hazardous and should adhere
temperatures for patient/resident trays (hot food hot, cold food cold) are not to be confused with the regulatory
requirements for holding temperatures (hot food -140F/60C or above; cold food -40F/4C or below.
Add up the total possible points for all scoring Areas 2-6, and place those
numbers in appropriate sections of boxes in the Scoring Columns at the
sections of boxes in the Scoring Columns at the right of the form.
Quality and preparation - consider: recipe compliance & degree of doneness
Completed Date
SODEXO HEALTH CARE SERVICES
Temperature standards. (See below)
to the cold food temperature standards for Milk, Cold Bev., and Potentially Hazardous Cold Forms, per form. Serving
Minimum standard on tray - as per form.
Portion size - follow portion sizes as outlined in Standards Manual or indicated by diet modification.
CORECTIVE ACTION PLAN
Missing items/substitutions - has substitution been approved?
tray and diet modification.
Tray completeness and cleanliness - all dishes and flatware clean, dry and appropriate to tray and
diet modification.
Patient/Resident Tray Assessment
a. Cold foods such as protein salads, custards, crme pies, etc. are considered potentially hazardous and should adhere
temperatures for patient/resident trays (hot food hot, cold food cold) are not to be confused with the regulatory
requirements for holding temperatures (hot food -140F/60C or above; cold food -40F/4C or below.