Form 9.6.

VISIT TO A DIETARY DEPARTMENT

Name of Facility ________________________ Date of Visit _______________

Dietary Supervisor ________________________________________________

Facility Size ____________ Number of meals served daily ________________

Number of employees in foodservice __________________________________

How is facility classified? ___________________________________________

Type of menu: Cycle (how many weeks)? _____ Seasonal? ___ Selective? ___

Standardized recipes? _____________________________________________

Number of general diets? ___________ Modified diets? __________________

List different modifications available: _________________________________

Describe the facility nutrition care process: ______________________________

Who does documentation? ____________ Attends care conferences? ______

Do they do any part of the care plan differently from you? _________________

Does the department have any forms you might find useful? (If so, include copies)